MOTIONS’S INFORMATION
clashes between diverse social groups. The ongoing
NHPEO 2019 YOGYAKARTA
PRELIM 1
Some researches suggest that the links
between body weight and health are
tenuous than people fought. The fear of
moral panic over fat will divert
government funds and energies from
other health concern. This rising tide of
obesity, however, affects the interest of
the whole nation.
TH disapproves of movements that aim to further the
acceptation of obesity in society
Is the UK in a moral panic about
obesity?
Three quarters of British men are predicted to be
obese by 2030. Have we become greedier and less
active or are more complicating factors at work? We
live in an age of moral panics. They are becoming so
common that in 2012 The Guardian produced a blog
on the ten best moral panics . It showed that successful
moral panics owe their appeal to their ability to find
points of resonance with society's wider
anxieties, suggesting a far deeper anxiety such as rapid
social change, economic uncertainty, and lifestyle
obsession with obesity can now be added to the list.
Many now argue that health and lifestyles have
become an important repository for new kinds of
moralising in society. We don’t have to look too far to
find evidence of this: consider UK Government
healthy eating initiatives such as ‘The Responsibility
Deal ’, and the Change4life campaign . Each implores
the individual, whether adult or child, to take personal
responsibility for their weight and health or the nation
will experience a health catastrophe.
A whole range of institutions, and individuals
associated with those institutions, are provided with
the responsibility to identify who might be ‘at risk’
and to regulate their behaviour. Doctors in the UK are
being encouraged to ‘nudge’ patients at risk of
overweight, counsel them about their risk and suggest
weight management treatment (whether or not there is
any other medical indication of risk).
Epidemic or panic?
In 1993, in England, 13% of men and 16% of women
were obese – in 2011 this rose to 24% for men and
26% for women, according to an NHS report . The
report estimated that one in 10 English children was
clinically obese, a significant increase since the turn of
the millennium. Health risks associated with obesity
seem clear, but some argue that the true scale and
nature of the obesity epidemic has been exaggerated
and this has triggered a new moral panic.
In discussing blame and responsibility for the so-
called obesity epidemic, scientists, journalists and
politicians alike tend to focus on individual
responsibility. And in doing so, they gloss over the
ways in which body size is tightly controlled by
genetic factors and shaped by social factor – such as
socio-economic status and neighborhood limitations,
including poor access to healthy food outlets, a high
density of fast food restaurants and a lack of open
space for exercise. In this perspective, obesity is
social.
But once obesity was listed among risk factors for
chronic diseases, such as heart disease and diabetes,
statistical evidence accumulated about obesity’s
widespread occurrence, dramatic graphs appeared
linking it to wellbeing.
Fattest towns
Wikipedia provides a snapshot of obesity levels in the
UK . If you live in Tamworth you might not wish to
learn that your town is the fattest in England, with
over 30 per cent of its inhabitants classified as obese.
Our obsession with body image and weight loss has
exacerbated the issue. You cannot pick up a
newspaper today without a story about body weight.
There are hundreds of websites devoted to the issue.
Just Google 'obesity time bomb' and you will find out
the extent of the concern. Governments offer advice
regularly on diet, health and fitness, and the
Government's former Chief Medical officer, Sir Liam
Donaldson, has talked up the obesity time bomb .
Characterising obesity firstly as a disease, and then
one of epidemic proportions, requires immediate
mobilisation of resources to bring about change. In the
context of the ‘obesity epidemic’ this is translated into
a sense that anyone might ‘catch it’. (Here we go, can
you feel the ‘fat anxiety’ yet?). People who are
overweight or obese have succumbed, and are thereby
dangerous ‘carriers’ to be avoided. This permits the
creation of notions like the obese ‘folk-devil’ (fat
devil?), and permits actions to be taken because of the
‘danger’ to them, and to society.
Spreading fat fear
Social policy and health strategies target individuals’
behaviors as though all were at risk. We are all
involved in helping to defuse a health time bomb! This
feeds a media frenzy and is of course a gift for the
multi-billion dietary industry. The preoccupations of
the powerful with the body’s appearance of a few are
visited on the wider population, through a fear of fat.
The message is that anyone could get fat, everyone is
at risk and that the risk begins very early in life. This
stimulates a constant, anxiety-driven, routine of self-
surveillance, and helps to produce a lifestyle for many
that is riddled with needless anxiety and
conspicuously short of fun.
Moral panic here? Certainly. Eat what you want? It is
up to you. Go ahead, but remember, the fat devils
await you.
sources : the open university, open learn
Obesity and overweight
16 February 2018
Key facts
 Worldwide obesity has nearly tripled since 1975.
 In 2016, more than 1.9 billion adults, 18 years and
older, were overweight. Of these over 650 million
were obese.
 39% of adults aged 18 years and over were

overweight in 2016, and 13% were obese.
Most of the world's population live in countries
where overweight and obesity kills more people
than underweight.
 41 million children under the age of 5 were
overweight or obese in 2016.
 Over 340 million children and adolescents aged 5-
19 were overweight or obese in 2016.
 Obesity is preventable.
What are obesity and overweight
Overweight and obesity are defined as abnormal or
excessive fat accumulation that may impair health.
Body mass index (BMI) is a simple index of weight-
for-height that is commonly used to classify
overweight and obesity in adults. It is defined as a
person's weight in kilograms divided by the square of
his height in meters (kg/m2).
Adults
For adults, WHO defines overweight and obesity as
follows:
 overweight is a BMI greater than or equal to 25;
and
 obesity is a BMI greater than or equal to 30.
BMI provides the most useful population-level
measure of overweight and obesity as it is the same for
both sexes and for all ages of adults. However, it
should be considered a rough guide because it may not
correspond to the same degree of fatness in different
individuals.
For children, age needs to be considered when
defining overweight and obesity.
Children under 5 years of age
For children under 5 years of age:
 overweight is weight-for-height greater than 2
standard deviations above WHO Child Growth
Standards median; and
  obesity is weight-for-height greater than 3
standard deviations above the WHO Child Growth
Standards median.
 Charts and tables: WHO child growth standards for
children aged under 5 years
Children aged between 5–19 years
Overweight and obesity are defined as follows for
children aged between 5–19 years:
 overweight is BMI-for-age greater than 1 standard
deviation above the WHO Growth Reference
median; and
 obesity is greater than 2 standard deviations
above the WHO Growth Reference median.
 Charts and tables: WHO growth reference for
children aged between 5–19 years
Facts about overweight and obesity
Some recent WHO global estimates follow.
 In 2016, more than 1.9 billion adults aged 18 years
and older were overweight. Of these over 650
million adults were obese.
 In 2016, 39% of adults aged 18 years and over
(39% of men and 40% of women) were
overweight.
 Overall, about 13% of the world’s adult population
(11% of men and 15% of women) were obese in
2016.
 The worldwide prevalence of obesity nearly tripled
between 1975 and 2016.
In 2016, an estimated 41 million children under the
age of 5 years were overweight or obese. Once
considered a high-income country problem,
overweight and obesity are now on the rise in low- and
middle-income countries, particularly in urban
settings. In Africa, the number of overweight children
under 5 has increased by nearly 50 per cent since
2000. Nearly half of the children under 5 who were
overweight or obese in 2016 lived in Asia.
Over 340 million children and adolescents aged 5-19
were overweight or obese in 2016.
The prevalence of overweight and obesity among
children and adolescents aged 5-19 has risen
dramatically from just 4% in 1975 to just over 18% in
2016. The rise has occurred similarly among both
boys and girls: in 2016 18% of girls and 19% of boys
were overweight.
While just under 1% of children and adolescents aged
5-19 were obese in 1975, more 124 million children
and adolescents (6% of girls and 8% of boys) were
obese in 2016.
Overweight and obesity are linked to more deaths
worldwide than underweight. Globally there are more
people who are obese than underweight – this occurs
in every region except parts of sub-Saharan Africa and
Asia.
What causes obesity and overweight?
The fundamental cause of obesity and overweight is
an energy imbalance between calories consumed and
calories expended. Globally, there has been:
 an increased intake of energy-dense foods that are
high in fat; and
 an increase in physical inactivity due to the
increasingly sedentary nature of many forms of
work, changing modes of transportation, and
increasing urbanization.
Changes in dietary and physical activity patterns are
often the result of environmental and societal changes
associated with development and lack of supportive
policies in sectors such as health, agriculture,
transport, urban planning, environment, food
processing, distribution, marketing, and education.
What are common health consequences of
overweight and obesity?
Raised BMI is a major risk factor for
noncommunicable diseases such as:
 cardiovascular diseases (mainly heart disease and
stroke), which were the leading cause of death in
2012;
 diabetes;
 musculoskeletal disorders (especially
osteoarthritis – a highly disabling degenerative
disease of the joints);
  some cancers (including endometrial, breast,
ovarian, prostate, liver, gallbladder, kidney, and
colon).
The risk for these noncommunicable diseases
increases, with increases in BMI.
Childhood obesity is associated with a higher chance
of obesity, premature death and disability in
adulthood. But in addition to increased future risks,
obese children experience breathing difficulties,
increased risk of fractures, hypertension, early markers
of cardiovascular disease, insulin resistance and
psychological effects.
Facing a double burden of disease
Many low- and middle-income countries are now
facing a "double burden" of disease.
 While these countries continue to deal with the
problems of infectious diseases and under
nutrition, they are also experiencing a rapid
upsurge in no communicable disease risk factors
such as obesity and overweight, particularly in
urban settings.
 It is not uncommon to find under nutrition and
obesity co-existing within the same country, the
same community and the same household.
Children in low- and middle-income countries are
more vulnerable to inadequate pre-natal, infant, and
young child nutrition. At the same time, these children
are exposed to high-fat, high-sugar, high-salt, energy-
dense, and micronutrient-poor foods, which tend to be
lower in cost but also lower in nutrient quality. These
dietary patterns, in conjunction with lower levels of
physical activity, result in sharp increases in childhood
obesity while under nutrition issues remain unsolved.
How can overweight and obesity be
reduced?
Overweight and obesity, as well as their related
noncommunicable diseases, are largely preventable.
Supportive environments and communities are
fundamental in shaping people’s choices, by making
the choice of healthier foods and regular physical
activity the easiest choice (the choice that is the most
accessible, available and affordable), and therefore
preventing overweight and obesity.
At the individual level, people can:
 limit energy intake from total fats and sugars;
 increase consumption of fruit and vegetables, as
well as legumes, whole grains and nuts; and
 engage in regular physical activity (60 minutes a
day for children and 150 minutes spread through
the week for adults).
Individual responsibility can only have its full effect
where people have access to a healthy lifestyle.
Therefore, at the societal level it is important to
support individuals in following the recommendations
above, through sustained implementation of evidence
based and population based policies that make regular
physical activity and healthier dietary choices
available, affordable and easily accessible to everyone,
particularly to the poorest individuals. An example of
such a policy is a tax on sugar sweetened beverages.
The food industry can play a significant role in
promoting healthy diets by:
 reducing the fat, sugar and salt content of
processed foods;
 ensuring that healthy and nutritious choices are
available and affordable to all consumers;
 restricting marketing of foods high in sugars, salt
and fats, especially those foods aimed at children
and teenagers; and
 ensuring the availability of healthy food choices
and supporting regular physical activity practice in
the workplace.
WHO response
Adopted by the World Health Assembly in 2004, the
"WHO Global Strategy on Diet, Physical Activity and
Health" describes the actions needed to support
healthy diets and regular physical activity. The
Strategy calls upon all stakeholders to take action at
global, regional and local levels to improve diets and
physical activity patterns at the population level.
The Political Declaration of the High Level Meeting
of the United Nations General Assembly on the
Prevention and Control of No communicable Diseases
of September 2011, recognizes the critical importance
of reducing unhealthy diet and physical inactivity. The
political declaration commits to advancing the
implementation of the "WHO Global Strategy on Diet,
Physical Activity and Health", including, where
appropriate, through the introduction of policies and
actions aimed at promoting healthy diets and
increasing physical activity in the entire population.
WHO has also developed the "Global Action Plan for
the Prevention and Control of No communicable
Diseases 2013-2020" which aims to achieve the
commitments of the UN Political Declaration on No
communicable diseases (NCDs) which was endorsed
by Heads of State and Government in September
2011. The “Global Action Plan” will contribute to
progress on 9 global NCD targets to be attained by
2025, including a 25% relative reduction in premature
mortality from NCDs by 2025 and a halt in the rise of
global obesity to match the rates of 2010.
The World Health Assembly welcomed the report of
the Commission on Ending Childhood Obesity (2016)
and its 6 recommendations to address the obesogenic
environment and critical periods in the life course to
tackle childhood obesity. The implementation plan to
guide countries in taking action to implement the
recommendations of the Commission was welcomed
by the World Health Assembly in 2017.
Controlling the global
obesity epidemic
The challenge
At the other end of the malnutrition scale, obesity is
one of today’s most blatantly visible – yet most
neglected – public health problems. Paradoxically
coexisting with undernutrition, an escalating global
epidemic of overweight and obesity – “globesity” – is
taking over many parts of the world. If immediate
action is not taken, millions will suffer from an array
of serious health disorders.
Obesity is a complex condition, one with serious
social and psychological dimensions, that affects
virtually all age and socioeconomic groups and
threatens to overwhelm both developed and
developing countries. In 1995, there were an estimated
200 million obese adults worldwide and another 18
million under-five children classified as overweight.
As of 2000, the number of obese adults has increased
to over 300 million. Contrary to conventional wisdom,
the obesity epidemic is not restricted to industrialized
societies; in developing countries, it is estimated that
over 115 million people suffer from obesity-related
problems.
Generally, although men may have higher rates of
overweight, women have higher rates of obesity. For
both, obesity poses a major risk for serious diet-related
noncommunicable diseases, including diabetes
mellitus, cardiovascular disease, hypertension and
stroke, and certain forms of cancer. Its health
consequences range from increased risk of premature
death to serious chronic conditions that reduce the
overall quality of life.
The response: making healthy choices easy choices
WHO began sounding the alarm in the 1990s,
spearheading a series of expert and technical
consultations. Public awareness campaigns were also
initiated to sensitize policy-makers, private sector
partners, medical professionals and the public at large.
Aware that obesity is predominantly a “social and
environmental disease”, WHO is helping to develop
strategies that will make healthy choices easier to
make.
In collaboration with the University of Sydney
(Australia), WHO is calculating the worldwide
economic impact of overweight and obesity. It is also
working with the University of Auckland (New
Zealand) to analyse the impact that globalization and
rapid socioeconomic transition have on nutrition and
to identify the main political, socioeconomic, cultural
and physical factors which promote obesogenic
environments.
DIFFERENTIAL SENSITIVITY TO OBESITY'S
COMORBIDITIES IN MANY GLOBAL REGIONS
It has long been known that some communities are far
more susceptible to type 2 diabetes due to weight gain
than others, with the first demonstration showing that
South East Asians in the UK were 3 times more likely
to develop diabetes as they gained weight especially in
the abdominal area (18). Then, the International
Obesity Taskforce with the George Institute in Sydney
assessed about 750000 Asians and compared their data
with Caucasians, predominantly Australasians, and
showed that both diabetes and hypertension increased
at much lower BMI values in Asians and that the
difference was more marked when either waist-for-
height or waist-circumference values were compared
(19).
Since then it has become clear that Asians are more
prone to cardiovascular disease for a variety of reasons
including possible genetic differences (20). Mexicans
are also more susceptible to both diabetes and
hypertension at each increment of BMI or of waist
circumference (21), and the same seems to be true of
African Americans and Hispanic Americans in the US
(22). Similar differences seem to be evident in the
Caribbean and now in the Middle East where diabetes
rates are extraordinarily high, affecting up to 20% of
all of a country's adults aged ≥20 years. However, the
reasons for this have to be treated with caution;
although there are clear ethnic differences in
mitochondrial haplotypes between different societies
(23), much of the excess diabetes from these
haplotypes may only affect the progression of the
complications of diabetes rather than the incidence of
diabetes itself (24). Recently, the genetic control of
adipocyte cellular mass and any limited capacity to
store fat has been proposed as enhancing individuals'
propensities to insulin resistance and diabetes (25).
Individuals' poor economic status and stress (26) are
important contributors, but so also is the long-standing
impact of much early nutritional deprivation in fetal
life and early childhood (27).
Analyses of the effects of the Dutch (28) and Chinese
(29) famines demonstrate clear effects on the
offspring's increased susceptibility to diabetes if the
mother had been semistarved in pregnancy. Yajnik's
extensive analyses (30, 31) in India have also shown
the predilection of even newborn babies to insulin
resistance if their mothers are poorly fed. Discrepant
folate/B12 status is particularly important and
indicative of the crucial nature of the metabolic
availability of one-carbon components for nucleic acid
synthesis (32). Further analyses show that food
deprivation in early childhood (33)—and also perhaps
in adolescence (34)—increases susceptibility to later
diabetes. There is also long-standing evidence that
childhood malnutrition in Jamaica leads to what seems
to be a persistent impairment of insulin secretion in
response to a glucose challenge (35), and this concept
of early pancreatic susceptibility to impaired
programing of islet capacity is reinforced by longer-
term studies on the reduced insulin secretion
associated with the greater likelihood of diabetes in
the offspring from the Dutch famine (36). So
extensive is the evidence for the importance of
women's nutritional status pre- and postconception on
the child's future propensity to obesity and diabetes
that this has now entered official WHO policy
approaches to the importance of epigenetic and
pathophysiological programming of obesity and
diabetes with the need for major new programs to
counter these problems (37).
REDUCING THE NATIONAL BURDEN OF OBESITY
Countering the problem of obesity and diabetes is
proving difficult because most policy makers assume
it is an individual's responsibility and is easy to
reverse. But there is substantial evidence for an
adaptive, presumably hypothalamic, response to
weight gain that then biologically resists attempts to
slim by increasing appetite and reducing basal
metabolism with thyroidal and sympathetic responses
akin to those seen in lean adults when semistarved
(38). These responses can be reversed by reinfusions
of leptin up to its previous higher concentration in the
obese state (39). Thus, in practice the majority of
obese individuals regain their excess weight after a
slimming episode, but persistent weight loss can be
achieved if there are clear incentives, e.g., to avoid the
development of diabetes in susceptible individuals
provided they have sustained family and medical
support to overcome what may well be biochemical or
humeral signaling to eat more (40).
Given that the obesity epidemic is recent, it follows
that a prevention strategy with policies to counter the
primary drivers of the epidemic is needed. The
epidemic follows the complete mechanization and
computerization of modern living, resulting in a
collapse in the routine demand for physical activity.
This sedentary status is not only intrinsically harmful
but requires a diet with a much lower energy density
with fewer total calories consumed to preserve energy
balance. This means we all need to eat far less dietary
total fat (contrary to many popular and some scientific
analyses) as well as less dietary sugar. The lower
energy density of food is helped if substantial amounts
of fiber-rich complex carbohydrates, fruits, and
vegetables are consumed.
However, huge industrial interests promote motorized
transport, mechanized work, and home entertainment;
these all counter the need for physical activity. The
problem is then amplified by an even more powerful
food industry that not only usually controls
government policies but also does its utmost to sell
more food, usually with additional fats, sugars, and
salt to appeal to the primitive taste buds that were so
important for our survival during our early evolution
in Africa.
So the challenge for medical specialists as well as
public health physicians is to accept the need not only
for effective (and usually costly) therapy but also to
support those who battle to improve public health by
changing government policies relating to public
transport, urban planning, and an everyday
environment conducive to spontaneous walking. This
needs to be combined with a range of diet-inducing
changes, including fiscal measures to progressively
change the price of different foods and to limit and
then ban the use of high-energy ingredients in all
public sectors and then general catering. Without these
drastic measures the epidemic of obesity and diabetes
will continue.
The problem of excess weight gain and obesity is
difficult for many scientists and doctors to understand
because it seems a simple consequence of eating too
much or doing too little. The remedy seems simple—
to reduce intake or increase exercise. However, soon
after I started running obesity clinics it became
obvious that the obesity problem was more complex
than that. A patient's failure to maintain any weight
loss required an understanding of the patient's energy
needs, and with more sophisticated analyses it soon
became clear that different individuals have markedly
different energy requirements. An individual's average
needs, assessed over a month, may range from 1500
kcals/day to 3500 kcals/day or more. We then found,
with whole body calorimetry, that individual energy
expenditures at rest were astonishingly constant, with
<1% differences over 24 h, unless we were
considering young menstruating women who were
shown to have a monthly cyclical resting metabolic
rate. Interindividual differences depended on the
patient's age, sex, size, and degree of physical activity.
Given also that their mean weight gain was usually
0.5–1 kg/year, this merely amounted to a mean excess
daily intake of 10–20 kcals/day over the year, a
difference that could not be measured. But people, for
social and other reasons, may vary their day's intake
by perhaps 1000–1500 kcals during the week,
implying there must be an extraordinary degree of
medium and long-term appetite control. It then
became clear that obese individuals adapted as they
gain weight and changed what we crudely called their
“energy set-point.” So on slimming, their behavioral,
hormonal and autonomic nervous system responses
resist weight loss, thereby helping to explain why
most people, however intelligent and committed, after
slimming find they have regained most if not all of
their weight loss after 1–2 years.
Many of these features were recognized in the 1970s
when obesity began to emerge as a major medical
problem, and here I bring the analysis up to date and
consider obesity as a global problem.
THE RECOGNITION OF OBESITY AS A GLOBAL
CONCERN
The recent Director General of WHO frequently cited
obesity as the major new global epidemic (1). She
clearly identified this epidemic as industrially driven,
yet there have been only modest attempts so far to
tackle the problem. This in part relates to obesity
being seen as a fringe interest for most major medical
societies and only in the past 2 decades has it become
a frequent medical challenge in clinical practice. The
interests from governments in public health are very
limited unless driven by decades of intense lobbying
and overwhelming medical data, e.g., on the hazards
relating to smoking or when there is an exceptionally
dangerous epidemic such as SARS or Ebola. Yet, no
health service in the world will be able to cope with
the fully developed impact of the huge burden of care
induced by obesity and its complications.
In the mid-1970s specialist groups in the UK and US
were established to consider the new phenomenon of
obesity, which was then affecting only middle-aged
adults, particularly women (2, 3). Both national groups
agreed to express the weight for height that was
optimum for health in terms of the body mass index
(BMI; kg/m2). The designated normal BMI of
approximately 20–25 was based on pre- and post-
World War II US mortality statistics (2). It was soon
recognized that smokers not only had a substantially
increased risk of premature mortality but also tended
to be thinner not only because they ate less but also
because their metabolic rate was stimulated by
smoking, with an additional small increase in their
basal metabolism (4). When analyzed separately,
smokers have an increased death rate at each
increment in BMI, and the mortality rate of a normal
weight smoker is similar to that of a very obese
nonsmoker (Fig. 1) (5). The 20–25 BMI range to
minimize mortality has recently been confirmed by an
integrated international prospective analysis of BMI in
relation to mortality in one million men and three
million women (6) and by the latest Global Burden of
Disease estimates (7). Both these analyses were
confined to nonsmokers and included adults in both
lower income and affluent societies.
THW FINE PARENTS WHOSE
CHILDREN ARE OVER OBESE
Could fining parents cut childhood obesity?
Obesity is described as one of the biggest problems
facing mankind. The small US territory of Puerto Rico
is debating whether to fine parents who fail to get their
children to lose weight. But would this work
elsewhere?
More than 600 million people, or 13% of the world's
adult population, are obese. The rate more than
doubled between 1980 and 2014, according to the
World Health Organization. The estimated cost to the
global economy is $2tn (£1.3tn), including £47bn to
the UK.
National and local governments have struggled to
address obesity, defined as having a body mass index -
based on the ratio of height to weight - of more than
30. They often face accusations of nanny-statism and
opposition from food and drink companies if they do
so. Attempts have been patchy and experts are divided
on what, if anything, works.
In 2011, Denmark brought in a "fat tax" on foods
containing more than 2.3% saturated fat, but the
inflated prices drove consumers over the border to
Germany. The policy was dropped a year later and the
government cancelled plans for a tax on sugar.
In 2012, France quadrupled the tax on saturated fat-
rich palm oil, dubbed the "Nutella tax" because the
popular hazelnut spread contained the ingredient.
Voters in Berkeley, California, backed calls for a one-
cent-an-ounce tax on fizzy drinks, in a referendum last
year. The beverages were banned from schools in New
South Wales, Australia, in 2007, but this has
sometimes been ignored.
Meanwhile, families in England and several US states
are sent warning letters warning if tests in schools
show children are overweight.
So far, anti-obesity policy has focused largely on
taxation or providing information. But, on Friday,
politicians in Puerto Rico, a self-governing US
territory, start debating whether the government
should get more involved in one of the main perceived
reasons for the growth in childhood obesity -
irresponsible parenting.
If the legislative assembly approves Senator Gilberto
Rodriguez Valle's plans, teachers will be told to look
out for students they think are obese. They would refer
those detected to a counsellor or, in severe examples,
to a social worker. Health department officials would
meet parents and decide whether the obesity comes
from overeating or a medical condition.
If food is the problem, it would be up to parents to set
a diet and exercise programme, with monthly visits by
officials to make sure it's being kept up. After six
months, they would examine the child again. Parents
would face fines of up to $800 (£525) if there was no
improvement within a year.
Opponents say that, in a society where thinness has
become a status symbol perpetuated by glossy
magazines and media images, the idea of teachers
acting as body police will further stigmatise the
overweight. There is also a large question mark over
whether this approach, very much "stick" rather than
"carrot", can work.
But Rodriguez Valle and his supporters insist families
will be informed in confidence, meaning no
humiliation for children in front of classmates. Fines
are "necessary for society", argues a colleague, saying:
"The obese child is a health problem that can become
a financial burden because the child can develop
diabetes, heart ailments and other diseases."
In 2013, 27.9% of adults in Puerto Rico were
described as obese, upper to middling by rates across
the US. However, the figure for children under the age
of four - 17.9% - is the highest of all US states and
territories. If parents are failing to do their job from
the start, schools have to ensure standards instead,
backed by financial penalties, it is argued.
There is a sense of helplessness in the face of the
world's weight gain, largely attributed to rising food
intake and falling activity levels. "Not only is obesity
increasing," a study funded by the Bill and Melinda
Gates Foundation, published last year, said, "but no
national success stories have been reported in the past
33 years. Urgent global action and leadership is
needed to help countries to more effectively
intervene."
The latest UK figures show 24.7% of adults are obese,
lower than Puerto Rico, but still the among the highest
in western Europe. The rate was 14% for children
aged two to 15 in England, 17% in Scotland and 19%
in Wales in 2012. In Northern Ireland in 2011-12, it
was 10%. So, does Puerto Rico's proposal appeal?
"Obesity isn't like smoking, the cutting of which has
been a public health success in recent years," says
Andrew Hill, professor of medical psychology at
Leeds University. "Smoking is a single behaviour
that's really explicitly linked to a number of adverse
health conditions, whereas obesity is a state of body,
"The causes are driven by environment. You live in an
environment which encourages you to eat lots of food
and discourages physical activity. To then apply a
penalty to punish something that people have varying
degrees of control over seems to be not just
counterproductive but morally dubious."
Obesity is more of a problem among poorer groups,
who live in an "obesogenic" environment, according
to Hill. He argues that exercise is less available and,
given the higher proportion of household income spent
on food, leads to the purchase of cheap, highly
calorific products, sugary or fatty, with limited
nutritional value.
Hill dislikes the Puerto Rican proposal. "We need to
move the argument away from saying it's all about
individual responsibility and 'it's you to blame'. People
do have some responsibility but we must recognise the
power of environment and how difficult it is to change
for the rest of your life."
Philadelphia - the most overweight of America's major
cities - has cut the obesity rate among children. The
city authority has persuaded shops to stock more fruit
and vegetables in areas once described as "food
deserts" because of a lack of nutritious offerings. It
has also banned full-fat milk from school canteens, as
well as deep-fat frying, while sugary drinks have
disappeared from vending machines.
"None of these efforts involved stigmatising or
penalising parents," says Rebecca Puhl, deputy
director of the Connecticut-based Rudd Center for
Food Policy and Obesity. "In contrast, these changes
exemplify ways to support and empower parents to
make it easier to improve the health of their children."
Puhl argues that a more integrated approach. involving
schools encouraging better eating and more exercise,
is needed.
But the Puerto Rico obesity plan has echoes of the
action taken in the UK and elsewhere to combat
persistent truancy from school. In March last year, it
was revealed that a record number of truancy fines had
been handed to parents but that persistent truancy was
falling. But there has been criticism that there is no
link and that fines do not work. Some critics believe
fines disproportionately affect poor parents.
For a study published in 2000, the economists Uri
Gneezy and Aldo Rustichini tested the effects of fines
on parents who consistently picked up children late
from daycare centres in Israel. Rather than deter the
behaviour, lateness increased because they started to
regard the fine as a reasonable fee for extra childcare,
rather than a punishment. "A powerful, intrinsic
motive was crowded out by a weaker, extrinsic one,"
they concluded.
"That's unlikely to happen with obesity because there's
a stigma surrounding it," says Peter Ayton, professor
of psychology at City University. "But there's
definitely room for thinking more about incentives,
maybe some sort of rewards for losing weight,
especially as obesity tends to affect the poor most.
"People respond to incentives and deterrents. There
needs to be more discussion of what works."
Proposed Law In Puerto Rico Would Fine Parents Of
Obese Children
Lawmakers in Puerto Rico have introduced a
controversial measure that could punish the parents of
overweight children.
As Fox Latino reports, the bill was introduced in
Puerto Rico's senate and would have education
officials identify obese children and then tell their
parents what they can do to help them. Fox Latino
adds:
"If, after six months, education officials determine that
the child's condition has not improved, a staffer can
refer the case to child-family services authorities as
one involving abuse or mistreatment.
"If after another six months the situation persists, the
parents can be assessed up to $500 in fines.
"Six months after that, if the problem continues, the
parents can be fined an additional $800."
The Associated Press reports that Sen. Gilberto
Rodriguez, one of the bill's sponsors says the program
aims to "improve children's wellbeing and help parents
make healthier choices."
The wire service adds that "more than 28 percent of
children in Puerto Rico are considered obese,
compared with some 18 percent in the U.S. mainland."
The Puerto Rican paper, El Nuevo Dia, spoke to legal
and health experts who called the proposal "incorrect"
and "superficial."
Ricardo Fontanet, the president of the local chapter of
the American Academy of Pediatrics, said that this
kind of initiative will complicate things, because some
"kids are obese because of medical complications or
genetic issues."
A law professor told the paper that it would be terribly
difficult to prove that having an obese child implies
that the parents have mistreated the kid.
THW EXPEL PEOPLE WITH
UNHEALTHY LIFESTYLES FROM
STATE INSURANCE
Should People With Unhealthy Lifestyles Pay Higher
Health Insurance Premiums?
Ethical Justification for Different Rates
Dubois reviews three ethical grounds that have been
used to justify charging unhealthy people more or
charging healthy persons less. (Economists consider
the respective approaches fungible, that is, equivalent
and interchangeable, from a rational economic
perspective.) The first is based on the principle of
beneficence: Encouraging healthy behaviors reduces
suffering, prevents social exclusion, promotes
autonomy, and reduces the threat to social solidarity
(in light of potential concerns about the "free-rider"
problem, where someone is seen to benefit from a
system without contributing a fair share). Dubois notes
that this line of justification suffers from the familiar
problems of paternalism, wherein the
state/government or some third party (the insurance
company) asserts that it knows what is in a person's
best interests better than the person himself.
Beneficence may not be sufficient to override the
principle of respect for autonomy, which holds that
people should decide for themselves how they want to
live their lives (as long as it does not harm others, as
discussed below).
Dubois devotes an entire section to challenging the
claim of actuarial fairness, i.e., because it costs more
to treat people who smoke, are overweight, are
sedentary, and drink too much, it seems only fair that
they should pay more for their coverage. Dubois
argues that this position is empirically disputable, and
if applied consistently, would raise thorny issues about
similar issues, like genetic disorders, which most
people would find ethically unacceptable (e.g., should
a family with a child born with cerebral palsy be
charged more, following the same logic of actuarial
fairness?). In the US context, the question of actuarial
fairness raises three points that deserve further
discussion. First, there is an important distinction to be
made between public and private insurance schemes.
In a competitive market system, private insurance
companies can offer differential plans, and in
principle, potential buyers can decide whether they
consider the contractual terms fair or not. The same is
not true of government-run, single-payer plans, where
the issue of discrimination against poor and minority
people would be inescapable (because it is an
empirically well-established fact that the health
behaviors and indicators at stake are more prevalent in
these groups). A variation of this concern arises with
respect to the difference between employers who offer
a number of insurance plan options versus those who
offer only a single employer-funded plan. In the latter
situation, the question of equal or differential plans
should be an issue for bargaining, where the
employees can decide how they want to represent their
collective interests, as they deliberate about the
relative weight that should be given to different ethical
considerations. Finally, though there is increasingly
convincing evidence that the total costs of treating
people with unhealthy lifestyles over a lifetime is less
than the total for healthy people (because unhealthy
people die younger), it is equally clear that, on annual
basis, unhealthy people use more medical services.
This is relevant because, in the long-term, it would be
in the financial interests of the collective insurance
industry to ignore unhealthy behaviors because such
behaviors would eventually save them money.
However, due to relatively high turnover in
employment and changes in health insurance plans in
the US, individual companies cannot bank on these
potential savings, and hence, they see it in their
interests to promote differentiated plans to attain
short-term savings. That said, the idea that charging
people more can be ethically justified strictly on the
basis of financial calculations appears thin,
unappealing, and unconvincing to most people, as it
seems to diminish the value of mutual caring and
commitment to a cold cash nexus.
The third grounds that Dubois discusses as
justification for charging people with unhealthy
lifestyles more is founded on an implicit social
contract. Dubois makes surprisingly short shrift of this
approach, devoting only a single paragraph to this line
of reasoning, and he casts it largely in terms of
individual responsibility to make productive
contributions to society or "cooperative schemes"
(about which he suggests that insurance schemes may
or may not qualify). Dubois quickly dismisses these
grounds, asserting that such arguments would require
a more comprehensive theory of justice or the good
society to be tenable. It may perhaps be because he is
writing from a European perspective, where Rawls
(1971) may not have as much influence, but I think
that it is precisely in terms of a social contract that
most Americans are struggling to make sense of this
issue. They argue about it in terms of a powerful
tension between a sense of reciprocity and mutual
obligation versus sympathy and understanding about
the degree to which individual health status is beyond
one's personal control. People want to believe that
they can and do exercise some degree of control over
their own health. At the same time, it is a rare person
who is not cognizant of the fragility of the human
condition and the capriciousness of being stricken by
disease. Given that there will never be enough money
to pay for all possible medical procedures for
everyone (the US already pays 2–3 times the
percentage of its gross national product for health care
expenditures as other industrialized nations, with little
to show for it), it is imperative to use limited resources
fairly. The major challenge then is coming to terms
with how much individuals should be held
accountable for exercising control over various health
behaviors and how much weight should be given to
the social determinants of health (where poor health
can be explained as the result of brute bad luck due to
circumstances of birth, which a just society should
strive to rectify). In addition, as Rawls reminds us,
finding an appropriate balance needs to be tempered
with justice considerations that give precedence to
concern for those who are least well off
Ethical Considerations in Designing a Differentiated
Plan
The fact that covering the higher medical expenses of
people with unhealthy lifestyles on an annual basis
means that others in the same plan will have to forego
other possible plan benefits (e.g., eye care, dental care;
or higher pay raises) is the nagging rub that points to
the larger issue of honoring a social contract based on
mutual obligation and mutual responsibility. There is a
general sense that, if everyone did not smoke,
maintained a healthy weight, drank only in
moderation, and got some regular exercise, plans
would cost less and/or be able to pay for procedures
that they cannot now afford. Is there an ethically
acceptable means to achieve the goal of assuring that
all members of a collective cooperative scheme are
making a comparable, honest effort at doing that
which is within their power to use limited resources
prudently? What sorts of ethical considerations weigh
against using financial incentives to remind people to
be mindful of their obligations to one another?
Dubois identifies several important ethical concerns.
The most significant is that charging people more will
fall disproportionately on those who already have less.
Without careful crafting, charging higher premiums
may further stigmatize those who are more likely to
feel bad about themselves already, and it may act as a
further disincentive to obtaining medical insurance,
thus, exacerbating existing health disparities. As
Dubois notes, its implementation may also harm third
parties such as dependent children; due to the inherent
opportunity costs, paying for a child's braces, for
example, may no longer be affordable in families of
less financial means. Finally, Dubois points out that
monitoring and enforcing compliance in such schemes
will inevitably prove costly. (Again, by analogy, both
divorce settlements and car accidents reports have
moved towards no-fault claims, due to the high costs
involved in seeking to assign or apportion blame.) He
raises a couple of other issues that seem less
compelling. Is it a form of state coercion? It depends.
Whereas it is easy to imagine horribly intrusive
requirements, it is equally possible to identify terms
that may not be particularly bothersome. Is it a
violation of an existing social contract or an
infringement on a right to health care? There are a
range of existing remedies that lessen the magnitude
of these concerns (such as switching insurance plans
or voting in the opposing political party).
For my purposes, an interesting point raised by Dubois
is the ambiguous effect of such plans on the issue of
social solidarity. Schmidt (2008) describes how
German law pertaining to health insurance avers an
inextricable link between personal responsibility and
social solidarity. The relevant section of the act, titled
"Solidarity and Personal Responsibility," reads,
In the spirit of a mutually supportive community
[Solidargemeinschaft], the task of the statutory health
insurance is to maintain, restore or improve health of the
insured. The insured have co-responsibility for their
health; through a health conscious way of living, taking
part in appropriately timed preventative measures [and]
playing an active role in treatment and rehabilitation, they
should contribute to avoiding illness and disability and
overcoming the respective consequences. (p. 200)
Here, the act of actively taking care of one's health is
seen to be an expression of one's participation in
contributing to a collective common good. Such
schemes incentivize and reward those who behave in
ways that benefit the collectivity as a whole.
Conversely, however, these same plans can be seen to
undermine social solidarity because such meritocratic
elements may be viewed as primarily benefiting those
who are already advantaged and by eroding traditional
notions of giving without expectation of return. In
short, the issue is whether plans can be devised that
benefit the least well off and reinforce the sense of
social solidarity.
Ethical Specifications
A number of criteria have been proposed by Dubois
and other analysts, which offer reasonable grounds for
striking an ethically appropriate balance between
completely ignoring unhealthy behaviors and
appreciating the many barriers that make it difficult
for individuals to live a healthy lifestyle. Four
proposed standards help to inform the discussion.
Feiring (2008) and Pearson and Lieber (2009) propose
that differentiated plans should be imposed only
prospectively for voluntarily refusing to take any
action to change one's unhealthy behaviors. With this
standard, people would not be charged more for
coming into a plan being overweight or smoking but
for stating that they are not willing to try to do
anything about them. Applying this standard would
recognize that health status is patterned by social
position while acknowledging that it is not
"determined," that is, that the majority of poor people
do not smoke, are not obese, do not drink excessively,
and have some physical activity in their lives
(arguably, with some quibbling at the margins), and
therefore, that it is reasonable to ask others in the same
position to do the same. This standard entails two
stipulations: first, that the proposed voluntary action
that would demonstrate the good faith effort to be a
contributing member to the collective goal of using
limited resources prudently is accessible, and second,
that it is the effort, not the outcome, that counts. It is
sufficient that the member enroll in a smoking
cessation program or weight loss program and not
necessary that they achieve abstinence or a BMI of 25
to avoid being penalized.
Second, members should be offered a range of options
to fulfill their obligation to contribute to the good of
the collective enterprise. Unfortunately, there is a high
correlation among the most common behaviors that
are used to define an unhealthy lifestyle: smoking,
drinking, overweight, and sedentary. Rather than
asking people to take action to address each of these
problems independently, allowing people to choose
the issue that they would like to address first
demonstrates sympathy and solidarity with their
efforts to overcome hardships. The measure also
promotes the exercise of autonomy, which has also
been linked with better health.
The third standard is setting limits on the range of
behaviors that should be considered for inclusion as
unhealthy. Members should not be required to change
behaviors such as sexual behaviors, childbearing,
sexual orientation, and participation in sporting
activities that elevate risk of injury because the harm
of proscribing them would far outweigh the benefits to
be gained by their reduction or elimination.
Each of these standards needs further specification, so
the final recommendation is to leave these details to be
resolved through a procedural process, such as Daniels
and Sabin's (1997) accountability for reasonableness.
Insurance companies should be required to present a
public rationale for meeting these standards, an
accounting of the anticipated benefits, and an appeals
process for exempting individual cases, with a public
review and rating process.
Discussion
As the contentious debates about health care reform at
the state and national levels in the US have shown, a
significant proportion of the American public demands
that individuals be held accountable for the behaviors.
They do not accept the strong egalitarian position that
people are entitled to an equal share of the benefits
irrespective of level of effort. With conscientious
development, policies can be written that achieve an
acceptable balance of principles that are fair to all
involved. As various plans are enacted, it will be
critical to examine the effects of such policies and
how much good they actually accomplish.
http://www.medscape.com/viewarticle/737955_5
Higher Health Insurance Rates for Unhealthy
Lifestyles?
Blog | December 06, 2014 | Healthcare Reform, Patient
Relations, Patients
By James Bartley
I recently had the opportunity to travel to Annapolis,
Md., for a weekend trip. Annapolis is an old historic
town on the Chesapeake Bay. It is the home of the
state capital, the U.S. Naval Academy, and, during the
winter of 1783 to 1784, it served as the temporary
capital of the United States. On my way back home,
we decided to visit Fort McHenry in Baltimore, Md.,
which recently celebrated the 200 anniversary of the
Battle of Baltimore, waged in 1814 on September 13
and September 14. That battle, part of the War of 1812
with Great Britain, is noted for the inspiration of our
national anthem, Frances Scott Key’s “The Star
Spangled Banner” — “Gave proof through the night
that our flag was still there.” Yes, I like history.
In any event, on our way to Baltimore, we stopped at a
typical strip mall diner for breakfast in the town of
Pasadena, Md. While eating breakfast, my friend and I
both observed and commented, that many of the
patrons were — sorry to be frank — obese. I really do
not know anything about the town or the area — the
demographics, schools, workforce, average age, etc.,
but the patrons that were enjoying breakfast at the
diner in Pasadena were not very healthy looking. The
sad part was their children were eating the same food,
and many were already obese.
A discussion regarding diet or lifestyle issues on a
national level should also include a discussion on
insurance, premiums, high deductibles, and also
Obamacare. It is also appropriate and timely to discuss
one’s individual responsibility when we all,
(government, businesses, individuals), pay a lot of
money for healthcare.
Last year, the former Mayor of New York City,
Michael Bloomberg, attempted to “implement” dietary
behavioral changes to the citizens by banning the sale
of “big gulp” sodas at New York City movie theaters.
A local judge decided Mayor Bloomberg
“overreached” his legislative authority level and the
law was never enacted. Bloomberg did ban cigarette
smoking in bars earlier in his tenure.
On a national level, the FDA recently announced it
will require restaurants with at least 20 locations, to
display the calorie count of food items on their menus.
“While no single action can fix the obesity problem,
the step we’re taking today ... is a really important one
for public health,” said FDA Commissioner Margaret
Hamburg.
While one may argue that it is not the government’s
responsibility to dictate lifestyle, the question stills
remains, at what point should an individual take
responsibility for his health, and should there be a
financial incentive/disincentive to influence that
lifestyle?
Numerous studies have linked poor diet, cigarette
smoking, lack of exercise to diabetes, coronary heart
disease, cancer, etc. Why should an individual who
has a healthy lifestyle, with no visits to the doctor,
hospital, clinic, pay the same insurance premium as
someone who has a poor lifestyle, with multiple visits
to the doctor, hospital, and clinic? When I purchased
auto insurance for my daughter, her premium was
greater than mine since “statistically” young adults
have more accidents. When someone purchases life
insurance, premiums are higher for someone who is a
smoker.
I would suspect that if all those folks who were
enjoying pancakes/syrup with sausage, danishes, and
chocolate milk at the diner in Pasadena were asked to
defend Baltimore against Great Britain in 1814, the
Union Jack would be flying over Annapolis and not
the Stars and Stripes.
THIS HOUSE WOULD FORCE PARENTS OF
OBESE CHILDREN TO SEND THEIR
CHILDREN TO FAT CAMP
Labour's secret plan to
send overweight children
to NHS fat camps
Tens of thousands of overweight children –
some as young as four – will be shipped off
to fat camp, under a Government scheme to
tackle obesity.
Primary school pupils identified as being overweight
will automatically be offered a place on a state-funded
diet and exercise scheme.
Although parents will have the right to refuse to send
their children to the classes, ministers hope the
majority will attend.
Parents groups said the new NHS rules meant Labour
had moved "beyond a nanny state, to a dictatorship."
Health experts warned that the public branding of
young children as fat could damage their confidence,
expose them to bullying and trigger eating disorders.
However, paediatricians welcomed the move.
Under existing regulations, children are weighed when
they start primary school – aged four or five – and
again as they leave, at 10 or 11. Parents of all children
receive a letter saying whether their children are
healthy, overweight, underweight or very overweight.
Latest figures show that by the time they leave school,
one in three children is overweight.
When it was introduced three years ago, the weighing
programme was met with a backlash from parents. In
its first year, more than half withdrew their children
from the scheme, for fear they would be bullied after
the class weigh-in.
When families were advised that pupils would not be
told their weights, nor singled out and told to diet, but
that data would simply be used by local health
planners to monitor the spread of obesity and to help
them set up the right services, participation rates
increased. Last year, nine out of ten children were
measured.
The new guidance, slipped out to NHS Primary Care
Trusts in England during the school holidays, orders
an immediate change of approach.
From this month, pupils whose weight is too high – or
too low – will automatically be offered a referral to
"weight management services" in areas which already
run such programmes or can set them up quickly.
Existing NHS schemes range from 12-week weight
loss courses taking place at weekends and on school
nights, to six-week residential courses costing £3,000
a patient for the most obese.
All PCTs have been "strongly encouraged" to have
children's weight management services in place by
next September, so that every overweight child in
England can be referred for diet and exercise sessions.
Those identified as obese may be sent to paediatricians
for specialist treatment, drugs or even surgery.
Margaret Morrissey, founder of family lobby group
Parents Outloud, said it was "unforgivable" to promote
schemes which would inevitably encourage
humiliation to be heaped on those children bused off
to fat camps.
She said: "This has gone beyond a nanny state, beyond
Big Brother."
"To label young children as overweight because they
are carrying a few extra pounds makes them so
vulnerable to bullying, and increases the risk of
developing eating disorders, especially among the
girls.
"Obviously it is unfortunate if parents feed their
children badly but this Government appears to have
forgotten that we do not live in a dictatorship."
Susan Ringwood, chief executive of eating disorder
charity Beat, said she was "deeply concerned" that
sending children to weight loss classes would increase
the risk of bullying, which could trigger conditions
like anorexia in the most vulnerable.
She said: "Children can be cruel, they exploit the
weaknesses they find and we know that those who are
bullied about their weight are more likely to develop
disorders".
But paediatricians said the scale of the obesity crisis
facing Britain meant that the drastic action being
introduced by the Government was necessary.
Dr David Vickers, from the Royal College of
Paediatrics and Child Health, said: "It seems to me
that it is more outrageous to tell parents that their child
is overweight then do nothing about it, than to send
them a letter and then offer some support.
"Children who are overweight are already far more
likely to be being bullied, I don't think enrolling them
on these schemes will make that any worse."
Tam Fry, from the National Obesity Forum, said
pupils should be weighed every year, and parents
given detailed information about their body mass
index so they could monitor their child, not a "badly
written letter" filled with alarming warnings.
Even if a child is just one pound overweight, parents
receive a standard NHS letter alerting them of an
increased risk of cancer, diabetes and heart disease.
Latest figures show that by the start of primary school,
23 per cent of children are overweight, rising to 33 per
cent by the time they leave.
If current trends continue, more than half the adult
population will be obese by 2050, while spending on
obesity will rise sevenfold, according to Government
forecasts.
Currently, just a handful of PCTs automatically offer
pupils a place on slimming programme if the school
weigh-in finds they are overweight.
They include Nottingham City PCT, which runs a
scheme which offers overweight pupils a place on a
12-week "Go 4 It" course which children and parents
attend twice weekly, to take part in fitness sessions,
and quizzes and games about nutrition, cooking and
exercise.
Richard Warsop, from Nottingham, is one of the
children who has benefited from the scheme. By the
age of 12, Richard weighed 10 and a half stone.
With a height of 5 foot 2, that made him obese,
according to charts of Body Mass Index – a
recognised way of measuring how healthy someone's
weight is compared to their size.
For years he had been bullied about his weight,
culminating in an incident in which his nose was
broken.
In the year since being referred to the Nottingham
scheme, he has lost two stone, while he has grown to 5
foot 9.
His mother Alison says the boost to his self esteem
from meeting other children in the same situation
made the biggest difference to her son, who is now far
more active, while the lessons for parents about health
and nutrition opened her eyes to the family's unhealthy
lifestyle.
https://www.telegraph.co.uk/news/health/ne
ws/6142249/Labours-secret-plan-to-send-
overweight-children-to-NHS-fat-camps.html
Child obesity: Why do
parents let their kids get
fat?
The health risks for obese children may be even
greater than previously estimated, new research
suggests. So why do parents let their children get fat?
The recent start of the new school year was greeted
with reports of a dramatic rise in demand for extra-
large uniforms for primary school pupils.
It came as no surprise to Carol. Her two nieces were
wearing size 14 skirts by the age of 11, the average
size worn by a grown woman in the UK.
Her son also struggled to find a uniform big enough at
secondary school as his weight crept up to nearly 20
stone (127kg) in his teens.
"You do feel judged by other people when your child
gets to that size, but the harshest critic is yourself,"
says the mother-of-two from Birmingham.
"I constantly asked myself 'what am I doing wrong?'"
It's a good question. Just over 33% of 11-year-olds are
now overweight or obese and among four and five-
year-olds it's 22%, according to the most recent
figures from the National Child Measurement
Programme, which assesses the height and weight of
primary children in England. The figures are similar in
Wales, Scotland and Northern Ireland.
New research published today by the University of
Oxford also suggests that obese children and
adolescents have several risk factors for heart disease,
including raised blood pressure and cholesterol,
compared with normal weight children.
Obesity experts say parents are struggling with a
multitude of problems when it comes to their child's
weight. They range from a lack of education about
food, limited cooking skills and limited money to buy
healthier food to longer working hours and marketing
campaigns for junk food aimed at kids.
But the more sedentary lives children now lead is also
creating huge problems. Last week a study suggested
that up to 75% of junior school children preferred to
stay at home than go to their nearby park.
My mum wasn't the problem
My problems started when I was between five and
seven. When I was younger everyone said I had puppy
fat and I would grow out of it - I didn't. By my teens I
had a serious weight problem.
People blame parents but my mum did everything she
could she could to control my weight.
I was very good at convincing myself and others that I
wasn't eating very much. I would skip breakfast and
lunch but make up for it at dinner. Sometimes I would
secretly eat through the night.
My mum would give me a good dinner because I said
I hadn't eaten all day. She didn't want me to over eat
but she didn't want me go without either
Stacey, once over 25 stone (159kg)
What are the health risks of obesity?
Is this the ultimate healthy meal?
Watching TV was one of the most popular activities,
with 89% saying it was how they liked best to spend
their time away from school, according to researchers
Lightspeed. In July, scientists from University of
Montreal claimed every extra hour of television that a
toddler watches each week adds to their waist size by
the time they turn 10.
While the problems parents face might be increasing
so is evidence about the dangers of obesity. So why do
they let their children get so fat?
Katy's son weighed over 23 stone (147kg) by the age
of 15. She knew the reason - he ate too much and did
too little exercise. She says she tried to help him but
things only changed after he decided to help himself.
"A lot of his eating habits were out of my control,"
says the mother-of-two from Buckinghamshire. "He
would eat too much when he was at school and then
come home and eat whatever was around, even cook
big meals for himself. He wouldn't wait for me to get
home and make dinner.
"I know I am not completely innocent when it comes
to his weight. I have always struggled myself and have
some bad eating habits, but I tried hard to change the
way we both ate."
The turning point came on a holiday last year to the
US. Her son was too big to go on certain rides at a
theme park. Upset and humiliated, he went on a six-
week weight-loss camp and lost nearly three stone
(18kg). The camp was run by Wellspring UK, one of a
number of firms offering camps in the UK.
"He had always refused to go before but now he
wanted to. He is a different child now, so happy and
confident. Before he had no self esteem and would
have temper tantrums. His whole attitude to food has
also changed, he now picks the right stuff to eat."
Some parents know they are a bigger part of the
problem. Tracey says she allowed her daughter to pick
up her own bad eating habits. Admitting to having a
"complicated relationship" with food herself, she says
she used it to bond with her daughter.
This starts with 'clean your plate' syndrome - my mother
put down huge portions and made us carry on eating long
after we were fullClaire, Nottingham
Childhood obesity: 10 of your stories
"We would snack together in the evening while
watching television and treat ourselves with sweets
and puddings. It was like our special time together,"
says the mother-of-one from Shrewsbury.
"I could see she was carrying a few extra pounds but
she seemed happy. I didn't want to mention it because
I didn't want her to feel negative about herself.
"When she started secondary she was almost 14 stone
(89kg) and by then her bad habits were hard to break. I
know I am responsible and I feel awful about it."
Despite the rise in child obesity, experts say it's wrong
to just blame parents.
"They definitely have a responsibility, but the issue is
much broader than simply blaming them," says Paul
Gately, professor of exercise and obesity at Leeds
Metropolitan University. He also runs weight loss
camps for overweight children.
Many parents don't realise their child is fat when it
might be obvious to other people, he says. According
to studies, 75% of parents underestimated the size of
an overweight child, while 50% underestimated the
size of an obese child.
http://www.bbc.com/news/magazine-
19661085
For Overweight
Children, Are 'Fat
Camps' a Solution?
Two summers ago, Alexis Werth Mason was 12 years
old and weighed 133 pounds. Not huge, but at 4-foot-
11, she was heavier than she wanted to be.
Shopping was painful. Classmates teased her. A
neighbor told her that she was too big to pull on his
sled. After desperately trying -- and failing -- at diets,
her mother, Bonnie Werth, asked if she wanted to go
to a weight-loss camp.
"She said, 'I can't go to a fat camp, Mommy, all the
kids will make fun of me,"' Ms. Werth, the president
of Team Services, a marketing firm in Woodbury,
N.Y., recalled. "But I convinced her to go."
"It wasn't so much the weight loss," Ms. Werth said,
"but I wanted her to be around other kids with the
same problems. She felt very isolated and alone in her
issues."
Alexis, who is known as Lexi, spent eight weeks at
Camp Shane, in Ferndale, N.Y., and lost 25 pounds.
She has kept off every ounce since.
Continue reading the main story
This is a big deal.
It is easy, after all, to lose weight in a controlled
environment, but it is a different story when you are
back home and faced with temptations like pizza and
ice cream and get little to no exercise. So it's not
surprising that many children who attend weight-loss
camps regain the weight.
"Coming home from camp was hard," Lexi, now 14,
said. "I knew what I had to do, but I saw everyone
eating at school. When you see all your friends
pigging out and watching old movies and crying and
stuff, you want to join in. It's peer pressure. So I ate in
moderation."
Thousands of young people will be spending this
summer at weight-loss camps, a popular option for
parents who have no idea how to inspire their children
to shed pounds. It is a slowly growing industry.
Nationwide, there are about a dozen camps devoted
strictly to weight loss, four of them opened in the last
year. But whether they work remains unclear.
Statistics about weight-loss camps are hard to come
by. Campers often do not keep in touch with camp
directors, nor do they always respond honestly to
questionnaires.
But of the 1,000 campers who will weave their way
this summer in and out of Tony Sparber's three New
Image camps in Florida, California and the Pocono
Mountains in Pennsylvania, more than half are repeat
customers. The figure is about the same for the 800
campers heading to Camp Shane in the Catskills.
"Maybe they're not losing the weight specifically, but
instead they're learning something that they can use 20
years down the road and put into use when they're
ready," said Marla Coleman, a former president of the
American Camping Association.
Ms. Coleman added: "It's education. Knowledge. It
goes to everything camp does, which is experiential
learning."
Perhaps more important, Ms. Coleman said, camp
gives children a reprieve from weight gain and the
torment they often experience back in the real world.
Many play sports for the first time, and have social
lives.
But that is not always the case. Danielle Rothman,
now 17, spent three summers at Camp Shane.
"Everyone at Shane was overweight, yet people were
still being made fun of about their weight," said Ms.
Rothman, who lives in Dix Hills, N.Y.. "The more
overweight kids are still made fun of. I was one of the
thinner kids, and people would say, 'Why are you
here?' It made me feel good, but after a while I wanted
to hit them."
Weight-loss camps usually run for three weeks, six
weeks or eight week sessions, and they cost about
$7,500 for the entire summer -- about $1,500 more
than nonspecialized camps. Campers get about 1,500
calories a day, and campers generally spend three to
four hours a day doing some kind of physical activity,
as well other activities like drama or arts and crafts.
There are weekly weigh-ins and regular classes in
nutrition and cooking.
Most camps offer sessions for campers to explore their
feelings about food and weight. But critics worry that
the camps are not run by people who have the
necessary credentials to handle children with serious
emotional baggage, and that the sessions are too short
to change a lifetime of bad habits.
Teresa Guerrero worked at a camp in Southern
California in 2003 and 2004, where she was a
guidance counselor.
"There were a lot of very messed-up kids," said Ms.
Guerrero, 26, who is a doctoral candidate in clinical
and school psychology at Hofstra. "The majority of
them were compulsive overeaters."
"A lot were medicated, or ate out of boredom, or cut
themselves," she said. "A lot had experienced divorce
or the death of a parent. They could trace the weight
gain back to that. It was a big responsibility for the
counselors, none of whom was really equipped to deal
with it."
One of the more promising programs is offered by the
two-year-old Wellspring Camps, which operates
Camp Wellspring, near Lake Placid, N.Y., for young
women ages 14 to 22; Wellspring Adventure Camp
near Asheville, N.C., for boys and girls 11 to 16; and
Western Wellspring Adventure Camp in California,
for boys and girls 13 to 18.
Unlike traditional weight-loss camps, Wellspring uses
a cognitive behavioral approach. Campers set goals
and monitor themselves, techniques that are
components of behavior modification, one of the most
widely accepted approaches to long-term weight-loss
success.
Each camper is responsible for her own eating and
exercise habits. At meals, for example, campers get
"controlled" foods, like measured entrees and dessert,
and "uncontrolled" foods: berries, melons or fat-free
soups. They can eat as much of the uncontrolled foods
as they want, but they have to jot down the calories
and fat grams in a journal, with the goal of staying
under 20 grams of fat and about 1,200 calories a day.
They use pedometers and are told to aim for a
minimum of 10,000 steps a day. The overall goal is to
change eating habits and make new ones.
"Self-control is a process in behavioral terms --
keeping track of target behaviors and systematically
evaluating these behaviors and goal setting," said Dr.
Daniel Kirschenbaum, a professor of psychiatry and
behavioral sciences at Northwestern who helped
design the program, but has no financial involvement
in the camps.
Dr. Kirschenbaum said self-control could be taught
like any other skill through instruction, modeling and
encouragement.
So far, the camps have had encouraging success. A
recent study by Wellspring found that 91 percent of all
its campers had maintained the weight or continued to
lose six months after camp ended; the weight loss
afterward averaged 7.4 pounds. The camps plan to
continue tracking campers' long-term weight loss to
try to persuade health insurers to cover the programs.
Still, those involved agree that the most significant
factor for success is the level of parental involvement
once camp ends. It is not enough for the child to return
home from 30 pounds lighter if the household does not
change as well -- whether that means eliminating junk
foods or encouraging exercise.
"The people who are successful are the parents who go
the extra mile and are observant and watch their kids,"
said Tony Sparber, 48, who has been in the industry
for 25 years.
Although all camps offer lectures for parents on
visiting day, only a few show up, organizers say.
After camp ends, a New Image nutritionist calls
families each month. Every two months they receive a
newsletter with recipes. But Mr. Sparber
acknowledges that most people do not follow through.
"It starts out strong, and as time goes on it fades," he
said. This year, in an effort to reach more people, he is
adding an online counseling program with a
nutritionist, as well as a weight management and
fitness program at the Jewish Community Center in
Tenafly, N.J.
Only about one-third of the campers at Camp
Wellspring and Wellspring Adventure Camp adhered
to its after-care program, which includes keeping a
daily online journal for self-monitoring and setting
goals, and chatting with a behavioral coach by phone
or e-mail.
All of those who followed that regimen, sustained or
continued their weight loss at the three-month mark,
said Ryan Craig, president of Wellspring camps, who
is also director of the Academy of the Sierras, a
boarding school for obese adolescents in Reedley,
Calif.
Lexi Werth Mason attributes her weight-loss success
to two things: her goal of fitting into a two-piece
bathing suit, and her mother. When she first returned
home from camp, her mother had snack bags full of
pre-cut vegetables waiting for her. Every night they
discuss what Lexi can eat. The two shop together, read
labels, prepare menus and cook.
"People don't have time to sit down to home-cooked
meals, and they're so busy they get Big Macs," said
Lexi. "At camp I learned that there's 590 calories in
one, so we don't do that anymore. Now we cook
dinners because I'm conscious of what I'm eating. We
substitute light or fat-free for sour cream. Even if you
do have a cookie every once in a while, it's not that big
of a deal. You work it off."
Lexi's mother said, "My fear was that when she lost all
this weight that she would get so obsessive about it
that it would develop into an eating disorder."
Ms. Werth continued: "From the day she came home, I
said, 'It's not about leaving all this stuff behind.' The
minute you deprive yourself of everything you've
loved and enjoyed, you will end up compulsively
overeating. I was trying to create a balance for her and
proving to her that you could have your cookies every
day but in moderation."
She added, "I signed her right up for Curves, and she
got on her bicycle and rode to the gym and watched
everything she's eating."
Ms. Werth also locks up junk food in a kitchen
cabinet, and only she has the key. Lexi said she found
that helpful.
Most important for Lexi, nothing tastes as great as thin
feels. And that kind of motivation is something that no
diet or weight-loss camp can instill in a person.
"Last winter my friend couldn't pull me on the sled
because I was too heavy, and I was really upset about
it," Lexi said. "This year, I went to his house and he
pulled me, and that was one of the happiest days of my
life."
http://www.nytimes.com/2005/06/28/health/nutrition/f
or-overweight-children-are-fat-camps-a-solution.html
PRELIM 2
Many people want to put their best face
(and body) forward, believing that
appearance is the key to success in life,
love and at work. This realization has led
men and women to undergo cosmetic
surgery (or plastic surgery) procedures.
Yet, despite an estimated rise in people
going under knife to improve their
appearances, cosmetic surgery remains
highly stigmatized and its recipients are
often deemed “fake.” Many believe that
this is caused by the changing cultural
norm in society in which entertainment,
fashion, and media tend to show
particular type of beauty and body.
This house would fund cosmetic plastic surgery.
TH, which is a woman, would not make any
cosmetic changes to her appearance, including but
not limited to makeup, shaving, and plastic
surgeries
THW ban cosmetic/plastic surgery aimed to change
racial features
THW Ban Plastic Surgery
The distinction between cosmetic surgery and other
types of surgery such as reconstructive surgery is that
cosmetic surgery involves techniques intended for the
'enhancement' of appearance. Cosmetic surgery involves
both surgical and medical techniques and it is specifically
concerned with maintaining normal appearance, restoring
it, or enhancing it beyond the average level toward some
aesthetic ideal. Cosmetic procedures have grown in
popularity dramatically, in 2006, nearly 11 million
cosmetic procedures were performed in the United States
alone. The number of cosmetic procedures performed in the
United States has increased over 50 percent since the start
of the century. Nearly 12 million cosmetic procedures were
performed in 2007. In Europe, the second largest market
for cosmetic procedures, cosmetic surgery is a $2.2 billion
business. Cosmetic surgery is now very common in
countries such as the United Kingdom, France, and
Germany. In Asia, cosmetic surgery has become an
accepted practice; currently most widely prevalent and
normal in China where it is currently Asia's biggest
cosmetic surgery market1. Proponents argue that the risks
inherent in surgery that is not medically necessary are too
great and that women are merely succumbing to the
pressures of men. Opponents, in contrast, argue women
have a right to choose both how they look and what
methods they choose to get to how they look. This debate
will examine whether cosmetic surgery should be banned.1
Cosmetic Surgery,(accessed 8/6/2011)
POINTS FOR
Cosmetic surgery can be psychologically damaging.
Point
The compulsion to change one's body is often a
symptom of a deeper mental instability. It should be
treated as a problem, not encouraged with surgery.
Research indicating that breast augmentation patients
are four times more likely to commit suicide compared
to other plastic surgery patients raises questions about
the mental health of women who choose implants1. It's
only a plaster patched over a much deeper problem.
There are also studies that show negative
psychological effects on patients after their surgery
has been completed. For example, a recent analysis 37
studies on patients' psychological and psychosocial
functioning before and after cosmetic surgery by
social worker Roberta Honigman and psychiatrists
Katherine Phillips, MD, and David Castle, MD, found
several predictors of poor outcomes, especially for
those who hold unrealistic expectations or have a
history of depression and anxiety. The researchers
found that patients who are dissatisfied with surgery
may request repeat procedures or experience
depression and adjustment problems, social isolation,
family problems, self-destructive behaviours and
anger towards the surgeon and his or her staff2.
1
American Psychiatric Association. Diagnostic and
Statistical Manual of Mental Disorders (4th ed.).
Arlington, Va: American Psychiatric Association
Press; 2000. available at
http://www.breastimplantinfo.org/what_know/teencos
urgery.html (accessed 11/6/2011)
2
Plastic and Reconstructive Surgery (Vol. 113, No. 4,
pages 1,229-1,237) (accessed 11/6/2011)
Counterpoint
However, the vast majority of people who have
cosmetic surgery have one procedure and never look
back. They're made happier and more secure in
themselves because of it. In fact, the same study by
social worker Roberta Honigman and psychiatrists
Katherine Phillips, MD, and David Castle, MD, also
suggested positive outcomes in some patients,
including improvements in body image and possibly a
boost in their quality of life as well1. Therefore, it
would be wrong to say that cosmetic surgery can be
psychologically damaging as a rule. Many studies
have shown that patients have higher self-esteem after
surgery. For example, in a recent study by Sarwer
found that a year after receiving cosmetic surgery, 87
per cent of patients reported satisfaction following
their surgery, including improvements in their overall
body image and the body feature altered. They also
experienced less negative body image emotions in
social situations2.
1 Plastic and Reconstructive Surgery (Vol. 113, No. 4, pages 1,229-1,237)
(accessed 11/6/2011)
2 Dittman, Melissa,. Plastic Surgery: Beauty or Beast? (accessed 11/6/2011)
The dangers involved in elective surgery are not worth
the risk
Point
Sometimes we must accept those dangers, as they
come in the course of necessary medical procedures.
But with elective surgery– procedures people don’t
need, but rather merely want – the risks can’t be
justified. These risks apply both to the surgery itself,
and to the long term. For example, leaking silicone
breast implants have been a widespread problem and
can lead to death. Silicone gel can leak from the
implant into healthy breast tissue and go other parts of
your body, such as the lungs and lymph nodes, where
it could be impossible to remove. Studies published in
2001 by scientists at the National Cancer Institute
raised questions about the long-term safety of breast
implants. One study found that women who had breast
implants for at least eight years were twice as likely to
die from brain cancer, three times as likely to die from
lung cancer or other respiratory diseases, and four
times as likely to commit suicide, compared to other
plastic surgery patients A second study found that
women with breast implants for at least eight years
were 21% more likely to be diagnosed with cancer
compared to other women their age.[1] There is also
the risk that the person having the surgery will be
dissatisfied with the results.
[1]What you need to know, available at
http://www.breastimplantinfo.org/what_know/having_
problems.html (accessed 15/6/2011)
Counterpoint
The risks of cosmetic surgery are negligible.In actual
fact, the American Society of Plastic Surgery
estimates that there is 1 death in 57,000 procedures,
while a study in the medical journal Plastic and
Reconstructive Surgery put the mortality rate slightly
higher, at about one in 51,459 operations.[1] To put
this in perspective, your chances of being injured in a
motor vehicle accident are about 1 in 1,000 in any
given year and there is about 1 maternal death for
every 7692 live births.[2] Therefore cosmetic surgery
is a lot safer than people perceive. Furthermore,
cosmetic surgery is becoming safer and safer. It is
increasingly strictly policed and sky-high legal pay-
outs by bad surgeons have ensured that practitioners
take more and more care.[3] Technology in surgery
and in implants and so forth is forever improving. For
example, new non-invasive procedures are being
developed such as Liposonix and UltraShape Contour.
These procedures use focused ultrasound devices
which aim to achieve targeted reduction of fat tissue
by focusing ultrasound energy that causes permanent
disruption of fat cells without damage to the
epidermis, dermis or underlying tissues and organs.[4]
Procedures such as this would decrease the risk of
infection.
Cosmetic surgery is unfair, for only those who can
afford it have access to it
Point
Only those that can pay for it get it. The most popular
surgeries include breast augmentation, liposuction,
nasal surgery, eyelid surgery and abdominoplasty.[1]
There surgeries cost between £3,000 and £5000,
between £2,500 and £6,000, between £3,500 and
£4,000 and between £2,000 to £6,000 respectively.[2]
So if it has the advantages the opposition claims, the
rich will look good, and the poor will not.
Counterpoint
You can spend your money how you like. Why
shouldn't people be allowed to make the personal
choice to change their appearance with their own
cash? Furthermore, the appearance division the
proposition seeks to suggest between rich and poor is
much more dependent on quality of diet. Diet is a
universal factor that affects complexion, height, etc.1,
while cosmetic surgery is a relatively insignificant
factor in statistical terms and one that only affects the
particular thing on which surgery is conducted.
1
Physical benefits of a balanced diet (accessed
11/6/2011)
An outright ban would be easier than the partial bans
that have been enacted in some places.
Point
The state of Queensland in Australia has a ban on
teenagers having plastic surgery. This prevents anyone
under 18 having cosmetic surgery unless it is to
correct deformities or disfiguring injuries, as well as
allowing for procedures to improve medical,
psychological or social well-being. This potentially
leaves difficulty drawing the line for what is allowed1.
A much more comprehensive ban would avoid this.
Cosmetic surgery is already to some extent regulated.
In the UK it is regulated by the GMC and practising
surgeons have to be enrolled on its specialist register.
At the same time all invasive cosmetic surgery and
laser treatments are regulated. A healthcare
commission inspects all registered establishments and
can revoke licences. As such it would not be difficult
to expand these regulating bodies to be making sure
that cosmetic surgery is only performed when as in
Queensland it is to correct deformities and disfiguring
injuries.
1 Point
http://abcnews.go.com/Health/BeautySecrets/story?id
=4694079&page=1 ">, Childs, Dan, Australian State
Bans Cosmetic Surgery for Teens, (accessed
25/8/2011)
Counterpoint
The desire for cosmetic surgery is driven not by
external pressure to seek the acceptance of men, but
the internal desire to look and feel better about
oneself. There are many who find that their
appearance truly troubles them and that improving it
would greatly enhance their quality of life. Operation
Smile, which fixes oral and facial deformities found in
poor children across the world, is doing "cosmetic
surgery."[1] You can survive with a hare lip or a cleft
palate. But your quality of life – your self-esteem,
employability, acceptance in a traditional society, etc
– is much better without one. Following this principle,
breast reduction or augmentation or the removal of
acne scars can be just as important. For example,
Carole Wrigglesworth's breasts shrank after
breastfeeding baby girls and as her breasts shrank so
did her self-confidence. As a result she opted to have a
breast enlargement surgery and reflecting on the
experience, Carole has absolutely no regrets — “I feel
sexier, more confident and extremely proud of my
body.[2]
The availability of cosmetic surgery increases pressures
on women that they must look beautiful.
There is considerable evidence that women's
attractiveness is judged more harshly than men's. For
example, in a study by Adams and Huston, 1975,
participants were asked to rate the attractiveness of
photographs of people of varying ages. They found
that although attractiveness ratings of both men and
women declined with age, the rate of decline for
women was greater.[1] Researchers report that
women’s magazines have ten and one-half times more
ads and articles promoting weight loss than men’s
magazines do, and over three-quarters of the covers of
women’s magazines include at least one message
about how to change a woman’s bodily appearance—
by diet, exercise or cosmetic surgery.[2] These views
about appearance are damaging because it leads to
seriously unhealthy lifestyles that women think they
need to look beautiful. For example, in 2003, Teen
magazine reported that 35 per cent of girls 6 to 12
years old have been on at least one diet, and that 50 to
70 per cent of normal weight girls believe they are
overweight.[3] Cosmetic surgery sends the message
that the prejudices some have about appearance are
valid.
POINTS AGAINTS
Banning cosmetic surgery would not prevent it occurring,
better for it to be legal and performed properly
Point
If banned, cosmetic surgery will flourish on a black
market. Of course cosmetic surgery is already
available on the black market but if banned then
potentially all the customers who have legal cosmetic
surgery will become customers for black market
cosmetic surgery. This will drive the prices up and it
will be much more dangerous as it will be done by
unscrupulous doctors and outside all the safety
precautions the legal environment provides. Examples
such as that of 46 year old Maria Olivia Aguirre-
Castillo died as a result of a black market cosmetic
procedure in which cooking oil was injected into her
buttocks by an unlicensed practitioner who promised a
cheap alternative to legitimate procedures. After
spending a week in a coma following the procedure,
Ms. Aguirre-Castillo succumbed to multiple organ
failure due to fat embolization, as the oil injected into
her buttocks attacked her body functions1. Examples
such as this would become much more of a common
occurrence if cosmetic surgery was banned due to the
increase in black market surgeries.
1 The development of cosmetic surgery over the years has
Cosmetic Surgery bargains, (accessed 12/6/2011)
Counterpoint
The black market argument applies to everything
illegal. Of course that risk exists, but the number of
those undertaking the activity will be smaller, as the
opposition suggests by saying that operations will
increase in price. Lack of legal safeguards and medical
accountability, and the probability that only badly
qualified doctors will offer illegal operations will deter
almost everyone from risking black market surgery.
Fewer operations must be desirable if it is agreed that
the activity concerned should be banned. Since
discussing the effects of banning cosmetic surgery is
at the present time a hypothetical task, this argument
will cite the prohibition of drugs as an example. A
2001 Australian study of 18-29 year olds by the NSW
Bureau of Crime Statistics and Research suggests that
prohibition deters illicit drug use. 29% of those who
had never used cannabis cited the illegality of the
substance as their reason for never using the drug,
while 19% of those who had ceased use of cannabis
cited its illegality as their reason1.
1
NSW Bureau of Crime statistics and research, Does
prohibition deter cannabis use?, (accessed 12/6/2011)
been intertwined with that of reconstructive and more
general medical surgery.
Point
Cosmetic surgery has greatly aided reconstructive
surgery. For example, maxillofacial surgery, or
surgery of the jaw, has developed with insights from
both plastic surgeons and oral surgeons. The roots of
oral and maxillofacial surgery lie in the World Wars,
when service personnel sustained devastating facial
injuries1. These grave injuries necessitated new
innovations in reconstructive surgical procedures. It
was around this time that aesthetic surgery began to
take its place as a somewhat more respected aspect of
plastic surgery. This progress also brought with it a
greater understanding of anaesthesia and infection
prevention, allowing surgeons to perform a wider
variety of increasingly complex procedures2. To shut
down cosmetic surgery would be to cut off a valuable
outlet for research and discovery. The market can
sometimes create great benefits: people work hard in
pursuit of profits and often their work can help us all.
Plenty of people make a good living from normal
medicine and they are not criticised, the same should
be true for privately provided medicine: there's
nothing wrong with turning a profit.
Counterpoint
It could however be argued that commercialized
medicine will harm society, yet produce little in the
way of benefits. Non-profit hospitals undertake costly,
but needed, research and maintain services which are
not economically viable but which provide doctors
with the training experiences necessary to medical
education. Where profits rule, however, such
necessary, but unprofitable, research and services
important to medical education will be neglected.
Furthermore, as for-profits come to dominate the
health care sector, society will suffer a severe shortage
of unprofitable, but critical, services, such as
emergency rooms. Meanwhile, scarce resources will
be squandered to produce and aggressively market
lucrative, but unnecessary, services, such as cosmetic
surgery1.
Women have the right and freedom to choose how they
look
Point
The freedom to change their body if they wish is
important to women who have historically been
subjugated by men, their bodies regarded as owned
and for the use of men. Cosmetic surgery– the ultimate
control over one’s body, perhaps – is the latest stage in
the emancipation of women and their ability to decide
what happens to their bodies. The French performance
artist Orlan, for example, sees plastic surgery as a path
towards self-determination – a way for women to
regain control of their bodies. Instead of having her
body rejuvenated or beautiful, she turns the tables and
uses surgery as a medium for a different project.[1]
Orlan designs her body, orchestrates the operations
and makes the final decision about when to stop and
when to go on. She is the creator, not just the creation;
the one who decides and not the passive object of
another's decisions that many people view recipients
of cosmetic surgery to be.[2] Feminists have often
envisioned a future where technology has been seized
for women for their own ends. Take, for example,
Shulamith Firestone's Dialectic of Sex (1970) in which
she fantasies a world in which reproductive
technology frees women from the chores and
constraints of biological motherhood.
Counterpoint
If anything, cosmetic surgery is the latest phenomenon
in the long history of the objectification of women in
society. In actuality this technology is not empowering
because it is largely used by women who are driven to
meet male standards of beauty, exaggerating their
shape and seeking to remain youthful lest their partner
leave them for (often literally) a younger model. A
preference for younger women (which is universally
documented) evolved for men to narrow the range of
productive mates to those still young enough to bear
children1. As women's reproductive capacity drops off
dramatically, so do men's ratings of 'attractiveness' for
her.
1
Goehring, Jennifer, Modern standards of beauty:
Nature or Nurture? An evolutionary perspective
(accessed 11/6/2011)
Given that the reality is that we're judged on our
appearance all the time, it's perfectly rational to want to
look good.
Point
Nobody's forcing anyone to have cosmetic surgery–
the market is driven by demand. Attractiveness is
greatly affects first impressions and later interpersonal
relationships. In a classic study entitled 'What is
Beautiful is good', psychologists Kenneth Dion, Ellen
Berscheid and Elaine Hatfield asked college students
to rate photographs of strangers on a variety of
personal characteristics. Those who were judged to be
attractive were also more likely to be rated intelligent,
kind, happy, flexible, interesting, confident, friendly,
modest, and successful than those judged unattractive
[1]. Teachers rate attractive children more highly on a
variety of positive characteristics including IQ and
sociability, and attractive babies are cuddled and
kissed more often than unattractive babies[2].
Counterpoint
On the other hand, it could be argued that instead of
giving into this reality we should be fighting against
the culture of unrealistic beauty ideals. Allen
Ginsburg, a radical writer of the 1960s, said,
"Whoever controls the media- the images- controls the
culture"1. The media constantly conveys unrealistic
images of the ideal female body. Every woman has a
unique build and make-up, yet the media always tries
to perpetuate what they believe the universal standard
of women should be2. These convince an individual
that something is terribly wrong with his physical
appearance and that it needs to be mended. The
growth in cosmetic surgery enhances people's
perception that there is something wrong with their
body if they don't conform to the ideal beautiful form.
It could also be argued that the lengths that women go
to to try and look good are indeed not rational.
Cosmetic surgery with its high cost and risks certainly
does not seem like a rational option3.
Surgery is always a risk.
In 2013, Americans spent more than $7 billon on cosmetic
surgery. From breast augmentation to rhinoplasty,
procedures to change our appearance are becoming
increasingly common. But these surgeries don’t come
without risks.
. If you’re thinking about plastic surgery, it is important
you are aware of both the benefits and the risks. Here are
some of the most common and most talked about cosmetic
surgery complications.
1. Hematoma
Hematoma is a pocket of blood that resembles a large,
painful bruise. It occurs in 1-6 percent of breast
augmentation procedures and is the most common
complication after a facelift. Hematoma is a risk in nearly
all surgeries, and treatment sometimes includes additional
operations to drain the blood.
2. Nerve Damage
The potential for nerve damage is present in many different
types of surgical procedures. Numbness and tingling are
common after plastic surgery and can be signs of nerve
damage. Most women experience a change in sensitivity
following breast augmentation surgery and 15 percent
permanently lose nipple sensation.
3. Infection
Though postoperative care includes steps to reduce the risk
of infection, it remains one of the more common
complications of plastic surgery. In breast surgeries, for
instance, cellulitis (a skin infection) occurs in 2-4 percent
of people. In some cases, infections can be internal and
severe, requiring IV antibiotics.
4. Deep Vein Thrombosis and Pulmonary Embolism
Deep vein thrombosis (DVT) is a condition where blood
clots form in deep veins, usually in the leg. When these
clots break off and travel to the lungs, it’s known as
pulmonary embolism (PE). Though relatively uncommon,
these complications can be fatal.
5. Scarring
Surgery typically results in some scarring. Since cosmetic
surgery seeks to improve the way you look, scars can be
particularly troubling. Hypertrophic scarring, for instance,
is an abnormally red and thick raised scar that occurs after
2-5 percent of breast augmentation procedures.
6. General Appearance Dissatisfaction
Although most people are satisfied with their postoperative
outcomes, disappointment with the results is a real
possibility. People who undergo breast surgery may
experience contouring or asymmetry problems, while those
undergoing facial surgeries could simply not like the result.
7. Organ Damage
Liposuction can be traumatic for internal organs. Visceral
perforations or punctures can occur when the surgical probe
comes into contact with internal organs. Repairing these
injuries can require additional surgery. The perforations
may also be fatal.
8. Anesthesia Complications
Anesthesia is the practice that allows patients to undergo
surgery without feeling the procedure. General anesthesia,
where medication is used to make you unconscious, can
sometimes lead to complications. These include lung
infections, stroke, heart attacks, and death. More common
anesthesia risks include waking up confused and
disoriented, and shivering. A less common complication is
anesthesia awareness, or waking up in the middle of
surgery.
9. Seroma
Seroma is a condition that occurs when serum from your
blood pools beneath the surface of the skin, resulting in
swelling and pain. It looks like a large blister. This can
occur after any surgery, and is the most common
complication of a tummy tuck. Because seromas can
become infected, they are often drained with a needle,
effectively removing them, although there is a chance of
recurrance.
10. Blood Loss
As with any surgery, some blood loss is expected.
However, uncontrolled blood loss can lead to a drop in
blood pressure with potentially deadly outcomes. Blood
loss can happen while on the operating table, but also
internally, after surgery.
The Takeaway
As with most surgeries, plastic surgery complications are
more common in certain people. For instance, people who
are obese and the elderly are more prone to complications.
You can reduce your risk of suffering these unwanted
effects by fully vetting your doctor’s credentials and
investigating the facility where your surgery will happen.
Educating yourself about the procedure and possible risks,
and discussing your concerns with your doctor will also
help you manage your expectations and reduce the risk of
complications.
RISKS WILL BE RARE IF …
When cosmetic surgical procedures are performed by
properly trained surgical specialists adhering to accepted
standards of clinical practice, serious complications are
extremely rare. However, no surgery is completely without
risk. Patient safety is always the most important
consideration in cosmetic plastic surgery, and a number of
factors contribute to increased safety. The American
Society for Aesthetic Plastic Surgery (ASAPS), the leading
organization of plastic surgeons who are certified by the
American Board of Plastic Surgery and who specialize in
cosmetic surgery, offers these safety guidelines for anyone
considering cosmetic surgery.
Credentials: Selected surgeons should be certified by the
American Board of Plastic Surgery (ABPS). Any doctor
(even one from a nonsurgical specialty) can legally perform
surgery. On the other hand, certification by the ABPS
ensures at least five years of surgical training, including
two years of training specifically in plastic surgery. Patients
undergoing a cosmetic procedure should select a member
of the American Society for Aesthetic Plastic Surgery
(ASAPS) to help ensure that their surgeon has extensive
cosmetic surgical experience and has met ASAPS
requirements for continuing cosmetic surgery education.
Hospital privileges: Cosmetic plastic surgery is often
performed outside the hospital in an office-based surgical
facility. Wherever the surgery is to be performed, selected
surgeons should have hospital privileges to perform the
specific procedure in an acute care hospital.
Facilities: Published data show that accredited office-based
facilities have a safety record comparable to that of hospital
ambulatory surgery settings. Ambulatory or office-based
facilities should be accredited by a nationally or state-
recognized accrediting agency, or be state licensed or
Medicare certified.
Health: Candidates for cosmetic surgery should be in
generally good physical health and must be candid with
their physician about any drugs they are taking. The
medical history should include hormones (oral
contraceptives and estrogen replacement) and even aspirin,
vitamins, and herbal medications since these substances can
interfere with blood clotting or interact with medications
used during surgery and could increase surgical risk.
Patient education: Before surgery, patients should be
educated about all aspects of the planned surgery, including
whether to discontinue certain medications and stop
smoking. Postoperative care should be thoroughly
discussed with the surgeon, as surgery is not truly over
until the patient is ambulatory and has returned to a
relatively normal routine.
Risks: Most cosmetic surgery is extremely safe in the
hands of surgeons certified by the American Board of
Plastic Surgery. However, even with the highest level of
care, every surgery carries risks as well as benefits, and
these should be discussed thoroughly before surgery is
undertaken. For example, multiple procedures performed at
the same time may increase the risks of surgery. There are
risks associated with anesthesia, analgesics and antibiotics.
Smokers are at greater risk of complications including
delayed wound healing, skin loss, scarring, and poor
surgical outcome Other risks include deep vein thrombosis
(DVT) [formulation of blood clots in the veins] and
pulmonary embolism (PE) [a blood clot that goes to the
lungs preventing the lungs from exchanging air]. Factors
such as general anesthesia and prolonged operating time
appear to increase the risk of DVT. Both DVT and PE are
unpredictable and can occur outside the surgical setting, as
the result of certain medical conditions or from
immobilization; for example, individuals have developed
DVT following long airplane trips.
Postoperative monitoring and home care: In the
immediate postoperative period, any patient undergoing
cosmetic surgery should be monitored by qualified medical
personnel and discharged from the surgical facility only
after evaluation by the surgeon. Usually, cosmetic surgery
is performed as an outpatient procedure; occasionally, the
surgeon may recommend an overnight stay. Patients should
arrange to have someone available for assistance for the
first day or two following surgery.
BENEFITS
Cosmetic surgery or plastic surgery is gaining popularity
fast due to its so many benefits and advantages. There is no
doubt about it that what make this kind of procedure
popular are its benefits, safer approach to correct many
deformities of the body, and faster results.
Facelifts, breast augmentation, liposuction, etc, are among
the type of cosmetic surgeries that are widely been
performed globally, especially in countries where people
can afford higher medical treatment cost. While cosmetic
surgery generously offers its help to correct many
deformities of the body, it doesn’t come cheaply. This is
something that makes many people just keep planning their
budget to undergo such a surgery.
Benefits of cosmetic surgery can be divided into two,
physical and emotional. Physical benefits are, obviously,
re-shaping or correcting a deformed part of the body. You
can notice, soon after the surgery, how you get back the
desired or normal shape of a deformed body part, say ear,
nose, breast, etc. You don’t have to wait long to see the
result, this is the beauty of cosmetic surgery. When a
woman undergoes a breast augmentation surgery, she can
soon notice her cup size change, which definitely improves
her body shape and makes her more attractive. The same
goes with Rhinoplasty or other cosmetic surgery
procedures, as once the procedure is completed, get the
results immediately.
Benefits of cosmetic surgery or plastic surgery from the
emotional angle have their own significance. It is quite
obvious that once you find your deformed body part has
been brought to its normal shape, or has been made more
attractive (as it is the case in breast enhancement in
women), you start to feel the lost confidence and self-
esteem coming back and you soon start to behave
differently. Actually, emotional benefits of cosmetic
surgery are more important than the physical. If you feel
good and different from ‘inside’, the whole world seems to
change around you. The joy, the confidence, and the self-
esteem, all such plus points very positively affect your
behavior and the pattern of life in general.
Emotional wellness plays an important role in our life. If
you are confident, with self-esteem, and feeling good about
yourself, the rewards are numerous. This very positively
influences your whole life, which increases productivity
and social behavior. This is the most encouraging benefit of
cosmetic surgery that many people fail to realize until they
experience themselves.
As other benefits of cosmetic surgery, you can get rid of
aging signs, a natural process through which everyone has
to pass. You can get rid of the visible wrinkles, fine lines,
blemishes, etc from your face or from other visible parts of
the body. Many such skin flaws make you appear
unsightly, tired or aged. After undergoing the relevant
cosmetic treatment, your appearance will become younger,
healthier and fresh.
Benefits of cosmetic surgery or cosmetic treatments are
many but to avail them and also to avoid any undesirable
results or complications, you have to find a surgeon who
has enough experience, certification and skill to do such
jobs. Cosmetic surgery or cosmetic treatment done
improperly usually results so negatively that makes the
condition still worse. Some people try to save few dollars
and neglect the criteria of selecting the right surgeon, suffer
heavily.
Moreover, in order to avail the benefits of cosmetic
treatments, the patient has another responsibility, to
follow the post treatment instructions seriously. It is
essential for you to seriously follow what you would be
told to do after the surgery or after a cosmetic treatment.
Taking care of such steps is a sure way to avail the
numerous benefits of cosmetic surgery.
PRELIM 3
Teenagers are already under a great
uncontrollable pressure due to the new
hormones flowing through their bodies.
Although many believe intercourse
should be avoided until finding a
significant other bound for life by
marriage, it is still important for
adolescents to be informed about this
new experience. Sex Education is a
very important part of maturing from a
teenager to an adult. Its medium varies
from off line teaching to on line
interaction.
THBT SCHOOLS SHOULD TEACH SEX
POSITIVE SEX EDUCATION (IE TECHNIQUES
FOR SEXUAL GRATIFICATION) IN
SECONDARY SCHOOLS.
THBT Sex Education Should Be Taught At Schools
Sex education has been taught in schools in a range of
countries around the world for nearly a century in
various forms[1] it has become a fixture in schools in
most Western countries. The specifics of the education
program vary between countries, but they all generally
deal with the basics of reproduction, physiological
development, sexual health, practice, and safety. In
recent decades many countries, such as Germany since
1992 and Sweden as far back as 1956, have made sex
education a mandatory part of schooling, a policy that
has been met with extensive criticism, particularly
from religious groups. Their criticism is that sex
education is permissive toward young people’s sexual
relationships and thus morally corrosive.
Opposition also derives from an objection to an
extension of the state’s involvement into the family
and questions of sexuality.[2] In developing countries
sex education schemes have developed in part at least
to attempt to stem the HIV/AIDS epidemic,
Although some religious groups have opposed these
developments. In western nations however
sex education is not always mandatory, in England
and Wales for example parents can refuse to let their
children take part in some although not in all lessons
which provide information about sex and
reproduction.[3] Proponents of mandatory sex
education highlight the benefits it provides in delaying
the age of first intercourse, preventing sexually
transmitted disease and teenage pregnancy and in
providing useful information for life regarding
sexuality and sexual expression. Opponents contend
that sex education encourage early sexual relationships
and the risks which attend that and should be the
purview of parents, and that forcing it to be provided
in schools undermines trust in the education system
and harms the individuals’ relationship with the state
Points for
Sex education provides “Immunization” against
sexually transmitted diseases and prevents
unwanted pregnancy
Point
It was said at the beginning of the HIV/AIDS
epidemic that the only vaccination against the virus
was knowledge. Knowledge about what is out there is
essential to guarding the self. There are a several of
ways in which this knowledge is essential; finding out
about the risks of sex is just one, having accurate
information about the pleasures as well as the risks is
another.[1] Knowledge also prevents misinformation.
Young people must be informed about sex, how it
works and what the risks associated with it are, and
how to access the risks and the pleasures. When sex is
not talked about and kept behind closed doors, young
people are forced often to grope around in the dark, so
to speak. This can result in unwanted pregnancies, and
even STDs, some of which can be permanent, a threat
to fertility or even life threatening. IT leaves young
people confused.[2] The state thus owes an obligation
to its citizens to prepare them adequately for their
interactions in society, including those of a sexual
nature.
A mandatory sex education regime serves as a defence
against misinformation about sex. Religious
organizations, most notably in the United States,
promote abstinence by lying about the effectiveness of
contraception and about the transmission of STDs.[3]
When such activity is not countered by a scientific
explanation of sex and sexual practices a culture of
ignorance develops that can have serious negative
social and health effects on those who are
misinformed. An example of the benefits of sex
education is highlighted in the case of the United
States. In primarily liberal states where sex education
is mandatory, young people are statistically more
likely to be sexually active. At the same time in states
where sex education is banned or deliberately
misleading, teen pregnancy rates are much higher.[4]
Clearly the trade-off between high promiscuity rates
on the one hand and much higher rates of teen
pregnancy and STDs on the other stands in the favour
of sex education.
Young people live now in a society which is very
sexualised[5] it has been described as a carnal jungle.
Adults need to offer guidance about negotiating a way
through the messages about sex which proliferate in
the mass media and consumer culture.[6] Underlying
this discussion is controversy about what sex
education should be. Sex education has become a
shorthand term for the broader subject of personal
relationships , sexual health and education about
sexuality[7] it is clear that views about what sex
education should be and what it should contain has
changed significantly over time.[8]
High quality sex education should not only contain
factual information about the physiological issues of
sexual development and reproduction. It should also
offer safe spaces for young people to consider the
social and emotional aspects of sexuality and the
social and peer pressures that arise in youth cultures.
Counterpoint
Sex education is not necessary to protect children from
disease and unwanted pregnancy. Young people can
be informed of the dangers of sex without sex
education. Besides, if enough people are versed
extensively in sex education they should provide
sufficient herd immunity that the minority who object
on ethical grounds can abstain from sex education
without negatively effecting the overall amount of safe
sexual practices in a society.
A safe framework for understanding sexuality and
sexual identity are essential to human existence
Point
Sex and sexual identity is fundamental part of human
life. Sexual desire, for both procreation and recreation,
forms one of the core human drives that shapes
behaviour.[1] Young people want to explore their own,
and one another’s, bodies from quite an early age,
long before they would be likely to settle down and
get married. Sex for almost everyone in Western
countries is not something exclusive to marriage, and
most people have multiple sexual partners in their
lifetimes. In order to face this reality, young people
must be armed with the knowledge of what sexual
intercourse entails and the pleasures and the risks
inherent in it.[2] Sexual identity itself can be very
confusing, especially for young homosexual or
transgender people who may not understand their
sexuality. A safe, objective environment in which the
objective physical facts and the emotional aspects of
sexual involvement and activity is provided is
essential to facilitate young people to come to grips
with sexual identity as it is essential for full
development as a person.
Counterpoint
Sexual identity is confusing in any situation. It
becomes even more confusing when one is exposed to
sex education and the broad spectrum of sexual
preference and practice before one is emotionally
equipped to understand and appreciate it.
Understanding one’s sexual identity is an exploration
that must be pursued at one’s own pace, not at the rate
mandated from the state or school. Children mature
physically and emotionally at very different rates and
mandatory sex education which offers the information
and the emotional guidance at the same rate to
everyone is not well tailored to the different
development rates.[1]
Parents cannot be guaranteed to provide a suitable
amount of sex education
Point
Parents have a great deal of responsibility in raising
children, but they are unsuited to teaching about
sexuality as the resulting education will not be
consistent, be biased and in some cases may not be
carried out at all. Parents tend to view their children as
less sexualized; they want them to be innocent. Thus it
is often the case that parents seek to shield their
children from the realities of sex, and themselves from
the young person’s developing sexuality maintaining
their innocence through enforced ignorance. This
tends to be particularly harmful to young women, as
culturally boys are often expected to be more sexually
active than girls, and such activity is usually
considered appropriate for boys, while not so for girls.
A double standard undoubtedly continues to exist.[1] It
is in the interest of the state, however, to produce well-
rounded individuals who can interact with society
effectively on all levels, including the sexual level.
When parents do not provide adequate sex education,
it is the state that is forced to pick up the tab to pay for
STD treatment and teen mothers. People dropping out
of school due to pregnancy, and individuals who are
unable to work due to debilitating venereal disease
impose a steep cost on society. It is thus the state’s
duty to provide what parents often cannot for the sake
of society as a whole.[2]
Leaving sex education in the hands of parents has the
further negative impact of normalizing incorrect or
bigoted views regarding sexuality. Homophobic
families, for example, will not be able to provide the
necessary information to homosexual children, who
will suffer not only from lack of education, but also
from a lack of sexual self-worth.[3] Mandatory sex
education can right the wrongs of such misinformation
and bias.
Counterpoint
Parents know their children better than anyone. They
know what s/he is like, and in what environment s/he
will grow up and often live. The state is not infallible
and its decisions are not purely objective. When
children are not adequately mature for sex education,
parents must have the ability to make the decision on
their behalf to withhold information that could be
potentially damaging to their future development. As
to homophobic or bigoted families, such views are
considered to be socially acceptable insofar as people
have the right to express such views. This does not,
however, give parents license to abuse their children if
they have alternative sexual preferences. Sex
education is not necessary to ensure against abuse, that
is the purview of law enforcement.
Even religious and conservative communities will
benefit from mandatory sex education
Point
Communities and organizations that oppose sex
education can actually benefit from it. Unfortunately
this is often not appreciated by the communities
involved. One argument is that shielding children from
knowledge of sex and sexual practice is disrespectful
to religion. Religious and moral abstinence is defined
by the decision not to have sex, not by the absence of
knowledge of the existence of sex itself. Sex education
can even be beneficial to understanding the religious
and ethical perspective toward sexuality when it
provides necessary discussion of the emotional aspects
of sexuality.[1] Information simply allows people to
make fuller, informed decisions.[2] Sex education does
not serve to normalize sexual activity and lewd
behavior, as religious groups fear, because everything
in life is already sexualized. One need only watch a
typical perfume ad on television to know that sexuality
inculcates popular culture already. Sex education
would not lift the scales from the eyes of children
entirely; they already have some idea of what is going
on. The danger is when they know something about
sex, but not enough to be safe. That is why mandatory
sex education is essential to people’s wellbeing.
The research evidence from across the world is clear
that sex education holds back the age of first
intercourse and most certainly does not foster early
promiscuity.[3] The abstinence programmes that have
been developed in the united states in particular have
been spectacularly unsuccessful in reducing rates of
sexual exploration and STD and unwanted pregnancy
rates.[4] Research has made it clear which kinds of sex
education are most effective.[5]
Counterpoint
Sex education does not benefit conservative
communities as sex education is not simply a provider
of information. Rather, it entails at best an
acknowledgement that kids will have sex regardless of
what they are told, and at worst a positive
endorsement of sexual activity. It is a shameful
abrogation of responsibility on the part of adults to
essentially allow children to make bad decisions. Sex
education encourages students to make a choice,
meaning more will make the wrong one.[1] Teaching
children about sex will necessarily make them more
prone to experimentation, and will likely cause them
to view their peers in school in a sexualized context,
leading to less focus in the classroom on study, and
more on sex. Conservative and religious households
have every reason to fear such developments.
Against for
Parents should have the final choice in sex education
for their children
Point
Parents are the ones who are responsible for their
children and they know what is best for their own.
Parents are the people who best know their children;
they live with them, feed them, understand them, and
know how and when is best to broach the topic of sex
with their children. Parents are in a very real way the
shapers of children’s psyche and development, so their
input on a central moral and physical issue such as this
must be respected. It is a myth that somehow parents
lacks the capacity to deal with an issue like sex.
Rather, they are the best suited to it. The fact is that
children generally listen to their parents, or at least
consider seriously what they are told by them.
Furthermore, parents are more capable than teachers,
in light of their intimate relationship with their
children, to discuss the emotional aspects of sex and
relationships, topics that would become jokes in the
classroom and the subject of ribald humour.[1] It is
better to leave sex education in the hands of parents
who can apply the delicate touch.
Counterpoint
Parents do not always know best, particularly when it
comes to sex education. Parents cannot be trusted to
instruct children effectively in sex education because
they themselves are often uneducated in the matter and
have personal biases regarding the subject.[1] Often
they will not understand the finer points of
contraception and STDs, things that have each
changed substantially in the past few decades, with
things like the morning after pill becoming readily
available in many countries, and diseases like
Chlamydia much more prevalent in populations than
they were in past generations.[2] Parents’ ignorance
may thus misinform children to their detriment. The
parent may not understand their child best preventing
their children from ever developing a meaningful
understanding of their sexuality. Such is the problem
for gay children raised in homes that say being gay is
sinful and unnatural.[3] With the only authority figure
on the subject he knows telling him he is defective, a
gay child is left to suffer and wallow in self-loathing.
Sex education damages the education system
Point
Sex education damages the education system by
confusing the children and by alienating some parents.
When children receive mixed signals from home and
at school they can suffer real confusion. When parents
tell their children that the teacher is wrong about sex,
it causes the student to raise his mental defences
toward the school thereafter and become less engaged
in the process of education.[1] Children will be told by
their parents, and will thus come to believe, that the
school is promoting a liberal view that is
fundamentally contrary to their own. For example, a
Muslim girl will find schooling a horrific and
alienating experience if she is forced to attend a sex
education class that conflicts with her faith as this will
be clashing with what she has been taught at home.
This will alienate the parents of these children who
hold the view that discussion of sex in such a
framework is morally repugnant.
[1]
Pogany, Sex Smart, 1998
Counterpoint
A disagreement over sex education will not alienate
someone, whether child or parent, from the entire
education system. Students can differentiate between
contentious aspects of education like sex education
and the general education over which parents,
teachers, and state do not disagree. Both parents and
teachers will be able to explain the reasons for the
difference in teaching in cases where the student is
taught different things at home and in school. Saying
that just because one issue is contentious all of
education is ruined is merely alarmist.
Sexual development is a process of gradual discovery
and cannot be effectively taught in a classroom
Point
Having a one size fits all sex education system cannot
effectively deal differences within classes. Sexual
experience is a gradual process and cannot be
meaningfully taught in the structured environment of
the classroom. People must discover much about their
own sexuality, through experimentation and self-
exploration. By trying to impose a strict curriculum
that explains sexual processes and practices along set
guidelines, much of the opportunity for self-discovery
is lost. Furthermore, when people are forced to
conform to the set sex education program, they cannot
move at their own pace. This is particularly harmful to
people who are physically or emotionally less mature
than their fellow students and who would be better
served if they were allowed to pursue sexual
knowledge at their own pace. When other students are
involved in the classroom, there is necessarily a
degree of peer pressure, which places a further strain
on the later bloomers of the class to conform and
experiment sexually before they are ready.[1] Another
example is the case of gay and gender dimorphic
students who will be left isolated within the class,
even singled out as different, in a way that may not be
conducive toward the promotion of understanding and
acceptance. Teachers cannot cater their lessons to
every single student, and thus students with less
conventional sexual preferences and identities are left
without meaningful engagement in the classroom.
[1]
Pogany, Sex Smart, 1998
Counterpoint
While certainly there should always be room for self-
exploration in sexuality, a set mandatory curriculum is
essential to understanding the basics of sex and
offering opportunity to consider the emotional and
social aspects of it in the cultures of young people.[1] It
is unfortunate that some students may feel unprepared
to undergo sex education, but the value of the
information outweighs any potential discomfort.
Certainly there is nothing so scarring about the nature
of sex that someone who is a bit immature cannot
handle with some effort. We need also to have some
confidence in the abilities and sensitivities of our
teaching professionals to be able to respond with
effective sensitivity to the different needs of their
students in the classroom situation. This means that
we need properly trained teachers to be delivering sex
education and teachers themselves have asked for this
to be the case.
The research evidence does make it clear that young
people are at varying stages of maturity when they are
at the same chronological age. Young men may lag
behind young women and act with considerable
immaturity in sex education lessons.[2] The effective
answer to this may be to offer single sex lessons in sex
education rather than removing the opportunity for sex
education from all young people.
The state has had no historical role in sex education
to no ill effect, so should it develop one now.
Point
Sexuality should not be within the purview of the
state. The state maintains order and security and
provides essential services. Sex education does not fall
within its responsibility. Sexuality is for many people
deeply personal and should be respected as such;
young people should be allowed to explore their
sexuality independently and with the guidance of
family, not under the watching eye of the state.[1] Sex
education programs reduce sexuality to biology and
fail to adequately address the emotional elements of
sexuality in a way that is not seen as a joke by often-
immature students. Inevitably teachers’ personal
opinions on sexuality will bleed into their teaching, as
will that of the state officials that set the teaching
standards for the subject. In this way there is always a
normative judgment in sex education that will be seen
as the state mandating certain sexual behaviour and
practice. This fundamentally attacks the rights of
individuals to develop their mode of sexual expression
independent of the nanny state’s instruction and can
irrevocably harm peoples’ sexual identity.
[1]
Lord, Condom Nation, 2009
Counterpoint
This argument is based on a particular view of the
state and its role in society.it is a view of the state
which is particularly innocent of and which fails to
acknowledge the range of cultural messages relating to
society and sexuality[1] which are broadcast
hegemonically although not entirely openly by the
state.[2] The state does have a role in sex education. It
has taken an ever more holistic view of young citizens,
and this is reflected in schools whose remit stretches
not just to the academic education of students, but to
the preparation of young people for the full spectrum
of activities and responsibilities they will face in adult
life. Sexual interaction is a fundamental part of that
life. Schools have evolved far beyond the provision of
skill in reading, writing, and arithmetic, and this
should be reflected in such programs as sex education.
The state does not in mandating sex education make
any normative judgment regarding sexual practices,
but rather provides the necessary information and the
space to consider the emotional and social issues
involved to make informed choices about sex.
[1]
Plummer, Sexual Cultures, Communities, Values
and Intimacy, 1996
[2]
Foucault, Studies in governmentality, 1979.
Throughgood, Sex Education as Social Control, 1992
Should Sex Education Be
Taught in Schools?
By Peter DeWitt on June 4, 2015 6:52 AM
Thinking about sex education conjures up all of those
uncomfortable moments as an adolescent when we
had to sit at our desks and listen to our health teachers
talk about things that we joked about with friends but
never wanted to have a conversation about with adults.
But things have changed a lot since then.
There has been an increase in the number of LGBT
students who have come out while in high school, or
sometimes, even middle school. We are surrounded
images that inspire conversations about sex education
and other images created by fashion that offer so much
skin that there is nothing left to the imagination.
AVERT defines Sex Education as
"the process of acquiring information and forming
attitudes and beliefs about sex, sexual identity,
relationships and intimacy. Sex education is also
about developing young people's skills so that they
make informed choices about their behaviour, and feel
confident and competent about acting on these
choices."
First and foremost, there is a debate between the use
of sexual education programs, where they openly
teach about sex and prevention, and abstinence-only
programs, which Advocates for Youth say,
1. "has as its exclusive purpose teaching the
social, psychological, and health gains to be
realized by abstaining from sexual activity;
2. teaches abstinence from sexual activity outside
of marriage is the expected standard for all
school-age children;
3. teaches that abstinence from sexual activity is
the only certain way to avoid out-of-wedlock
pregnancy, sexually transmitted diseases, and
other associated health problems;
4. teaches that a mutually faithful monogamous
relationship in the context of marriage is the
expected standard of sexual activity;
5. teaches that sexual activity outside the context
of marriage is likely to have harmful
psychological and physical side effects;
6. teaches that bearing children out-of-wedlock is
likely to have harmful consequences for the
child, the child's parents, and society;
7. teaches young people how to reject sexual education (20 of which mandate sex
advances and how alcohol and drug use education and HIV education).
increase vulnerability to sexual advances, and  33 states and the District of Columbia
8. teaches the importance of attaining self- require students receive instruction
sufficiency before engaging in sexual activity." about HIV/AIDS.
 19 states require that if provided, sex
Advocates for Youth also believe, education must be medically,
factually or technically accurate. State
"Accurate, balanced sex education - including definitions of "medically accurate"
information about contraception and condoms - is a vary, from requiring that the
basic human right of youth. Such education helps department of health review curriculum
young people to reduce their risk of potentially for accuracy, to mandating
negative outcomes, such as unwanted pregnancies and that curriculum be based on
sexually transmitted infections (STIs). Such education information from "published
can also help youth to enhance the quality of their authorities upon which medical
relationships and to develop decision-making skills professionals rely."
that will prove invaluable over life. This basic human
right is also a core public health principle that Many states define parents' rights concerning sexual
receives strong endorsement from mainstream medical education:
associations, public health and educational
organizations, and - most important - parents."  37 states and the District of Columbia
require school districts to allow
But is it the job of teachers in schools to educate parental involvement in sexual
students about sex or is it the job of the parents? education programs.
According to the National Conference of State  Three states require parental consent
Legislatures, before a child can receive instruction.
 35 states and the District of Columbia
All states are somehow involved in sex education for allow parents to opt-out on behalf of
public schoolchildren. their children.
As of Jan. 1, 2015:
Of course, if it's taught in schools, how properly are
 22 states and the District of Columbia the students being educated? This debate between
require public schools teach sex whether it's the school's job or a parent's job will last
for a very long time, and quite frankly it is an area that
many parents and teachers may agree. There are
parents who do not want their children to be taught sex
education in schools, just as there are some teachers
who don't think it is their job to teach it.
On the other side are parents and teachers who agree it
should be taught in schools and at home because it is a
topic that we all cannot escape. And I'm sure there are
a bunch of people in the middle who do not even want
to discuss the topic at all and just hope for the best.
NPR
The NPR story, called Beyond The Birds And The
Bees: Surviving Sex Ed Today (which can be heard
here) inspired me to think about all of the places that
the topic of sex comes up in conversation. Sometimes
it's through jokes on television or social media, other
times it's in stories on the news, and most times it's the
center of the conversation on the back of a school bus.
Whether it makes us uncomfortable or not, we can't
seem to escape the topic.
In the NPR story, Lena Solow, a teacher of ten years,
"Covers the topics you'd expect: how to prevent STDs,
pregnancy. But Solow talks about way more than
going all the way. "One of my biggest goals as a sex
educator is to be sex-positive," she explains, "to talk
about pleasure and to talk about sex not just as
something that just makes babies."
Listening to the story made me blush a little as I drove
alone in my car through Massachusetts, and made me
laugh a bit when Solow said that when she was a
student her sex education class was taught by the
physical education teacher and revolved around
spelling tests.
Yes, spelling tests. She said,
"I definitely had spelling tests as a big part of my sex-
ed when I was in middle school: 'Spell gonorrhea.
Spell gonococcus. Now you pass or don't pass health.'
Literally, that was what was prioritized."
She wants her students to have a much more
knowledgeable experience, and she also explores
topics that are unfortunately still controversial in
today's schools, which is the topic of LGBT students.
In the NPR story, Garsd writes,
"Beyond the basics, Solow is delving into topics that
many teachers would skirt. Things like tolerance.
Solow recently asked her students if they thought
LGBT people would feel comfortable at the school. A
lot of the kids say they didn't think so."
It's definitely a complicated debate, which will last for
a very long time. What are your thoughts?
THW INCLUDE SAFE SEX IN THE SCHOOL
SEXS’ EDUCATION
This House Would Promote Safe Sex through Education at
Schools
This discussion starts from the point of view that
sexual education classes should be given at schools.
But does this mean that so-called “safe sex” should
also be promoted within these lessons? Safe sex is the
practice of sexual activity in a manner that reduces the
risk of infection with sexually transmitted diseases
(STDs) such as Chlamydia and HIV/AIDS, typically
by use of condoms. Safe sex also includes sexual
practices that do not involve penetration.
Traditionally sexual education lessons have focused
on covering the biological facts about human
reproduction, and warnings against unsafe sexual
practices. Often today sex education is combined with
relationships education, in an attempt to place sex in a
broader emotional, social and family context. But now
every day more and more people talk about “safe sex”
and how teenagers should be more informed about
protection against STDs.
Despite the worries some people have about whether
sex should ever be seen as entirely risk-free, every day
this so-called "safe sex" is promoted more and more as
a solution for the epidemic of sexually transmitted
diseases amongst teenagers. But what if the promotion
of "safe sex" has the opposite effect for which it was
introduced in Sexual Education classes? In 2011 the
proportion of British 16-19 year olds who had had
unprotected sex rose to 26% and 45% did not consider
themselves to be well informed about
contraception.[1] Opponents argue that today sexual
education and promoting safe sex are mostly
considered the same thing, while it isn't and shouldn't
be. They say it is one thing to inform teenagers about
sex and its risks, and quite another to promote and
encourage them to use "safe sex" as prevention.
Other issues include whether parents should have the
ability to ‘opt-out’ of sex education for their children –
or indeed whether the children themselves should be
able to opt-out; whether or not sex education should
be done with a particular focus (such as promotion of
abstinence); and whether or not faith schools should
be compelled to teach elements of a sex-education
syllabus (such as on homosexual relationships) which
run contrary to their beliefs.
[1]The Guardian. ‘More young people having unsafe
sex.’ 26th September 2011.
http://www.guardian.co.uk/education/2011/sep/26/you
ng-people-unsafe-sex-contraception
POINTS AGAINTS
Sex education leads to experimentation and early
intercourse, and indirectly encourages promiscuity
Point
Sex education leads to experimentation and early
intercourse, and indirectly encourages promiscuity.
The most moral form of Sex Education says ‘you
shouldn’t do this, but we know you are,’ thus pushing
children to consider their sexual existence before they
need to or indeed should. Thus sex education’s
message is invariably confused – on the one hand, by
saying ‘here are the perils of teen sex – so don’t do it,’
and on the other hand, ‘here is how to have teen sex
safely.’
Less moral forms start by saying, ‘the best form of a
relationship is a loving, constant relationship’ and then
say, here are the ways to use protection if you’re not in
such a relationship’ – a logic which presumes children
are in sexual relationships to begin with. The
justification for this is that ‘adolescents know all about
sex’ – an idea pushed in our permissive society so
much it’s almost a truism – but contrary to that bland
generalisation, many children don’t do these things
early, don’t think about these things – they actually
have childhoods, and these lessons stir up confusion,
misplaced embarrassment or even shame at slower
development. They also encourage children to view
their peers in a sexualised context.
The openness with which education tells students to
treat sex encourages them to ask one another the most
personal questions (have you lost your virginity? –
how embarrassing, how uncool, to have to say no),
and to transgress personal boundaries – all with the
teacher’s approval. Inhibitions are broken down not
just by peer pressure, but by the classroom. As pro-sex
education people love to point out, children develop in
their own time – but that means that some are learning
about this too early, as well as ‘too late.’ We in society
are guilty of breaking the innocence of childhood,
earlier and earlier – and these lessons are a weapon in
the forefront of that awful attack on decent life.
Counterpoint
Our children are sexually active. They are making
decisions that can affect the rest of their lives. They
should be able to choose responsibly and be well-
informed about the likely outcomes. They should
know about sources of free or cheap contraception,
who to turn to when pregnant or if they suspect they
have a venereal disease, how to use contraception to
avoid both, and, contrary to the impression of
abolitionists, they should be told the benefits of
abstinence. How can you tell people about that if you
refuse to discuss sex? How can you imagine they will
take you seriously if you turn a blind eye to something
so many of their peers are doing?
They need an external source of support to resist peer
pressure, and have sex later rather than sooner:
lamentably, it is presumed amongst many young
people that having unprotected sex with many partners
at an early age is the norm and they encourage others
to do it (and attempt to humiliate those that don’t). We
need mechanisms to support those that want to resist
that pressure: sex education is such a mechanism. Sex
education is part of a package of provisions needed to
help our teenagers avoid the terrible pitfalls of
unwanted pregnancy and venereal disease. This
problem is here – pretending that it isn’t won’t make it
go away. How else do opponents of sex education
propose to deal with the huge problems of STDs and
teen pregnancy? Effective and widely supported sex
education programs can achieve real results. For
example, in the Netherlands, amongst people having
intercourse for the first time, 85% used contraception
– compared to 50% in the UK.
Children are bad decision makers
Point
Sex education informs children about sex, and then
invites them to make a choice. But as demonstrated all
the time, children are bad decision-makers, often
choosing what is bad for them. That is why adult
society often needs to decide for them – what they
should eat, what they should watch on T.V., when
they are mature enough to be able to choose whether
or not to drink or smoke. Surely sex is just as
important as those things – just as dangerous, just as
potentially destructive. The abdication of our
responsibility in the sexual arena is shameful; we
should be unafraid to simply tell children this is
something they cannot do, aren’t mature enough to
consent to yet – a responsibility we seem to shrink
from even though it is reflected by the stated aim of
society enshrined in the law of the age of consent.
Lessons implicitly lauding the pleasures of intercourse
are entirely contrary to that aim.
Counterpoint
That logic might sound impressive – but it’s the same
one that fails to control underage drinking, underage
smoking, the watching of rated movies by those
forbidden to do so, the eating of bad food – and
underage sex. It’s the same poor parental logic that has
seen a generation of children grow up divorced from
the society around them, children who die from drugs
overdoses and whose parents say (honestly), ‘I just
had no idea.’ It’s time to talk to our young people
about what they do – honestly, frankly, without
frightening them into dishonesty and deception. To do
otherwise perpetuates the cycle of ignorance about
youth society, and perpetuates the status quo of being
able to do nothing to change it.
Responsibility for children's moral and sexual
upbringing is not the responsibility of schools
Point
This is none of the state’s business. Teaching this
subject en masse in a classroom reduces it to
biological notions, group embarrassment and crude
jokes. Furthermore, children have never needed this
from the state: left alone, they learn from their family
and surroundings and grow naturally into adults
without the state’s involvement. Few things are
responsible for parental disaffection with education
more than the teaching of sex and sexuality in ways
contrary to their wishes.
Parents have a right to determine the moral
environment in which their children develop and this
is a huge intrusion into that right. That moral
environment has been manipulated again and again
over the last forty years by a liberal teaching
establishment set on undermining traditional values
and beliefs. Sex education has been a prime weapon in
that social engineering. That tool should be taken
away from teachers, who as a body have proven
themselves undeserving of it. As for the tedious idea
that children somehow need the nanny state to look
after their sexuality – who knows children and their
needs better than parents? Schools are responsible for
so much that is wrong with our children, and by giving
them free licence to delve into students’ sexuality,
things become so much worse, blurring the line
between teacher, adviser, confidante, and sometimes
in extremes, between teacher and lover – an abuse of
power that bringing sex into the classroom makes so
much easier.
Counterpoint
Parents often know nothing (or worse, are armed with
dangerously naive delusions) of the sexual state of
their children. The picture painted by abolitionists is
inaccurate – the process of deciding what is taught in
schools involves parents’ groups and school governing
bodies on a school-by-school basis, so parents do have
a role in deciding what is taught. But ultimately, the
state should be involved in educating the whole child,
not just in doling out academic ideas – and should
work hard to safeguard sexual health of youngsters, a
field near-impossible to separate from sex education.
This is a subject just as important for the development
of young people as the conventional subjects such as
maths and English. The role of ‘teacher’ has to change
with time. Once, teachers only instructed the children
of the well-off or acted as a branch of the church, now
they teach everyone in a secular society. As their role
changes, they must remain responsible and obey the
law: thus, the scaremongering of suggesting teachers
will abuse their students or lure them into relationships
is irrelevant, as both sides believe that is wrong, and
should be prosecuted.
Rules banning discussions of sex in schools can deny
teachers the ability to deal with real problems. When
an individual student comes to a teacher with a
problem, a rule against discussing such things in the
classroom will probably mean that this outlet of help
the troubled adolescent has sought out, often because
he feels the family isn’t the place to get help, will be
denied to him, will turn its back on him. Like it or not,
in today’s fractured society teachers have taken on the
role of counsellor, and this rule will indirectly curtail
their ability to fulfil it. The result of that will be
appalling.
Sex education for underage children undermines the
law
Point
Sex education classes for those under the age of
consent undermines the law. It says, ‘don’t do this –
but given that you are, do this, this and this.’ This
sends a terrible message about the law – that breaking
it isn’t serious, that authority (as represented by
teachers) tacitly approves of that illegality, will
tolerate it and even encourage it.
Sex education fails to tell our children clearly what is
right and what is wrong. And remember that these are
children, who need clear boundaries to guide their
behaviour, and who may not understand the subtleties
appreciated by liberal educationalists. In any case, so
few teachers want to teach this subject that the quality
of teaching is awful. Those that do end up teaching it
are often the oddest characters in the teaching
establishment. Many teachers happy to ‘cover’ other
subjects are uniquely embarrassed by this one, or
object to it on moral grounds and will not do so,
leaving it to the most liberal members of staff.
Counterpoint
Well taught sex education does no such thing. Sex and
responsibility classes must tread a fine line, first
stressing the importance of waiting until ready before
having sex, and pointing to the physical benefits of
fewer partners and starting sex later – but must then
move on to the reality of modern Britain’s sex-ridden
teen culture, without applauding it, and try to decrease
the very high levels of STDs and pregnancy. Yes,
that’s hard to do – but that doesn’t mean we shouldn’t
do it. On the contrary – it’s one of the most important
duties society faces today. Arguments about poor
teaching apply equally to maths. We often have to try
to recruit teachers in unpopular fields – true, difficult,
but hardly unique. The answer is to improve teacher
training, both for new graduates and for practising
teachers, and to bring in outside consultants from the
health and social welfare sectors, who have deep
experience in this area.
POINTS FOR
Ignorance about sex is the primary cause of the
spread of sexually transmitted diseases (STDs)
Point
The spread of AIDS in the 80s and 90s showed that
education and information is more important than ever
as exemplified by the slogan in the British 1980’s
advertising campaign to prevent AIDS ‘AIDS: Don’t
Die of Ignorance’. The campaigns were credited with
credited with changing behaviour through warnings on
adverts and informing through an information
leaflet.[1] This shows that education can work even
when starting from scratch. Giving sex education in
schools is crucial to the spread of information to each
successive generation, and may be supplemented by
frank discussion at home.
[1] Kelly, Jon, ‘HIV/Aids: Why were the campaigns
successful in the West?’, BBC News Magazine, 28
November 2011, http://www.bbc.co.uk/news/magazine-
15886670
Counterpoint
While a serious disease, AIDS transmission makes up
only a tiny proportion of sexually transmitted
infections each year. [1]
Firstly the harm of these infections has always been
satisfactorily low before public Sex Education, and
secondly even if mandatory public education did have
a substantive benefit it would not outweigh the
infringement on the moral freedom of the parents.
[1] Health Protection Agency, STI Annual Data Tables
http://www.hpa.org.uk/web/HPAweb&Page&HPAwebAut
oListName/Page/1201094610372
Abstinence is an outdated view, based on religious
teaching, which may be a personal choice but is not
to be expected as the norm for everyone
Point
Young people express their sexuality as part of their
development to adulthood. It is not having sex that is a
problem, but having unsafe sex or hurting people
through sexual choices. Refusing to promote safe sex
would mean not moving with the times. Just because
schools do not promote safe sex does not mean that
adolescents will not experiment with sex. They will
already be exposed to sexual imagery and ideas of sex
so it is necessary that they are taught properly how to
remain safe.
Schools may also want to talk about abstinence at the
same time; it is a way of keeping sexually safe.
However schools have to recognise that the majority
of pupils are unlikely to stick to abstinence regardless
of how much the school promotes it. It is therefore
necessary for the school to also promote and educate
about safe sex.
Counterpoint
To not promote abstinence is not a neutral position, it
is a position the implicitly encourages sexual
promiscuity. Children are at risk of severe
psychological and physical harm from having sex too
young, and should be encouraged not to do so.
Promoting ‘safe sex’ is implicitly encouraging sex by
implying that it is safe and a normal thing to be doing.
This will encourage young people to believe that there
is no risk when this is not the case even if they do
follow the prescriptions they have been taught about
sex.
The information age makes attempting to hide
information on sex impossible
Point
The internet provides a vast amount of easily
accessible information about sex, of varying degrees
of quality. Most children in the west now have access
to the internet and are therefore likely to have access
to this information on sex, or at least educational
materials on sex even if the child’s access to the
internet is controlled.
Given that it is impossible to prevent children from
accessing this information if they really want to, it
makes sense to present it to them in an organised and
accurate fashion. Rather than allowing children to find
information on their own through what may well be
unreliable resources it is necessary that they should get
good reliable information. That this information when
there is safe sex education comes from the school
means that the children know that they information is
reliable. They can then use this information to help
them decide how reliable any further information they
may find from other sources is.
Counterpoint
The problem with mandatory sex education is
precisely that it presents that information in an
organised fashion – by the state. In doing so the right
of the parents to raise their children in accordance
with their structure of beliefs is usurped.
Restricting information to children is inconsistent
with the age of consent
Point
With the age of consent being 16 and with young
people being able to vote at 18, it does not make sense
for parents to have control over whether their children
attended sex education classes right up until the age of
19 or whenever they finish full time schooling.
The age of consent means that there is clearly a need
to be taught about sex from that age of consent. This is
something that cannot be guaranteed to happen in all
individual households if left to the parents whereas it
can be ensured in schools.
Counterpoint
True, but nor does it make sense to make the classes
mandatory once the child reaches an age where it is
legally able to decide whether it wants to partake of
them. Nor does this mean that these classes need to be
promoting safe sex rather than simply teaching the
facts and encouraging abstinence.
PRELIM 4
Medicine has become a business. New
illnesses are being invented. Doctors
are paid according to the number of
their prescriptions and operations. As a
result, new illnesses are invented and
unnecessary surgeries are performed.
The ultimate goal is no longer health; it
is turnover. This is an impact of
pharmaceutical industry in which
medicine is beginning to be bought and
sold in a market, where prices
determine outcomes, and where the
not-for-profit, service orientation of
health care providers is threatened.
THBT ALTERNATIVE MEDICINE IS A
THREAT FOR MODERN MEDICINE
POINTS for
Many alternative remedies, such as homeopathy, offer
nothing but a false hope and can discourage patients from
consulting a doctor with what may be serious symptoms
Point
There are good reasons why new therapies are tested
in scientific trials first, rather than just released on the
public that it might work. The first is to weed out side-
effects but the other is that if you give most people a
medicine they will, not unreasonably, expect it to
make them better.
An entire industry has grown out of alternative
medicines. No doubt many alternative practitioners are
well meaning, but this does not change the fact that
people are making money out of something that, as far
as anyone can determine, is basically snake oil.
Although many people take both alternative and
established treatments, there are a growing number of
patients who reject conventional medical wisdom
(there’s an account of one such case here[i]) in cases
that prove fatal the availability of alternative
medicines raises serious ethical and legal concerns,
and also undermines the stringent regimes of
monitoring and supervision that qualified medical
professionals are subjected to..
[i] David Gorski. “Death by ‘Alternative Medicine”: Who’s
to blame?”. Science-Based Medicine 2008.
Counterpoint
The overwhelming majority of practitioners of
alternative therapies recommend that they be used in
conjunction with conventional medicine. However, the
rights and opinions of the patient are foremost and
should be respected. In the case of cancer, since that is
the study considered by proposition, there are many
sufferers who decide that chemotherapy, a painful and
protracted treatment, which rarely yields promising or
conclusive results, may well be worse than the disease.
Of course there is a cost associated with alternative
medicine, although it is as nothing compared with the
cost of many medical procedures, notably in the US
but also elsewhere. There are plenty of conventional
practitioners willing to prescribe medications that may
not be necessary or, at the very least, select
medications on the basis of financial inducements
from pharmaceutical companies.
Despite legal rulings[i], such practices still take place;
it would be disingenuous not to explore the extent to
which commercial dealings influence the practice of
conventional medicine.
Clearly advice should always be given on the basis of
the needs of the patient. However, there are many
circumstances in which conventional medicine fails to
adhere to this principle. Venality and petty negligence
are not behaviours that are exclusive to the world of
alternative therapies.
Although there are many accounts of the efficacy of
alternative cancer treatments, not one has been
demonstrated to work in a clinical trial
Point
The National Centre for Conventional and Alternative
Medicines has spent over $2.5bn on research since
1992. The Dutch government funded research between
1996 and 2003. Alternative therapies have been tested
in mainstream medical journals and elsewhere. Not
only have thousands of research exercises failed to
prove the medical benefit ”alternative” treatments for
severe and terminal diseases, serious peer-reviewed
studies have routinely disproved them.
It’s all well and good to pick at mistakes in individual
studies. Indeed, this tactic often forms the mainstay of
pleas for legitimacy made by members of the
alternative medical community. However, the odds
against such consistently negative results would be
extraordinary.
By contrast, conventional medicine only prescribes
medicines and treatments that are proven, and
vigorously proven, to work.
Counterpoint
Partly the problem here may well be that clinical
research is simply looking for the wrong things. There
is enough anecdotal evidence of success to at least
suggest further research – it is worth noting that
there’s no money in many of these treatments so they
actually get relatively little academic discussion.
A meta-study of the available material on analyses of
the effectiveness of complementary medicine by the
Cochrane Library found positive or confirmatory
outcomes in 34 percent of those papers it reviewed on
the subject.
It is also worth reiterating that there is a massive
financial interest in ignoring, sidelining or
condemning therapies that pose a threat to the medical
establishment.
It seems incredibly unlikely that people would come
back for more than one dose of a treatment that was
having no effect, and yet they do.
Overwhelmingly alternative therapies are used in
conjunction with established remedies - oddly the
latter tends not to get the credit for the miracle cure
Point
Thankfully only 4.4% of the 60million or so
Americans who say they use alternative therapies rely
on them exclusively. It is odd that in the cases of
anecdotal accounts of the success of alternative
medicines this statistic is rarely mentioned[i].
Equally, the impact of other treatment which may
have been used by patients eager to credit
complementary and alternative medicines with curing
their conditions, tend not to get a look in, neither do
the relative successes of conventional medicine.
This is probably why in every trial alternative
medicine has a success rate of between 0% and 0%.
By contrast there needs only be one instance of harm
caused to demonstrate that this motion must stand.
Interestingly, although conventional medicine
publishes its mistakes in an effort to correct them,
nothing similar exists for alternatives. Moreover, there
are many accounts of fatalities caused by alternatives
– both directly and indirectly through delaying
accurate diagnosis as seen above (Oh, the same
applies to animals too[ii]).
The food supplements industry alone is worth $250 a
year worldwide, with little examination of the medical
impact of merrily shoving things into your system that
were bought at WalMart or Tesco.
Counterpoint
Statistics for alternatives are difficult to generate as
patients will often move between practitioners and
frequently self-medicate.
Clearly there are also conditions that any responsible
practitioner would refer to a specialist in that
particular field.
However, many people are mistrustful of so-called
conventional medicine and the alternative medicine
sector has proven both popular and has often brought
about changes in lifestyle as well as direct health
benefits, if anecdotal evidence is to be believed.
Responsible practitioners have welcomed the actions
of those governments who have licensed and regulated
the Complementary and Alternative sector.
Although science may struggle to explain the benefits
of these therapeutic technics, as they do not lend
themselves to the tools of commercial medicine.
Against for
A huge number of fully accepted medical practices
started being seen as something a bit off the wall, it’s
wrong to deny sick people access to a treatment that
may be mainstream in 20 years
Point
There is a fine line between what is considered
alternative and what is thought of as mainstream.
Techniques do move across that line and when they do
so, they are seen as mainstream. However, this process
of reform, refinement and acceptance takes time.
In the meantime it is simply unfair to deny treatment
to patients who want it because the medical
establishment is beholden to a conservative academic
orthodoxy and drug and treatment providers with
vested interests in ensuring that particular cures and
techniques will continue to be purchased and utilised.
Counterpoint
This comes down to the ‘well it can’t hurt, can it’
approach to alternatives. There is simply no serious
medic – or any other scientist for that matter who
would suggest that it’s a good idea to ingest products
that are of dubious origin and purport medical benefits
without having been tested. In many cases these have
been shown to be at least irrelevant and at worst
actively harmful.
Of course it is painful to deny treatment to a patient on
the basis that the medication has yet to complete its
trial stage but there is a reason for doing that in that it
allows doctors to be 100 percent sure of a product
before they’re prescribed.
The pharmaceutical and medical industries are
worth billions of dollars annually. They have an
interest in ignoring the efficacy of remedies that are,
for the most part, free or considerably cheaper
Point
It’s understandable that the medical establishment has
an interest in ignoring treatments that are freely
available. Pharmaceutical companies make billions
each year selling drugs that cost pennies to
manufacture.
There is an enormous vested interest in insuring that
the world in general- and the West in particular-
remain tied to the idea that the only solution to disease
is to swallow a pill provided by a man in a white coat.
There are other solutions that have been used for
thousands of years before anybody worked out how to
make a buck out of it. For much of the world these
therapies continue to be the ones people rely on and
the rush of pharmaceutical companies to issue patents
on genes of some of these traditional remedies
suggests that there must be at least some truth in them.
Counterpoint
Absolutely nobody questions that many remedies can
be drawn from nature- penicillin provides one
example- but there is something of a jump that
happens between chewing on a piece of bark and a
regulated dose of a chemical.
Let’s deal quickly with the cost of medications – the
second pill may well ‘cost pennies’; the first one, by
contrast, costs hundreds of millions of dollars in
research. On the basis that there is probably more than
one medicine in the world that procedure will need to
be repeated.
As for the idea that there are older or more traditional
remedies and that these are still frequently used in
much of the world, that is, indeed true. They are the
same periods of history and parts of the planet were
the bulk of humankind died – or continues to die –
agonizing deaths from relatively commonplace
diseases that modern medicine is able to cure with ‘a
pill from a man in a white coat’. It is admittedly
regrettable that more of the world isn’t covered by the
protection science offers but that is scarcely the fault
of science.
Alternative medical practitioners tend to spend more
time with their patients and get a better
understanding of them as a whole, as a result they
are more likely to treat the person than the symptom
Point
Modern medicine tends to treat an individual symptom
without putting it in the context of the whole person
and so will often fail to see it as part of a wider
pathology.
Alternative practitioners tend to spend more time with
their patients and so are better placed to asses
individual symptoms as a part of the person as a whole
rather than just dealing with symptoms one as a time
as the crop up.
Counterpoint
his is of course an excellent argument for more and
better funded clinics, especially in parts of the world
(including much of the West) where access to
medicine is difficult.
It is also evidence that when people are genuinely
worried about their health they tend to consult
providers of conventional medicine who are, as a
result, extremely busy.
It perhaps says more than anything else about many
practitioners of alternative medicines that they have
time to sit around bonding with their patients.
Unsurprisingly, such a luxury is rare in an A and E Yet despite the pervasiveness, power, and promise of
ward or even in the average GP’s surgery. contemporary medical science, large segments of
humanity either cannot access its benefits or choose
THIS HOUSE BELIEVES THAT WE SHOULD not to do so. More than 80 percent of people in
developing nations can barely afford the most basic
PROHIBIT PUBLIC HOSPITALS TO medical procedures, drugs, and vaccines. In the
industrial nations, a surprisingly large proportion of
PROSCRIBE ALTERNATIVE TREATMENT people opt for practices and products for which proof
as to their safety and efficacy is modest at best,
(THE HOMEOPHATIC TREATMENTS, practices that in the aggregate are known as
complementary and alternative medicine (CAM) or as
ACUPUTURE OR BACH FLOWER REMEDIES) traditional medicine (TM).
Much of this book considers the formidable challenges
to advancing human health through the further
Chapter 69 Complementary and
dispersion of effective and economical medical
practices. This chapter considers both proven and
Alternative Medicine unproven but popular CAM and TM approaches and
attempts to portray their current and potential place in
the overall practice of medicine.
The objective of medicine is to address people's
unavoidable needs for emotional and physical healing. With globalization, the pattern of disease in
The discipline has evolved over millennia by drawing developing countries is changing. Unlike in the past,
on the religious beliefs and social structures of when communicable diseases dominated, now 50
numerous indigenous peoples, by exploiting natural percent of the health burden in developing nations is
products in their environments, and more recently by due to noncommunicable diseases, such as
developing and validating therapeutic and preventive cardiovascular diseases, diabetes, hypertension,
approaches using the scientific method. Public health depression, and use of tobacco and other addictive
and medical practices have now advanced to a point at substances. Because lifestyle, diet, obesity, lack of
which people can anticipate—and even feel entitled exercise, and stress are important contributing factors
to—lives that are longer and of better quality than ever in the causation of these noncommunicable diseases,
before in human history. CAM and TM approaches to these factors in particular
will be increasingly important for the development of
future health care strategies for the developing world.
Definitions and Domains of Complementary
and Alternative Medicine and Traditional
Medicine
We refer to medical practices that evolved with
indigenous peoples and that they have introduced to
other countries through emigration as traditional
medicine. We refer to approaches that emerged
primarily in Western, industrial countries during the
past two centuries as scientific or Western medicine,
although we acknowledge that not all Western
medicine is based on scientifically proven knowledge.
The terms complementary and alternative describe
practices and products that people choose as adjuncts
to or as alternatives to Western medical approaches.
Increasingly, the terms CAM and TM are being used
interchangeably (Kaptchuk and Eisenberg 2001;
Straus 2004).
Endless varieties of practices are scientifically
unproven and poorly accepted by medical authorities.
For the sake of organizing an agenda for research into
these approaches, the U.S. National Institutes of
Health has grouped them into five somewhat
overlapping domains
(http://nccam.nih.gov/health/whatiscam) as follows:
 Biologically based practices. These include use of a
vast array of vitamins and mineral supplements,
natural products such as chondroitin sulfate,
which is derived from bovine or shark cartilage;
herbals, such as ginkgo biloba and echinacea; and
unconventional diets, such as the low-
carbohydrate approach to weight loss espoused by
the late Robert Atkins.
 Manipulative and body-based approaches. These
kinds of approaches, which include massage, have
been used throughout history. In the 19th century,
additional formal manipulative disciplines
emerged in the United States: chiropractic
medicine and osteopathic medicine. Both
originated in an attempt to relieve structural
forces on vertebrae and spinal nerve roots that
practitioners perceived as evoking a panoply of
illnesses beyond mere musculoskeletal pain.
 Mind-body medicine. Many ancient cultures
assumed that the mind exerts powerful influences
on bodily functions and vice versa. Attempts to
reassert proper harmony between these bodily
systems led to the development of mind-body
medicine, an array of approaches that incorporate
spiritual, meditative, and relaxation techniques.
 Alternative medical systems. Whereas the ancient
Greeks postulated that health requires a balance
of vital humors, Asian cultures considered that
health depends on the balance and flow of vital
energies through the body. This latter theory
underlies the practice of acupuncture, for
example, which asserts that vital energy flow can
be restored by placing needles at critical body
points.
 Energy medicine. This approach uses therapies
that involve the use of energy—either biofield- or
bioelectromagnetic-based interventions. An
example of the former is Reiki therapy, which aims
to realign and strengthen healthful energies
through the intervention of energies radiating
from the hands of a master healer.
Alternative systems of medicine use elements from
each of these CAM and TM domains. For example,
traditional Chinese medicine incorporates
acupuncture, herbal medicines, special diets, and
meditative exercises such as tai chi. Ayurveda in India
similarly uses the meditative exercises of yoga,
purifying diets, and natural products. In the West,
homeopathic medicine and naturopathic medicine
each arose in the late 19th century as reactions to the
largely ineffectual and toxic conventional approaches
of the day: purging, bleeding, and treatments with
heavy metals such as mercury and arsenicals.
Economics of Complementary and
Alternative Medicine and Traditional
Medicine
Although social, medical, and cultural reasons may
account for why people in a given country prefer
CAM and TM to conventional (Western) medicine,
economic forces are also at play. This section
describes the socioeconomic determinants of seeking
treatment from traditional healers and providers of
CAM; reviews the evidence on the cost-effectiveness
of CAM and TM; and discusses cost-effective
approaches to regulating, improving, and expanding
the use of CAM and TM. Much of this evidence is
from industrial countries; few studies have been
conducted in or are applicable to low- and middle-
income countries. This caveat is important for two
reasons. First, the CAM and TM modalities discussed
in this section may not be used in many developing
countries. Second, the limited data on cost-
effectiveness may not be applicable in the case of
those countries. Nevertheless, the data give a rough
picture of the relative cost-effectiveness of a number
of CAM and TM practices.
Economic Factors That Influence the Use of
Complementary and Alternative Medicine and
Traditional Medicine
Users of CAM and TM approaches choose health
practices that resonate with their beliefs about health
(Astin 1998). Although economic factors play a role in
this choice, the underlying incentives are not always
predictable. For instance, a common misconception is
that patients opt for CAM and TM services because
they are cheaper alternatives to conventional medical
care. Even though there are certainly instances when
the cost of treatment using CAM or TM is much
cheaper than the cost of accessing a conventional
medical service, several studies have found that CAM
and TM cost the same or more than conventional
treatments for the same conditions (see, for example,
Muela, Mushi, and Ribera 2000).
At least one study has shown that financial
considerations are rarely the primary factor in
choosing a traditional healer, ranking behind such
reasons as confidence in the treatment, ease of access,
and convenience (Winston and Patel 1995). In the
United States, the average cost of a single visit to a
Navajo healer was US$388, and the average annual
cost of using a traditional healer represented roughly a
fifth of the reported annual income of respondents in a
survey (Kim and Kwok 1998). The high cost of using
a healer was cited as the most common barrier to
seeking care from this source. In Kenya, the average
charge per patient per visit to a TM practitioner was K
Sh 46 (US$4 in 1981), which was significantly greater
than the average charge per visit even in private health
care facilities (Mwabu, Ainsworth and Nyamete
1993). Finally, a survey in Zimbabwe reported that the
median cost of consulting an herbalist was Z$23 per
visit, compared with Z$1 for a government clinic and
Z$29 for a private doctor (Winston and Patel 1995).
The same survey found that outcomes tended to be
better when patients went to government clinics (67.3
percent of visits resulted in a good outcome) than
when patients consulted herbalists (50 percent of visits
resulted in a good outcome).
TM is not always more expensive than conventional
medicine, however. Survey respondents in Ghana
reported that the cost of malaria treatment at a health
clinic ranged from ¢1,900 to ¢3,000 (US$1.30 to
US$2.00 in 1997), treatment at home using drugs
bought from pharmacies or health care workers ranged
between ¢200 and ¢1,000 (US$0.10 to US$0.70), and
treatment by an herbalist was virtually free (Ahorlu
and others 1997).
Another common misconception is that the poor are
more likely to use TM. At least one study shows that
this may not be true. In Zimbabwe, the mean monthly
income of households visiting an herbalist, Z$877,
was greater than the mean monthly income of
households using government clinics, Z$718 (Winston
and Patel 1995).
Although some traditional healers charge more than
conventional practitioners, their fees may be
negotiable, the method of payment may be flexible
(often on credit or in exchange for labor), and payment
may be contingent on outcome. The availability of an
outcome-contingent contract favors TM over Western
medicine when the disease condition requires
providers to both exert effort in curing patients and
induce patients to comply with their
recommendations. Nonetheless, this strategy may be
difficult to apply to the larger health care system.
Furthermore, patients tend to seek care from
traditional healers for conditions such as mental
illness, impotence, and chronic disorders, which they
perceive as requiring greater involvement by the
extended family and kinship group. Accordingly, the
availability of financial support for seeking treatments
for these disorders is greater than it is for illnesses
such as malaria or diarrhea, for which patients more
often seek conventional treatment.
Few published data are available on the financial costs
of TM in low- and middle-income countries. The data
presented here on the use of traditional healers are
extracted from the World Bank's living standards
surveys in Vietnam to provide one nationally
representative snapshot of the situation. Of 28,254
individuals in the sample, 10,033 had consulted a
health care provider in the four weeks preceding the
survey. These consultations included both home visits
and visits to a provider. Of the 10,033, 1,829 had been
to a public provider, 1,431 to a private provider, 7,650
to a pharmacy, and 259 to a traditional healer. 1 The
most common reasons for visiting a traditional
provider were headache, followed by cough and fever.
The per visit drug cost for consulting a traditional
healer was D 46, and the total cost per visit was D 51,
compared with drug costs of D 38 and total costs of D
41 for going to a private clinic.
One commonly cited motivation for using CAM and
TM is that their use might lower the incidence and
costs of side effects associated with conventional
treatments, but the published evidence on this point
remains mixed. There is some evidence that CAM is
used in addition to conventional treatments (Thomas
and others 1991), but CAM may also have the effect
of displacing conventional treatments. An outpatient
survey found that, of 246 patients who had been
receiving conventional treatment from the Royal
London Homeopathic Hospital since the onset of care,
a third had halted their conventional treatment and
another third had reduced their intake of conventional
medication (van Haselen 2000). 2 The extent to which
homeopathic treatment displaced conventional
treatment varied by indication. The use of
homeopathic treatment often replaced conventional
treatments in patients with skin and respiratory
infections; in patients with cancer, its use was purely
complementary and therefore added to overall health
care costs.
Thomas and others (1991) observe that patients who
use CAM and TM also commonly access conventional
medical care. In industrial countries, most CAM usage
complements conventional care, but this is also
common in developing nations. For instance, Mwabu
(1986) provides evidence from Kenya that patients are
likely to use more than one type of provider from the
range of those available, such as government facilities,
mission clinics, private clinics, pharmacies, and
traditional healers. Furthermore, the choice of provider
depends on patients' illness, condition, socioeconomic
status, and education. If an initial visit to one kind of
provider did not resolve the disease satisfactorily, a
follow-up visit was made to a different kind of
provider. Finally, the quality of care—including
efficiency of service and waiting time at government
and private clinics—is an important determinant of
whether patients choose to go to traditional healers.
Most traditional healers surveyed in a second study
referred patients to Western practices for treatment
when necessary (Mwabu, Ainsworth, and Nyamete
1993).
Economic Evidence
Although most studies tend to focus on a specific
CAM or TM practice, Sommer, Burgi, and Theiss
(1999) looked more broadly at whether the provision
of CAM and TM services through prepaid health plans
or government insurance reduces the overall costs of
health care and found that it does not. A possible
reason is that few individuals who are offered access
to CAM use them, and those who do might access
those services in addition to, not in place of, more
conventional health services.
Studies that compare the cost-effectiveness of
different CAM and TM approaches using the same
analytical framework are rare. One such study in Peru
looked at the costs and cost-effectiveness of treatment
using conventional medicine and TM (EsSalud and
OPS 2000). Complementary medical practices
evaluated included acupuncture, homeopathy, tai chi,
meditation, reflexology, hydrotherapy, naturopathy,
and massage. Patients were enrolled in either the
Western medicine group or the CAM group. Patients
were not randomized between the two treatment
groups, but they were matched by disease pathology
and severity, age, and sex. Furthermore, selected
patients had completed at least one year in the health
system, as the investigators reasoned that this would
enable them to evaluate their follow-up. Overall, the
investigators found that complementary medicine was
between 53 and 63 percent less expensive than
conventional medicine for achieving equivalent levels
of effectiveness. Complementary medicine was
especially cost-effective for osteoarthritis,
hypertension, facial paralysis, and peptic ulcers.
The rest of this section looks at the economic evidence
on specific forms of CAM or TM.
Acupuncture
Lindall's (1999) study finds that an acupuncture
referral for musculoskeletal conditions costs a mean of
US$422, roughly 60 percent less than the cost of
referral to a Western practitioner. However, this study
was not randomized, and patients had to have failed
first-line drug treatment before being offered the
choice of second line-treatment, either with
acupuncture or with Western medicine.
Homeopathy
Evidence indicates that the cost of homeopathic
medication is lower than the average cost of allopathic
products, which would be an economic factor in favor
of its use if homeopathy were proven to be effective.
A study by the National Health Service in the United
Kingdom found that the drug costs associated with
homeopathy were lower than those of allopathic
practitioners (Swayne 1992). A four-year study of 100
patients that compared homeopathic drug costs with
those of conventional drugs found an average cost
saving of US$96 during the study period for those
using homeopathic drugs (Jain 2003). 3
Ayurveda
A study that compared medical expenditures over a
four-year period for participants in a comprehensive
program of ayurvedic-based natural medicine (which
included antioxidant strategies, mind-body medicine,
and other techniques) with participants whose
expenditures were covered through a BlueCross
BlueShield health insurance plan found that the
expenditures for the ayurvedic group were 50 percent
lower per person (Orme-Johnson and Herron 1997).
However, the study was not randomized and failed to
control for the inclination of only a subset of people to
accept and remain compliant with ayurvedic
approaches.
Chiropractic
Some studies found that spinal manipulation is less
expensive than conventional treatments for episodes of
back pain. One nonrandomized study found that the
cost of chiropractic treatment over a five-year period,
including both provider costs and equipment costs
(US$28,902), was 24 percent less than the cost of
Western pain therapy (US$38,029) (Kumar, Malik,
and Demeria 2002). Moreover, 15 percent of patients
in the chiropractic group were able to return to work,
compared with none in the control group.
However, other larger and better-controlled studies
failed to find a difference between chiropractic and
physical therapy in terms of either outcomes or costs
(Cherkin and others 1998; Skargren and others 1997;
Skargren, Carlsson, and Oberg 1998). A study of
adults with low back pain who were randomly
assigned to physical therapy or chiropractic
manipulation or were just given an educational
booklet found no significant differences in either the
mean costs of care or the outcomes between the
physical therapy and chiropractic groups (Cherkin and
others 1998). Three-quarters of the participants in
these groups—who incurred costs of roughly US$430
over the two-year period of the study—reported that
their outcome was either good or excellent, compared
with a third of those who were assigned booklets;
however, the mean cost of care for the booklet group
was only US$153 for the two-year period.
Mind-Body Treatments
Little evidence is available on the cost-effectiveness of
practices such as meditation and yoga, but the cost of
acquiring the skills required for these practices, as
well as the time costs of practicing them, are so low
relative to conventional medicine that evidence of
their clinical effectiveness might suffice to justify their
use on economic grounds. Available evidence from
clinical studies suggests that mind-body treatments
can be cost-effective (Caudill and others 1991;
Friedman and others 1995; Hellman and others 1990;
Sobel 1995). Blumenthal and others (2002) find
significant declines in coronary events and in
predicted costs of care for patients who were assigned
to a one-and-a-half-hour long weekly class on stress
management, relative to usual care for each of the first
two years of follow-up and after five years.
Beyond Cost-Effectiveness: Ancillary Benefits and
Costs of CAM and TM
Although cost-effectiveness is one guiding rationale
for determining resource allocations for expanding (or
restricting) access to CAM and TM, additional societal
benefits and costs, such as effects on biodiversity,
must also be considered. CAM and TM could provide
a rationale for conserving species, but overharvesting
of endangered species for medicinal purposes is also a
concern. According to WHO, 85 percent of the world's
population (principally those in developing countries)
depends on plants for medicine, and 25 percent of
prescription drugs have an active ingredient derived
from a flowering plant (Cox 2001). The possible
extinction of medicinal plants is of concern not only to
developing countries but also to industrial countries,
as in the cases of poaching of American ginseng and
overharvesting of native saw palmetto. Similarly, the
reliance of Chinese TM on tiger genitals, bear
gallbladders, and black rhinoceros horns has played an
important role in poaching and threatens to wipe out
these mega fauna.
Local knowledge and culture regarding the uses of
medicinal plants may be important determinants of
whether a certain species will survive (Etkin 1998). In
addition to the biodiversity value of these saved
species, scientists may be able to analyze these plants
for potential clinical application on a broader scale
than TM permits. Although preserving traditional
knowledge of healing practices helps preserve the
culture and identity of indigenous populations, CAM
and TM may impose significant costs. In such
instances, promoting conventional treatments that do
not depend on endangered species may bring
important benefits to society.
Expanding the Beneficial Use of
Complementary and Alternative Medicine
and Traditional Medicine
Despite the uncertainty about the clinical efficacy and
cost-effectiveness of certain CAM and TM practices,
expansion of their use in instances in which moderate
evidence of their efficacy and good evidence of their
safety exists could yield health, social, and economic
benefits. A number of surveys show that local
pharmacies are the primary source of treatment for
many ailments, especially in rural areas where
government or private clinics are less accessible. In
these situations, improving the quality of TM might
serve as an effective substitute for allowing the
unregulated use of conventional medical treatments.
Training traditional healers is substantially less
expensive than training doctors or nurses. A study of
52 traditional healers interviewed as part of a survey
in Kenya estimated that the average out-of-pocket
(cash) costs of training to be a traditional healer were
K Sh 418 (US$40 in 1981) (Mwabu, Ainsworth, and
Nyamete 1993).
Traditional healers can also be recruited into a more
broadly based system for delivering public health; for
example, with additional training, traditional healers
can serve as primary health care workers (Hoff 1997)
and provide advice on such matters as sexually
transmitted diseases and oral rehydration therapy
(Nations and de Souza 1997; Nations and others 1988;
Ndubani and Hojer 1999). In addition, permitting
access to CAM and TM within the context of the
conventional health care system would facilitate
access to multiple health services at one location.
Comprehensive policy on CAM and TM is lacking in
most countries, including the United States. According
to the 1994 Dietary Supplement, Health, and
Education Act, the U.S. Food and Drug
Administration cannot require proof that dietary
supplements and herbal products are safe and effective
before they are sold, although it is charged with
requiring good manufacturing practices. The quality of
herbal products is not regulated, and herbal products
typically differ from source to source and from batch
to batch in terms of their component ingredients and
respective amounts and in terms of whether they
contain contaminants. In the United States, no single
entity is responsible for all aspects of CAM and TM
control, education, information, and research, and no
national, voluntary system of self-regulation exists.
National nongovernmental organizations, such as the
Accreditation Commission for Acupuncture and
Oriental Medicine, the American Board of Medical
Acupuncture, the Council of Chiropractic Education,
the Council of Homeopathic Education, and the
Commission on Massage Therapy Accreditation,
accredit education in some CAM and TM fields, but
such accreditation bodies do not exist in many
developing countries. Nearly all countries lack
rigorous research training programs in CAM and TM.
A common misperception is that in the developing
world CAM and TM is used primarily by poorer,
uneducated populations, while in industrial countries it
is used more by affluent and better-educated segments
of the population (Eisenberg and others 1998). In both
settings, relatively little evidence supports this view.
Many investigators have failed to critically assess the
use of CAM and TM by minority and immigrant
populations in Western nations. In Africa, nearly 85
percent of the population uses TM, often as the only
way to obtain primary health care, and wealthier
people in developing countries often use TM (WHO
2002). Investments in improving the quality and
consistency of TM could reduce the cost of health care
delivery, especially for chronic conditions such
arthritic pain and AIDS, where TM interventions may
improve patients' sense of well-being, appetite, and
energy. At the same time, in the absence of resources
to extend the public health infrastructure, a network of
certified CAM and TM providers could provide the
infrastructure for delivering other care, such as
immunizations and maternal-child health programs.
Recognizing the redistributive nature of investment in
TM is important. Indigenous people will seek the help
of traditional healers because of proximity, familiarity,
and trust. Investments in TM could therefore be used
strategically to increase access to conventional
preventive and therapeutic care. Including the
traditional healer as part of the health care team may
thus be an important strategy both to attract patients
and to upgrade the skills and training of traditional
healers.
How equity is affected by the proportions in which
different condition-specific interventions are
combined and how other interventions (regulations,
tax policy, managerial changes) are likely to affect
equity need to be studied. Given that the majority of
indigenous populations in developing countries use
TM for their primary health care, the availability,
safety, and affordability of TM, including herbal
medicines, should be ensured as a matter of equity.
One way to do this is by supporting local production
of safe and effective herbals such as artemisia at
affordable prices. In addition, rigorous research on
TM should be supported. WHO is currently
conducting collaborative studies on herbal treatments
for HIV/AIDS, malaria, sickle cell anemia, and
diabetes. Ineffective or unsafe herbal products
identified by such studies should be removed from
use, while those with proven efficacy and safety
should be made available for therapeutic use.
Lessons Learned and Implementation
The pervasiveness of different modalities of TM and
CAM varies greatly from country to country. For
example, in China, where traditional Chinese medicine
is well integrated into the health system, many
different modalities may be used to treat a given
condition. In the United States, by contrast, CAM
programs are slowly being integrated with
conventional medicine. Several medical schools have
nascent CAM programs and have integrated them into
medical school curricula to differing degrees. One of
the more acclaimed programs of this kind in the
United States is that developed by Andrew Weil at the
University of Arizona Health Sciences Center. His
Integrative Medicine Fellowship Program trains
physicians in CAM and TM and strives to produce a
new delivery model whereby physicians, patients, and
nurses form a healing team for the care of the patient.
However, this program needs to be critically evaluated
before its adoption by more institutions can be urged.
Despite the complexity, diversity, and controversy
surrounding CAM/TM approaches, some notable
success stories reveal the influence of globalization,
whereby modalities discovered in the developing
world have been adopted in the West, with or without
modifications, and vice versa.
Artemisinin
Artemisinin is a recently developed, active metabolite
of artemisia, an herbal extract that has been used in
China for centuries to treat fever. Chinese scientists
determined the active ingredient of the herbal in the
1970s, and Western pharmaceutical companies have
developed several derivatives as drugs for use against
resistant Plasmodium malaria (Li and others 2000).
Randomized clinical trials have shown that one such
drug, dihydroartemisinin-piperaquine, is effective
against drug-resistant Plasmodium falciparum malaria
(Hien and Dolecek 2004). Another artemisinin
derivative, artesunate, was shown to increase parasite
clearance and reduce the gametocyte count when
added to existing drugs to combat malaria (Adjuik and
others 2004).
Acupuncture
Another CAM and TM modality that has considerable
acceptance is acupuncture. Many pain management
clinics, hospitals, and academic centers in the West
now provide acupuncture services, and some
insurance companies reimburse for acupuncture
services. Rigorous clinical trials have demonstrative
positive efficacy in two areas: (a) management of
postoperative nausea and emesis (Shen and others
2000) and (b) amelioration of the pain of chronic
osteoarthritis (Ezzo and others 2001; Soeken 2004;
Tukmachi and others 2004). Studies providing rational
explanations of the mechanisms whereby acupuncture
might be achieving its effects complement the
evidence about its efficacy; for example, one
mechanism of action appears to involve opioid-
dependent brain pathways. This kind of two-step
process—that is, initial demonstration of clinical
efficacy followed by scientific research into the
mechanism of action—is one way that CAM and TM
will gain scientific acceptance and integration into
conventional medicine.
Chiropractic Medicine and Osteopathy
Chiropractic medicine was invented in the American
heartland during the waning years of the 19th century.
It uses spinal manipulation to treat an array of
conditions thought to arise because of abnormal
alignment of or stresses on vertebrae, most often in
patients with musculoskeletal complaints. Two aspects
of chiropractic medicine are success stories. First,
even though practitioners of conventional medicine
ostracized practitioners of chiropractic medicine in the
late 19th century and the first half of the 20th century,
it has gradually evolved into a viable healing
discipline that is increasingly accepted by the
conventional medicine community. The evolution of
chiropractic can be compared with that of osteopathy.
Osteopathy was developed in the United States in
parallel with chiropractic, but the field elected to
accommodate rather than reject allopathic techniques.
The second success story is research showing that
chiropractic manipulation for low back pain is
superior to bed rest, physical therapy, or provision of
an educational booklet (Cherkin and others 1998).
Chiropractic manipulation has also shown results
comparable to those achieved with nonsteroidal, anti-
inflammatory drugs in alleviating back pain (Straus
2004).
Homeopathy
Homeopathy is a success in terms of its broad appeal
and use, not because of the strength of evidence
supporting it. Indeed, few conventional scientists and
physicians find homeopathy to be plausible.
According to the "principle of similars" underlying
homeopathy, practitioners choose remedies that, when
given in high concentrations, produce symptoms
similar to those that the patient presents with. The
substance is then put in solution and serially diluted by
as much as 1060, well beyond the point defined by
Avogadro's number (at which a single molecule of the
original substance could remain in the solution).
Homeopathy claims that the acts of serial diluting and
vigorous shaking imprint information into water so
that medicinal properties are retained even when no or
few molecules of the starting medicine are present.
As implausible as this claim may seem, homeopathy is
used worldwide with reported success (Jonas,
Kaptchuk, and Linda 2003). Randomized controlled
trials have suggested that it might be effective for
treating influenza (Vickers and Smith 2000), allergies
(Taylor and others 2000), and postoperative ileus
(Barnes, Resch, and Ernst 1997). However, critics
have questioned the quality and analyses of these
trials. Some have questioned the validity of pooling
data from trials of different populations, interventions,
and outcome measures, as several reviews of
homeopathy have done. Jonas, Kaptchuk, and Linda
(2003, 393) assert that "there is a lack of conclusive
evidence on the effectiveness of homeopathy for most
conditions. Homeopathy deserves an open-minded
opportunity to demonstrate its value by using
evidence-based principles, but it should not be
substituted for proven therapies."
Mind-Body Intervention
The work of David Spiegel at Stanford University on
group support for breast cancer patients excited wide
interest in the potential value of mind-body
interventions (Spiegel and others 1989). The study
was a randomized controlled trial with a 10-year
follow-up involving 86 women with metastasized
breast cancer. A one-year psychosocial intervention
consisting of weekly supportive group therapy with
self-hypnosis for pain showed that the mean survival
time in the treated group was 37 months, compared
with 19 months for the control group. Moreover,
Spiegel (1994) notes that appropriate psychotherapy
(both group and individual) not only reduced
depression and anxiety and improved coping skills,
but also saved money by reducing the number of
office visits, diagnostic tests, medical procedures, and
hospital admittances. Although Spiegel's findings have
not been replicated, they do illustrate the potential
benefits of mind-body intervention and have led to
studies of possible mechanisms through which such
interventions may operate.
The Research and Development Agenda
The lack of product quality and consistency and the
absence of compelling data on the safety and efficacy
of most CAM and TM approaches present major
challenges to any effort to optimize the distribution of
precious health resources. These difficulties also pose
opportunities for research. Other formidable
challenges include the variability in training,
credentialing, and licensing CAM and TM
practitioners. Increasingly, efforts are being made in
several countries to regulate both products and
practitioners. Ultimately, stringent controls on
training, practices, and products must be
complemented by rigorous research to ascertain which
approaches are safe and effective—and for which
indications.
The global use and potential effect of CAM and TM
practices, the lack of adequate data validating their
safety and efficacy, and the existence of highly
effective conventional alternatives for many of them
dictate that resources should be devoted to fuller
characterization and standardization of CAM and TM
approaches. Investing precious resources in integrating
such approaches further into health care infrastructures
can be justified only on the basis of compelling data.
This point leads to the question of what constitutes a
rational agenda for this work.
For resource-rich industrial nations, one model for
CAM and TM research is that being implemented by
the National Center for Complementary and
Alternative Medicine (NCCAM) of the U.S. National
Institutes of Health (http://nccam.nih.gov). In 2004,
NCCAM planned to invest US$117 million in
research and research training. It is supporting some
800 individual projects at present, including studies of
the composition of natural products and their
pharmacological effects, studies of the neurobiological
mechanisms of acupuncture and the placebo effect,
and clinical trials with 30 to 30,000 participants.
NCCAM now has a strategic plan for its international
programs that emphasizes research, training, and
efforts to learn about the rich, indigenous TM heritage.
Australia, through a government agency similar to
NCCAM, is conducting research and training
programs in collaboration with its indigenous people.
Although the scope of NCCAM's research agenda is
larger than what most other nations could
accommodate, its underlying philosophy should be
universal. That is, the standards for research into CAM
and TM approaches should be no different from those
used in conventional biomedical research.
Both CAM and TM and biomedical practitioners need
to understand the strengths, limitations, and
contributions of their particular approaches so that
they can work together in ways that ensure the best
possible care for their patients and the achievement of
their shared goals of improved individual and public
health. Once these issues have been addressed,
countries could devote additional resources to
studying those CAM and TM approaches that appear
to be the most promising in relation to their most
pressing public health problems. Some priority areas
for CAM and TM research are widely applicable,
including studies of approaches to palliate chronic
pain and suffering, relieve depression, help release the
grip of addictive substances, and slow the progression
of degenerative disorders such as arthritis and
dementia.
https://www.ncbi.nlm.nih.gov/books/NBK11
796/
NHS stops funding for
homeopathy at UK's largest
alternative medicine hospital
Policy change should save London £3m and leaves
Bristol and Glasgow as last vestiges of publicly-
funded complementary medicine, campaigners said A
major taxpayer-funded centre for homeopathic, herbal
and alternative medicines will no longer be providing
these remedies on the NHS after health service chiefs
said homeopathy was “at best, a placebo”.
The Royal London Hospital for Integrated Medicine
(RHLIM), formerly the Royal London Homeopathic
Hospital, describes itself as the “largest public-sector
provider of integrated medicine in Europe”.
Integrated medicine centres offer alternative remedies,
such as acupuncture and herbal medicines, alongside
more evidence-backed interventions such as cognitive
behavioural therapy, for managing conditions like pain
and insomnia.
Policy changes by NHS commissioners in London will
now end funding for those without robust evidence, in
line with national guidance.
A patient leaflet from University College London
Hospitals Foundation Trust, which RLHIM is part of,
says: “From 3 April 2018, The Royal London Hospital
for Integrated Medicine (RLHIM) will no longer be
providing NHS-funded homeopathic remedies for any
patients as part of their routine care.”
A statement on the RLHIM website said it would also
“no longer be providing NHS-funded Herbal Medicine
for any patients as part of their routine care”.
“This is in line with the funding policy of Camden
Clinical Commissioning Groups, the local NHS body
that plans and pays for healthcare services in this
area,” the statement added.
Non-evidence backed treatments can still be purchased
privately.
The statement continued: “Should you choose, you
will be able to purchase these medicines from the
RLHIM pharmacy, while other homeopathic
pharmacies may also be able to supply the medicines.
“You can speak to your clinician or the RLHIM
pharmacy at your next visit about this.”
Critics of homeopathy welcomed the change, saying it
left just Bristol and Glasgow funding homeopathy in
the UK.
Remedies are made up of ingredients which cause that
condition or replicate its symptoms, based on the
premise that “like will cure like”, and are then diluted
to one part in a trillion.
According to the NHS: “Practitioners believe that the
more a substance is diluted in this way, the greater its
power to treat symptoms.”
However, systematic reviews of the evidence found it
was no better than a placebo for 0 out of 68 illnesses.
NHS England wrote to Health Secretary Jeremy Hunt
calling for an outright ban on homeopathic remedies
on the NHS and changed its guidance to make clear it
should not be routinely funded.
Chief executive Simon Stevens, ahead of the health
service’s review of homeopathic, herbal and
alternative remedy funding, said: “At best,
homeopathy is a placebo and a misuse of scarce NHS
funds which could better be devoted to treatments that
work.”
Michael Marshall, project director at the Good
Thinking Society which has been tracking NHS
funding of homeopathy and campaigning against it,
told The Independent: “This now should mean that
homeopathy is finished in London, saving the NHS
£3m.
“We’ve already tackled and ended funding across the
majority of the rest of the country, leaving just Bristol
and Glasgow as the last remaining pockets of NHS
homeopathy spending”.
Humanists UK Director of Public Affairs and Policy
Richy Thompson, said: “We are delighted by the
announcement by The Royal London Hospital for
Integrated Medicine that it will end public funding of
a pseudo-scientific ‘medicine’ that for decades has
failed to show any beneficial outcomes for patients.
The Hospital has in recent years been responsible for
the majority of state funding.
He added that some state-funded Steiner schools also
still fund these services and this will be "increasingly
difficult to justify".
http://www.independent.co.uk/news/health/nhs-
homeopathy-uk-alternative-medicine-hospital-
camden-royal-london-hospital-for-integrated-
medicine-a8253061.html
PRELIM 5
CRISPR is a biological system for
altering DNA. Known as gene editing,
this technology has the potential to
change the lives of everyone and
everything on the planet. Some biotech
firms are working on the theory that
CRISPR might be used to boost the
function of the body's T cells so that
the immune system is better at
recognizing and killing cancer.
Disorders of the blood and immune
system are other potential targets.
However, gene editing could be used to
genetically engineer bacteria or viruses
to be used in biological attacks against
humans, or to cause widespread crop
damage. Some experts claim that
editing the DNA of a human embryo,
sperm, or egg to influence the embryos would be kept for up to 14 days to harvest
characteristics of a future person could stem cells.
be morally permissible In the present state of science, hybrid embryos are
produced as research tools, and only kept alive for 14
THIS HOUSE SUPPORTS HYBRID- days or fewer. The article below only deals with the
ethical issues of this case, and not with the ethics of
EMBRYONIC CLONING producing new creatures that are a combination of
animal and human.
Human-animal hybrid A hybrid embryo is a mixture of both human and
animal tissue. There are several types of hybrid
embryo (listed below), but recent controversy has
focused on cytoplasmic embryos.
embryos
These are created by transferring nuclei containing
DNA from human cells into animal eggs that have had
A hybrid embryo is a mixture of both human and
almost all of their genetic information removed.
animal tissue.
The resulting embryos are more than 99% human,
with a small animal component, making up around
The science 0.1% (more detail below).
The embryos are grown in the lab for a few days, then
Bioethics: Human-animal hybrid embryos
harvested for stem cells: immature cells that can
In May 2008 a cross-party attempt to ban hybrid become many types of tissue. The embryonic stem
human animal embryos was defeated on a free vote in cells are used in research into different diseases as a
way of addressing the shortage of human eggs
the House of Commons, by 336 to 176. MPs had been
available for research.
debating the Human Fertilisation and Embryology
Bill, which would allow regulated research using
hybrid or 'admix' embryos, where the nuclei of human Scientists do not intend to actually create living
cells are inserted into animal eggs. The resulting animal-human hybrids. [Such beings are often referred
to as chimeras after a creature in Greek mythology
which had a lion's head, a goat's body, and a serpent's
tail.]
Some 200 medical charities have urged MPs to
support legislation allowing the creation of animal-
human embryos.
Possible types of animal/human hybrid embryos
 Cytoplasmic hybrid embryos: embryos created
through cell nuclear replacement using animal
eggs
 Hybrid embryos: embryos created by mixing
human sperm and animal eggs or human eggs and
animal sperm
 Human chimera embryos: human embryos which
have animal cells added to them during early
development
 Animal chimera embryos: animal embryos which
have human cells added to them during early
development
 Transgenic human embryos: human embryos
which have animal genes inserted into them
during early development
Source: Human Fertilisation and Embryology
Authority
Proportions of human and animal DNA
In cytoplasmic hybrid embryos, all the DNA in the
cell nucleus is human. The remaining animal DNA is
found only in the mitochondria, which are small rod-
shaped organelles found outside the nucleus that
produce energy for the cell. Mitochondrial DNA is
separate from nuclear DNA; it is not involved in
cellular division or reproduction.
So the main genetic material is 100% human.
Embryos produced by this technique are considered
fully human - a "live human embryo" - by the Human
Fertilisation and Embryology Act.
A combination of human nuclear DNA and animal
mitochondria is likely to make a difference to the
resulting cells, but not enough is known about
mitochondrial disorders to predict what the effects
might be. The House of Commons Select Committee
report acknowledged this and viewed it as a positive
point.
However, rather than deem this a reason not to
conduct such research, [Dr Justin St John from
Birmingham University] believes that the creation of
human-animal chimera or hybrid embryos may
actually "offer us the opportunity to elucidate some of
the causes of mitochondrial DNA disease" and that
"not to allow this work to go ahead would
considerably disadvantage experimental work in these
fields".
House of Commons Select Committee on Science and
Technology Fifth Report, June 2007
Public opinion
In 2007, a poll conducted by the HFEA found that
61% of the public supported the research after having
the process and goals explained to them, while a
quarter was opposed to the research.
The debate
Ethical issues
We believe, too, that we are God's partners in the
work of creation, both as innovators and as protectors,
and that this partnership obliges us to be guided by
ethical principles.
Office of the Chief Rabbi, Memorandum to Select
Committee on Science and Technology November
2004
There are strong arguments on both sides of the ethics
of creating human/animal embryos. We've listed some
of the arguments put forward below.
In some cases the arguments seem to be similar but
expressed in a different way.
In some cases arguments on the same side of the case
seem to conflict with each other.
Quotations on both sides of the argument can be found
at BBC News - In quotes: The ethics of embryos
Arguments against creating human/animal
embryos
...the creation of an animal-human being represents a
natural border that has been violated, the most grave
of violations.
Bishop Elio Sgreccia, president of Pontifical Academy
for Life, May 2007
 It blurs the distinction between human beings and
other animals
 It's a repulsive thing to do
 It's unnatural
 It's playing God
 It violates human dignity
 Human embryos have a special (moral) status from
the moment of fertilisation that should be
respected and this makes any research using
human embryos wrong and a violation of their
human rights
 It's wrong to create beings (embryos) that are
solely at the disposal of scientists; it says that it is
acceptable to create motherless beings and could
open the way to the creation of beings that are
effectively owned by whoever controls the
medium in which the embryo develops
 Even if using human embryos for research is
sometimes acceptable, creating animal/human
hybrid embryos is a step too far
 It's the start of a slippery slope that could lead to
creating hybrid human/animal creatures capable
of independent life
 It's wrong to use animals in this sort of research
 The research will be of little scientific value - no
new treatments have been produced by
embryonic stem cell research
 Mixing human and animal genetic material risks
creating new diseases
Arguments in favour of creating human/animal
embryos
We think there is nothing illegal, immoral or unethical
about this.
While we understand the concerns, we think they are
largely founded on misinformation. People think we
are generating some sort of hybrid animal. This is just
cells, just for science. No animal is ever going to be
created.
Professor Chris Shaw, Kings College London, 2008
 It may produce enormous benefits for human
beings
 It is a strictly limited procedure - creatures capable
of independent life will not be created. These are
'just cells', not actual beings
 It avoids the use of human eggs in research
 The genetic contribution of the animal to the
embryo is so small that it is essentially a human
embryo
 Since the embryo was not produced by human
fertilisation, it can't be regarded as a human
embryo
 It's very similar to cell nuclear replacement
research, and if we accept research on human
embryos up to 14 days, there is no reason to
oppose research on an embryo that is less than
wholly human
 Neither human nor animal rights are violated since
the embryo will never be allowed to become a
human or an animal
http://www.bbc.co.uk/ethics/animals/using/hybridem
bryos_1.shtml
Researchers Claim Embryonic
Cell Mix Of Human and Cow
Correction Appended
Venturing deep into uncharted realms of ethics and
medicine, a small biotechnology company said
yesterday that its scientists had for the first time made
human cells revert to the primordial, embryonic state
from which all other cells develop, by fusing them
with cow eggs and creating a hybrid cell.
The research comes from biologists who are well
known in their field but has yet to be confirmed or
published in a scientific journal. Their company,
Advanced Cell Technology of Worcester, Mass., said
the method could eventually be used to grow
replacement body tissues of any kind from a patient's
cells, sidestepping the increasing scarcity of organs
available for transplant and the problems of immune
rejection.
The technique is likely to concern and perplex
ethicists because it would involve the creation of an
embryonic cell that is part human and part cow,
consisting of a human cell's nucleus in a cow egg
whose own nucleus had been removed. The company
said the hybrid cell quickly became more humanlike
as the human nucleus took control and displaced cow
proteins with human proteins. Creation of the
embryonic cells is an important component of a
strategy that in principle offers high medical benefits
if it can overcome the high barrier to public
acceptance.
The technique would involve creating an embryo of
uncertain moral status, and one that crosses the barrier
between humans and other species. Even though a
hybrid would be in the form of cells, not a whole
organism, the concept of half-human creatures arouses
deep-seated anxiety, as is evident from the unfriendly
powers ascribed to werewolves, centaurs, mermaids,
Minotaurs and other characters of myth and folklore.
''Many people are going to be horrified by this
scenario, others will say 'So what?' '' said Thomas
Murray, director of the center for biomedical ethics at
Case Western Reserve University in Cleveland and a
member of the National Bioethics Advisory
Commission. ''This is the sort of thing that makes me
very uncomfortable,'' Mr. Murray said. ''I think we are
likely to get a very powerful reaction to it, and I would
like for all of us to have a breathing space here to
articulate our moral concerns.''
Another serious uncertainty is the preliminary nature
of Advanced Cell Technology's work. No article has
yet been submitted for peer review and publication in
a scientific journal, an essential touchstone of
credibility. Scientists asked about the company's work
said they would require much more proof before
believing that human embryonic stemlike cells had
been created as the company contends, and some were
skeptical that the technique would work.
Announcement Tests the Waters
The company said yesterday that it had achieved the
feat with one cell almost three years ago. Dr. Michael
D. West, Advanced Cell Technology's chief executive,
said that he was announcing the work to test its public
acceptability He said the company, which is privately
held, was not planning to go public or raise money
now but needed to decide whether to commit money
to development of the technique.
Some scientists praised Dr. West's decision to make
his work public but others were critical, saying he has
invited a possibly fraught public debate on a slender
basis of fact.
Dr. West is the founder of Geron, a biotechnology
company in Menlo Park, Calif., that has had two
spectacular successes this year in research on aging. In
January it developed a method for ''immortalizing''
human cells grown in the laboratory by making them
leap the supposedly immutable barrier at which cells
usually lapse into senescence. Last week two
university teams sponsored by Geron said they had
isolated and cultivated human embryonic stem cells,
the all-purpose cells from which the fetus develops.
Dr. West laid the foundations for these developments
by sponsoring leading scientists in the two fields.
Researcher Uses His Own Cells
Advanced Cell Technology, which Dr. West joined in
October, has focused on cloning and genetically
improving cows, a technology developed by James M.
Robl and colleagues at the University of
Massachusetts at Amherst. Dr. West said he hoped to
use the technology to further the idea on which he
founded Geron, that of delving into the mystery of
human aging and sidestepping some of its processes.
The company said the work with human cells was
performed in 1996 by a Jose Cibelli, a colleague of Dr.
Robl's at the University of Massachusetts. Using 52 of
his own cells, some of them white blood cells and
others scraped from the inside of his cheek, Dr. Cibelli
fused each one with a cow egg whose own nucleus
and DNA had been removed, the company said. Most
failed to thrive but one embryo grew and divided five
times, generating cells resembling embryonic stem
cells. Dr. Cibelli and Dr. West say the method could
be made more efficient with present technology. They
use cow eggs because these are far cheaper and more
available than human eggs and raise no ethical
problems.
Considering this work was sufficient to describe an
invention, Dr. Robl and Dr. Cibelli filed a patent
application and then set the research aside to focus on
the more immediately practical field of cow cloning,
they said. Only two others beside himself and Dr.
Robl knew what had been done, Dr. Cibelli said. The
patent has not yet been issued but Dr. West said he
was confident of receiving ''important intellectual
property'' in the field. He said he is making the hybrid
cell technique public now ''because I want to be very
open and level with everyone. We need to get the
ethicists to talk about it so as to encourage a rational
response to these new technologies.''
Dr. Cibelli said he regarded any embryos obtained in
this way as ''not a separate individual, just a de-
differentiated cell from a patient.'' Differentiation is
the process whereby the all-purpose cells of the very
early embryo, known as human embryonic stem cells,
become committed to their roles as the various
specialized tissues of the body. The process is
irreversible in nature, but egg cells apparently have the
ability to de-differentiate, or reset to default mode, the
settings in a specialized cell's nucleus. This is
presumably what happened in the experiment reported
this July when mice were cloned by transferring the
nucleus of an adult mouse cell into another mouse's
egg cell.
Dr. Cibelli, who trained as a veterinarian in Argentina,
said he believed he and his colleagues ''were the first
to de-differentiate a human cell by nuclear transfer.''
Asked if he was concerned about destroying, in
principle, potential twins of himself, he said: ''I never
thought about it, it's a good question. But if you use
your own cells to treat a disease you may have, you
are not taking cells from another person selfishly.''
Dr. West and Dr. Cibelli said they had no intent of
transferring the embryos to a uterus, a step considered
unethical and unsafe: the embryos would be created
solely for the purpose of tissue culture. ''Any
technology can be abused, but once the public
understands how these cells can be used to treat any
disease caused by loss or malfunction of cells, from
Parkinson's to diabetes to heart disease, the concerns
will be overshadowed,'' Dr. West said.
Lack of Evidence Raises Doubts
Whether Dr. West's prediction will be borne out
depends on two major sets of factors, the scientific
validity of the proposed method and the ethical and
legal questions that related work has already raised.
From discussions with scientists, ethicists and lawyers
in the past few days, these concerns have emerged.
Scientists are particularly critical of the lack of
supporting evidence accompanying Advanced Cell
Technology's announcement, saying in essence the
claim could be true but there is no compelling reason
to accept it. Even if the claim is valid, biologists note a
serious uncertainty relating to an important component
of the cells known as the mitochondria, which produce
the energy the cell needs and are, in essence, its
batteries. If the bovine mitochondria should prove
incompatible with their humanized environment, the
cells will not be viable.
Ethicists said the mixing of species was likely to
trouble the public severely, at least at first. Lawyers
who specialize in issues of human reproduction note
that the moral and legal status of the human embryo is
undecided in American law, a fact pointed up by the
isolation of the human embryonic stem cells
announced last week. The new entity adds further
complexity.
If Advanced Cell Technology can produce viable
hybrid cells, they would offer a new route to growing
new tissues for transplant. This is the same goal held
by the scientists who announced last week that they
had grown human embryonic stem cells in the
laboratory. It is widely accepted in principle that
embryonic stem cells can be directed to develop into
any desired tissue, with enormous potential for
medicine, though this has yet to be achieved in
practice.
Dr. West said the advantage of the Advanced Cell
Technology method is that embryonic cells derived
from the patient being treated would generate entirely
compatible tissues. The two methods reported last
week, by Dr. James A. Thomson of the University of
Wisconsin and Dr. John Gearhart of the Johns
Hopkins University, derive stem cells from human
embryos or fetuses. Tissues made from these cells
would be incompatible with the patient, a problem that
has not been resolved.
In support of its claim, Advanced Cell Technology
supplied a patent application and a photograph taken
of its embryonic cells under a microscope. The patent
application describes how the cells are made but
provides no proof that they possess the properties to
be expected of human embryonic stem cells. Dr. Robl
said his laboratory was not set up to perform the
required tests at the time the hybrid cells were made.
Shown the photograph of the purported hybrid cells,
Dr. John Gearhart of Johns Hopkins, author of one of
the two methods reported last week, said that ''they
certainly could be embryonic stem cells'' but that no
scientific journal would publish the result without
further proof. ''It's not that I don't believe this
biologically, I just think they could have given a little
bit more assurance as to what was done here.''
Dr. Roger Pedersen of the University of California,
San Francisco, who also works on human embryonic
stem cells, said he doubted any hybrid cells would last
long enough to develop into useful tissue because of
their cow-derived mitochondria. The mitochondria of
chimpanzees and gorillas work well enough in human
cells but those of primate species that diverged more
than 10 million years ago from the human line, do not
work.
Because cows and humans last shared an ancestor so
long ago, cow mitochondria are very unlikely to work
well with a human nucleus, in Dr. Pedersen's view,
and as most of the mitochondria in the hybrid cells are
contributed by the cow egg, the cells would probably
not remain viable for long. ''It's hard to say this is a
total sham, but I smell a sham here,'' he said.
Citing the same data, Dr. Gearhart said the
mitochondria in the hybrid cell had clearly carried it
through its first few divisions but might not sustain it
in further development, unless the few human
mitochondria that were also present somehow took
over.
Dr. Pedersen said Advanced Cell Technology should
be held to a high standard of proof ''because of what
the implications are for upsetting people unnecessarily
-- if you cry fire in a crowded auditorium you may be
liable if it's a false alarm.''
New Frontiers For Medical Ethics
The human embryonic stem cells announced last week
have already pushed against the frontiers of ethical
acceptance. Experts in biomedical ethics say the
public is likely to be alarmed by the new technique,
particularly because of the mingling of species. Dr.
Murray of Case Western Reserve University in
Cleveland said that the hybrid embryo ''escapes our
usual categories.'' When biologists first learned to
transfer genes from one species to another, ''The idea
of human-animal hybrids was often raised as the kind
of monstrosity that no morally perceptive person
would ever create,'' he said.
''Even if it's only to create tissue, the minute you start
mixing species you raise all kinds of red flags in
people's minds,'' said Barnie Steinboch, a moral
philosopher at the State University of New York in
Albany. But she noted that pig valves are now seen as
acceptable replacements in human hearts.
Rebecca Dresser, a law professor at Washington
University in St. Louis, noted, as did several
biologists, that distinctions between humans and other
animals are less clear in nature than they are in
people's minds. ''Biologically a lot of this research is
showing us similarities and the upshot in a hundred
years may be that the lines between humans and
nonhumans will be viewed as a little bit grayer,''
Professor Dresser said.
A perplexing feature of the hybrid embryo would be
that it would start mostly bovine, then become mostly
yet not entirely human. But some legal experts have
no doubt that any hybrid should be regarded from the
start as a human embryo. ''It doesn't matter that the
mitochondria come from a cow, it also has human
mitochondria and so has all the potentials of a human
embryo,'' said Lori Andrews, a professor at the
Chicago-Kent College of Law in Chicago.
''Once it's gone through that first division it has gone
from being a somatic cell to a thing with potential
life,'' Dr. Andrews said, referring by somatic to the
ordinary specialized cells of the human body. If
transferred to a woman's uterus the embryos might or
might not come to term, ''but under state laws it
doesn't matter whether the fetus is going to be born or
not -- it doesn't make them less human.''
The human body consists of 100 billion cells. Should
embryos created from them by the cow egg method be
regarded as having special status when they can be
made so easily and plentifully? Dr. Andrews said that
human embryos are not so hard to make the usual
way, and the fact that an embryo is easily made, by
whatever means, is irrelevant to arguments about its
status.
The moral status of the human embryo ''is not clearly
established in U.S. law,'' Dr. Dresser said. The embryo
can be regarded as mere property, as a person, or as
something in between but deserving of special respect.
Congress, in banning the use of Federal money for
research on human embryos, has favored the view that
they are in the category of people. But in custody
battles over fertilized embryos, courts have favored
the special respect status. Dr. Dresser said the hybrid
cells could be seen as between the property and
special respect status.
The company said the hybrid cells were made by Dr.
Cibelli in Dr. Robl's laboratory in the University of
Massachusetts at Amherst. Michael Weinberg,
executive secretary of the university's human subjects
committee, said the experiment was given
administrative approval, without review by the
committee or major discussion. Dr. Cibelli was using
his own cells, not experimenting on other people, and
self-experimentation does not require special consent.
''If someone wants to inoculate themselves they can do
that,'' Dr. Weinberg said.
orrection: November 14, 1998, Saturday An article on
Thursday about a biotech company's claim to have
converted human cells to their primordial state by
fusing them with cow eggs misspelled the name of a
philosophy professor who said the technique would
raise red flags in people's minds. She is Bonnie
Steinbock, not Barnie Steinboch.
http://www.nytimes.com/1998/11/12/us/researchers-
claim-embryonic-cell-mix-of-human-and-cow.html
First British human-
animal hybrid embryos
created by scientists
· Breakthrough could pave way for stem cell supply
· Move will aid research into untreatable conditions
Britain's first human-animal hybrid embryos have
been created, forming a crucial first step, scientists
believe, towards a supply of stem cells that could be
used to investigate debilitating and so far untreatable
conditions such as Alzheimer's disease, Parkinson's
and motor neurone disease.
Lyle Armstrong, who led the work, gained permission
in January from the Human Fertilisation and
Embryology Authority (HFEA) to create the embryos,
known as "cytoplasmic hybrids".
His team at Newcastle University produced the
embryos by inserting human DNA from a skin cell
into a hollowed-out cow egg. An electric shock then
induced the hybrid embryo to grow. The embryo,
99.9% human and 0.1% other animal, grew for three
days, until it had 32 cells.
Eventually, scientists hope to grow such embryos for
six days, and then extract stem cells from them. The
researchers insisted the embryos would never be
implanted into a woman and that the only reason they
used cow eggs was due to the scarcity of human eggs.
The team's success comes days after Gordon Brown
was forced to give MPs a free vote on the human
fertilisation and embryology bill, which has faced
condemnation from Catholic bishops. Cardinal Keith
O'Brien used his Easter sermon to denounce what he
called experiments of "Frankenstein proportion" and
called the bill a "monstrous attack on human rights,
human dignity and human life".
Catholics object to the idea of putting human and
animal DNA in the same entity and to the notion of
creating what they regard as a life for the purposes of
research, a life that will then be destroyed.
John Burn, head of the Institute of Human Genetics at
Newcastle University, said the embryos had been
created purely for research. He told the BBC's Six
O'Clock News last night: "If you look down the
microscope it looks like semolina and it stays like that.
It's never going to be anything other than a pile of
cells. What it does is give us the tools to find out the
simple questions: how can we better understand the
disease processes by working with those cells in the
body?"
The research has not yet been published, but the team
plans to submit the work for peer review in the coming
months. Other scientists welcomed the work but also
urged caution in interpreting the results.
Colin Blakemore, a former head of the Medical
Research Council, said: "The creation of hybrid
embryos is not illegal and researchers in Newcastle
and London were granted provisional licences for such
research in January, after extensive consultation by the
HFEA ... This research is at a very early stage and no
results have been peer-reviewed or published.
"However, these preliminary reports give hope that
this approach is likely to provide stem cells for
research without the use of human eggs or normal
human embryos. The new bill is intended to confirm
the arrangements for regulation of this important area
of research."
Mark Walport, director of the Wellcome Trust, agreed
that it was too early to assess the significance of the
results. "The aim of the research is to advance human
health," he said. "This work emphasises the
importance of the parliamentary scrutiny of this area
of research over the coming weeks."
Peter Andrews, professor of biomedical science at the
University of Sheffield's Centre for Stem Cell
Biology, said: "The production of embryos by
transferring the nucleus of an adult human cell to a
human egg ... has already proved very difficult, let
alone combining a human nucleus with an animal egg.
Apparently these researchers have achieved some
success - but by using the nucleus from a very early
embryonic cell, which might be easier to reprogramme
than an adult cell. At the moment it is impossible to
assess the significance of this report until we know
more details of what has been achieved ... the results
have been repeated and, importantly, they have been
reviewed by independent researchers in the usual
way."
Josephine Quintavalle, of the pressure group
Comment on Reproductive Ethics, said the research
should not worry those opposed to hybrid embryos
because the Newcastle work did not seem convincing.
"The embryos didn't survive, they were created from
embryonic stem cells rather than adult tissue, and
there's a lot of question marks over the research."
But she added: "What it has done is wake up the
public to this reality, that while parliament is getting in
a tizz about this, while the whole country is up in arms
discussing it, the HFEA is already issuing licences."
Evan Harris, the Liberal Democrat MP who led a
campaign to ensure that research on human-animal
hybrids was not banned by parliament said: "Creating
these sort of cytoplasmic hybrid embryos was deemed
legal and legitimate under the 1990 HFEA Act and the
2001 Therapeutic Cloning Regulations by both the
HFEA and by the science select committee, and was
approved on that basis by the HFEA after a public
consultation and after approval by a further unanimous
select committee report. Therefore it is wrong to say
that this is pre-empting parliamentary debate or votes
on the new legislation in this area - the statutory
framework is being updated."
https://www.theguardian.com/science/2008/apr/02/me
dicalresearch.ethicsofscience
CRISPR goes wild, and
scientists debate its
fidelity
by Hannah Furfaro / 30 April 2018
This article was originally published 5 July 2017,
based on a paper published in Nature Methods. The
journal retracted this paper on 30 March 2018, citing
problems in the study design.
The researchers used the gene-editing tool CRISPR to
correct a mutation that causes blindness in mice. They
concluded that the editing caused thousands of off-
target mutations. In its retraction, the journal stated
that the researchers’ methods leave open the
possibility that the edited and control mice had
different genomes before the researchers used
CRISPR. The researchers also didn’t publish data
showing the mice were identical before they used
CRISPR. As a result, the retraction reads, the
researchers didn’t prove that gene editing led to the
unintended mutations.
The gene-editing tool CRISPR may cause thousands
of unintended mutations, but critics say it’s way too
soon to accuse it of infidelity1.
A two-page study, published 30 May in Nature
Methods, put biology’s hottest technique in the
crosshairs, questioning its ability to rewrite DNA with
the precision necessary for medicine. The paper’s
findings quickly dominated social media
conversations on biology. And the stocks of biotech
companies with CRISPR-based projects dipped by as
much as 15 percent.
But some researchers are loath to end their love affair
with CRISPR. Reports of the method’s infidelity, they
say, are greatly exaggerated. One reason, they note, is
that the study is small — just two mice for CRISPR
and a single control mouse.
“I think it’s an important finding that we really need to
follow up, but it’s really hard to judge why there are
so many [mutations],” says Guoping Feng, professor
of brain and cognitive sciences at the Massachusetts
Institute of Technology. He says another enzyme the
team used may in fact have caused the errant
mutations.
Two weeks after the paper’s publication, Nature
Methods editors added a note to the paper, saying they
are considering the criticism of the results and plan to
respond soon.
Wandering scalpel:
CRISPR is a molecular scalpel that cuts DNA. It can
home in on a specific spot on the molecule using a
piece of RNA as a guide. The tool holds significant
medical promise because it could help modify or fix
genes that cause medical conditions.
In 2016, Alexander Bassuk’s team reported injecting
mouse embryos with CRISPR fused to its usual
protein partner, CAS9, which binds to DNA. The
researchers targeted a gene called PDE6B that is
involved in vision. The experiment was designed to
correct a mutation that causes blindness in the mice2.
It did.
For the new study, Bassuk and his collaborators
looked for off-target effects of the treatment. They
sequenced the whole genomes of the two mice and the
control mouse. They compared the results from the
edited mice against a database that includes genomes
of 36 mouse strains.
CRISPR-CAS9 introduced more than 100 unintended
mutations and more than 1,600 one-letter swaps in the
code of DNA, the researchers found.
None of these changes had any obvious consequences.
“As far as we can tell, it hasn’t affected the mice,”
says Bassuk, professor of pediatric neurology at the
University of Iowa in Iowa City. But the researchers
tested only the mice’s vision and do not know if the
mutations affected the animals’ behavior or
perception.
This was not the first time that CRISPR had caused
accidental mutations, though previous reports found
far fewer mutations3.
“It’s always been a concern for everyone in the field
that this is not a completely clean method,” says Anis
Contractor, associate professor of physiology at
Northwestern University in Chicago. Contractor was
not involved in the research but uses CRISPR to make
mouse models. “This is a big red flag.”
Contractor and others say the findings may prompt a
change in best practices when using the method.
Scientists may need to sequence the genomes of their
models — an expensive task — to uncover any
unexpected mutations.
Rushed job:
Others, however, are downplaying the results.
“I don’t think this paper has any merit for CRISPR
research,” says George Church, professor of genetics
at Harvard University. “I think it’s a negative example
that we can use as a cautionary tale.” Church is co-
founder of Editas Medicine, a biotechnology company
that is using the technique to develop gene-editing
therapies. The company lost 12 percent of its value the
day the study was published. (Its stock has since gone
up, surpassing its previous value.)
Church and the company’s other executives wrote to
Nature Methods with a laundry list of concerns about
the paper. Their biggest beef, says Church: The
study’s control mouse likely wasn’t genetically
identical to the ones that had been edited with
CRISPR, so it’s impossible to know whether the
mutations resulted from the method.
Instead, Church argues, it’s possible that the mutations
represent natural genetic variance between the
animals. Church stops short of saying the paper should
be retracted but calls it a “rushed job.” Another gene-
editing company, Intellia Therapeutics, voiced similar
complaints.
The team also used an unusual version of the editing
system, says Feng, who is using CRISPR to create
animal models of autism. He says the use of extra
nickase, an enzyme that can cause breaks in a strand
of DNA, could have caused the mutations.
“I couldn’t figure out what reason you’d need to do it
this way,” he says.
Bassuk points out that the team did the editing work in
2015, early in CRISPR’s use.
“We used what was available at the time,” Bassuk
says. “It’s obviously not what people are using in
2017.” He says he is not sure whether the editing
system made a difference in the results.
In the past three months, researchers have debuted the
first two mouse models of autism created using
CRISPR. No one has yet published work on using
CRISPR to correct genes in animal models of the
condition.
In the short term, the findings “will definitely temper
the enthusiasm for CRISPR models,” says J. Tiago
Gonçalves, assistant professor of neuroscience at
Albert Einstein College of Medicine in New York,
who was not involved in the research. “But in the end,
I’m confident the problems will be solved and we’ll
figure out what’s happening.”
https://www.spectrumnews.org/ne
ws/crispr-goes-wild-scientists-
debate-fidelity/
Researchers Debate on
Whether CRISPR Works
in Embryos
Published: Aug 13, 2018 By Mark Terry
CRISPR, the gene editing technique that promises
designer babies, to end to all disease as we know it,
and biohacking where individuals could change their
own genome to include that of fluorescent jellyfish or
lobster claws, seems to have more problems than
originally thought. It’s still an amazing technique, but
the further researchers push into it, the more
controversy it seems to generate, and as far as is
known, nobody’s trying to merge human DNA with
that of lobsters—yet.
At least two studies in June linked CRISPR to cancer.
This is because CRISPR, using the Cas9 enzyme
(other enzymes are now appearing to be more precise
than Cas9, the first discovered), sometimes makes
mistakes in other parts of the genome, which could
result in cancer cells.
And at least as controversial, in August 2017,
researchers at Oregon Health & Science
University conducted work on human embryos, using
CRISPR to remove a mutated, heart-disease-causing
gene, replacing it with a healthy gene. What
Shoukhrat Mitalipov, the biologist in the study,
found was that every one of the 112 embryos ignored
the healthy gene replacement. “Instead,” STAT wrote
at the time, “they copied the healthy gene from their
mother and incorporated that into their genome to
replace the father’s.”
And then the controversy erupted. Although some of
the controversy was related to an ethical debate about
so-called “designer babies,”—and isn’t likely to end
anytime soon—there was quite a bit of debate among
scientists on exactly what the findings of the study had
to say about using CRISPR for gene replacements.
Which is good, that’s what science is all about.
STAT writes, “Recent studies have shown that
CRISPR can tear through a genome like a tornado
through Kansas, leaving swaths of nothingness. That
can make it impossible to tell what CRISPR actually
did, as a study last month revealed, which could be
why Mitalipov didn’t detect the mutant paternal gene,
argued scientists led by Maria Jasin of Memorial
Sloan Kettering Cancer Center and, separately, Paul
Thomas of Australia’s University of Adelaide. Both
critiques and Mitalipov’s response were published in
Nature.”
Dieter Egli of Columbia University, Jasin’s co-
author in the critique, told STAT, “Evidence for
correction was not provided in the original article.
[But] I’ve come to accept that some of the embryos
have been edited.”
Mitalipov, however, defends the original conclusions,
and in his response, published in Nature, wrote, “To
rule out the possibility of large deletions, we decided
to carry out a large-scale re-testing of all embryonic
blastomere samples from our published study,” and
detailed the different methods they used to re-analyze
the embryos. “In summary, all these tests failed to
detect the presence of large deletions up to ±5 kb from
the mutation site in CRISPR-Cas9-treated human
embryos. Although the PCR primers used in this study
did not identify much larger deletions, available
evidence suggests that most deletions induced by
CRISPR-Cas9 should have been detected with our
assays.”
In other words, Mitalipov stands by his original
interpretation and backs it up with further testing.
If further work verifies Mitalipov’s findings, it
suggests that using CRISPR as is won’t be enough to
start fixing genes in embryos, at least not yet. STAT
noted, “In every case where CRISPR deleted the
paternal, mutant gene as intended, the embryo’s
genome repaired it not with the healthy gene that
CRISPR carried but by copying the healthy gene on
the maternal chromosome.”
Currently, there are clinical trials ongoing in China,
Europe and the United States using CRISPR. CRISPR
Therapeutics is treating patients with beta
thalassemia in Europe using its gene-editing tool. In
that trial, researchers harvest stem cells from the
patients and use CRISPR to fix the cells, so they have
increased levels of fetal hemoglobin, then infuse them
back into the patients’ bodies via stem cell transplant.
As of February 2018, there were nine registered
clinical trials of CRISPR-edited cells to treat cancer
and HIV infections in China. There is one at the
University of Pennsylvania for melanoma, sarcoma,
and multiple myeloma.
It’s possible that the techniques will “stick” when used
in individual cells that are then transplanted back, as
compared to Mitalipov’s experiments on embryos. It’s
also possible that the technique, as is the case with
many immuno-therapies like CAR-T, is easier to do in
hematological diseases than in solid tissue diseases.
Time will tell.
STAT writes, “For DNA not carried by either parent,
including for supposedly desirable cosmetic or other
traits, ‘that procedure doesn’t really work,’ Mitalipov
said. ‘The external repair template has no chance’
against the gene from mom or dad. That underlines
something CRISPR experts agree on: The technique is
too unpredictable and unreliable for use in fertility
clinics any time soon."
https://www.biospace.com/article/
researchers-debate-on-whether-
crispr-works-in-embryos/
Questions and Answers about CRISPR
Q: What is “CRISPR”?
A: “CRISPR” (pronounced “crisper”) stands for
Clustered Regularly Interspaced Short Palindromic
Repeats, which are the hallmark of a bacterial defense
system that forms the basis for CRISPR-Cas9 genome
editing technology. In the field of genome
engineering, the term “CRISPR” or “CRISPR-Cas9”
is often used loosely to refer to the various CRISPR-
Cas9 and -CPF1, (and other) systems that can be
programmed to target specific stretches of genetic
code and to edit DNA at precise locations, as well as
for other purposes, such as for new diagnostic tools.
With these systems, researchers can permanently
modify genes in living cells and organisms and, in the
future, may make it possible to correct mutations at
precise locations in the human genome in order to
treat genetic causes of disease. Other systems are now
available, such as CRISPR-Cas13’s, that target RNA
provide alternate avenues for use, and with unique
characteristics that have been leveraged for sensitive
diagnostic tools, such as SHERLOCK.
Q: Where do CRISPRs come from?
A: CRISPRs were first discovered in archaea (and
later in bacteria) by Francisco Mojica, a scientist at the
University of Alicante in Spain. He proposed that
CRISPRs serve as part of the bacterial immune
system, defending against invading viruses. They
consist of repeating sequences of genetic code,
interrupted by “spacer” sequences – remnants of
genetic code from past invaders. The system serves as
a genetic memory that helps the cell detect and destroy
invaders (called “bacteriophage”) when they return.
Mojica’s theory was experimentally demonstrated in
2007 by a team of scientists led by Philippe Horvath.
In January 2013, the Zhang lab published the first
method to engineer CRISPR to edit the genome in
mouse and human cells.
For more on many of the scientists and teams who
contributed to the understanding and development of
the CRISPR system from the initial discovery to the
first demonstrations of CRISPR-mediated genome
editing, visit our CRISPR timeline.
Q: How does the system work?
A: CRISPR “spacer” sequences are transcribed into
short RNA sequences (“CRISPR RNAs” or
“crRNAs”) capable of guiding the system to matching
sequences of DNA. When the target DNA is found,
Cas9 – one of the enzymes produced by the CRISPR
system – binds to the DNA and cuts it, shutting the
targeted gene off. Using modified versions of Cas9,
researchers can activate gene expression instead of
cutting the DNA. These techniques allow researchers
to study the gene’s function.
Research also suggests that CRISPR-Cas9 can be used
to target and modify “typos” in the three-billion-letter
sequence of the human genome in an effort to treat
genetic disease.
Q: How does CRISPR-Cas9 compare to other
genome editing tools?
A: CRISPR-Cas9 is proving to be an efficient and
customizable alternative to other existing genome
editing tools. Since the CRISPR-Cas9 system itself is
capable of cutting DNA strands, CRISPRs do not need
to be paired with separate cleaving enzymes as other
tools do. They can also easily be matched with tailor-
made “guide” RNA (gRNA) sequences designed to
lead them to their DNA targets. Tens of thousands of
such gRNA sequences have already been created and
are available to the research community. CRISPR-
Cas9 can also be used to target multiple genes
simultaneously, which is another advantage that sets it
apart from other gene-editing tools.
Q: How does CRISPR-Cpf1 differ from CRISPR-
Cas9?
CRISPR-Cpf1 differs in several important ways from
the previously described Cas9, with significant
implications for research and therapeutics.
First, in its natural form, the DNA-cutting enzyme
Cas9 forms a complex with two small RNAs, both of
which are required for the cutting activity. The Cpf1
system is simpler in that it requires only a single RNA.
The Cpf1 enzyme is also smaller than the standard
SpCas9, making it easier to deliver into cells and
tissues.
Second, and perhaps most significantly, Cpf1 cuts
DNA in a different manner than Cas9. When the Cas9
complex cuts DNA, it cuts both strands at the same
place, leaving ‘blunt ends’ that often undergo
mutations as they are rejoined. With the Cpf1 complex
the cuts in the two strands are offset, leaving short
overhangs on the exposed ends. This is expected to
help with precise insertion, allowing researchers to
integrate a piece of DNA more efficiently and
accurately.
Third, Cpf1 cuts far away from the recognition site,
meaning that even if the targeted gene becomes
mutated at the cut site, it can likely still be re-cut,
allowing multiple opportunities for correct editing to
occur.
Fourth, the Cpf1 system provides new flexibility in
choosing target sites. Like Cas9, the Cpf1 complex
must first attach to a short sequence known as a PAM,
and targets must be chosen that are adjacent to
naturally occurring PAM sequences. The Cpf1
complex recognizes very different PAM sequences
from those of Cas9. This could be an advantage in
targeting, for example, the malaria parasite genome
and even the human genome.
Q: What other scientific uses might CRISPR have
beyond genome editing?
A: CRISPR genome editing allows scientists to
quickly create cell and animal models, which
researchers can use to accelerate research into diseases
such as cancer and mental illness. In addition,
CRISPR is now being developed as a rapid diagnostic.
To help encourage this type of research worldwide,
Feng Zhang and his team have trained thousands of
researchers in the use of CRISPR genome editing
technology through direct education and by sharing
more than 40,000 CRISPR components with academic
laboratories around the world.
Crispr’s Next Big Debate: How
Messy Is Too Messy?
When it comes to Crispr, the bacterial wünderenzyme
that allows scientists to precisely edit DNA, no news
is too small to stir up some drama. On Tuesday
morning, doctors from Columbia, Stanford, and the
University of Iowa published a one-page letter to the
editor of Nature Methods—an obscure but high-profile
journal—describing something downright peculiar.
About a year ago, they used Crispr to edit out a
blindness-causing genetic defect in mice, curing two
of their cohort. Later, they decided to go back and
sequence their genomes, just to see what else Crispr
did while it was in there.
A lot, it turned out. With their method, the researchers
observed close to 2,000 unintended mutations
throughout each mouse’s genome, a rate more than 10
times higher than anyone had previously reported. If
that holds up, Crispr-based therapies are in for some
serious trouble. No one wants to go in for a vision-
restoring treatment, only to wind up with cancer
because of it.
The ensuing headlines were gleefully apocalyptic:
“Crispr May Not Be Nearly as Precise as We
Thought,” “Crack in Crispr Facade after Unanticipated
In Vivo Mutations Arise,” and my personal favorite,
“Small Study Finds Fatal Flaw in Gene Editing Tool
Crispr.” And then the biotech stocks went into a
tailspin. The big three Crispr-based tech companies
got hit the hardest. By the close of trading Tuesday,
Editas Medicine was down nearly 12 percent, Crispr
Therapeutics fell more than 5 percent, and Intellia
Therapeutics had plunged to just over 14 percent.
This was far from just a blip in the nerdy news cycle.
A reaction to a single scientific publication on this
scale raises important questions about science’s
incentive structure, its processes for publicly
evaluating evidence, and what happens when those
butt up against the prevailing philosophies of other
professions—namely, medicine.
A decade ago, most of the conversations about this
letter would have happened in laboratory hallways.
But this week, geneticists, microbiologists, and
molecular bioengineers took to Twitter to digest the
paper in public. While some experts decried the paper
as unnewsworthy (everyone’s known about Crispr off-
target mutations forever!) the majority of threads
ticked off the experiment’s flaws: Tiny sample size!
Insufficient controls! Weird Crispr delivery! Out of
date/inefficient version of Crispr! The list goes on.
Many doubted if it had been peer-reviewed. (It had.)
The hashtag #fakenews even made a few appearances.
To be sure, the results do not match up well with
what’s already in the literature on this subject. And, as
the paper itself says, “The unpredictable generation of
these variants is of concern.” Which is to say, the
authors have no idea why or how these mutations are
happening. Derek Lowe, a longtime pharmaceutical
industry researcher who writes a blog on the subject
for Science, had enough doubt in the results that he
bought up some Editas and Crispr Therapeutics stocks
while they were down.
But most scientists, while skeptical of the results, were
more disappointed in the way the paper was blown out
of proportion. “It’s critically important to look closely
at genomes being edited with the Crispr system,
ideally with a method sensitive enough to detect even
rare off-target events,” says Stephen Floor, a
biophysicist who worked in Crispr creator Jennifer
Doudna’s lab at UC Berkeley before beginning his
own gene editing cancer research at UCSF. Saying
Crispr is 100 percent accurate or grossly inaccurate
isn’t helpful. What scientists need to understand is
which sites are being cut, what rules govern which
sites get cut, and how to emphasize only cutting at
sites you want. “It will be interesting to watch
subsequent validation that gets to the bottom of why
this report found such a surprisingly high rate of
mutation,” he says.
The key word there, if you didn’t catch it, is
“validation.” It’s pretty much the foundational tenet of
science. You have an idea, you test it, you test it again,
you eliminate confounding factors as best as you can
and then you validate your results. All the critiques of
the Nature Methods paper assumed the authors were
operating with that same premise.
But in this case, the authors weren’t just scientists:
They were also doctors. And in medicine, there’s a
different guiding principle that places a premium on
sharing significant results at face value.
The history of the case study is long and celebrated in
medicine. The first recorded report of what would one
day be known as HIV/AIDS was published by the
CDC as five strange cases of pneumonia in gay men in
Los Angeles. Vinit Majahan, an opthamologist at
Stanford and co-author of Tuesday’s Crispr paper,
says it was in that spirit that he and his collaborators
submitted their results to the journal. “I don’t have any
money in Crispr, I only have patients,” he says. “The
culture and pressures of science right now push people
to not share results that aren’t a splashy cure. But in
medicine you can’t do that. If you make an
observation that’s important enough to share with your
community, you’re obligated to do that right away.”
Since Majahan’s team is working on turning its
previous work into a human treatment, they saw it as
irresponsible to take their results, small as they were,
and sweep them under the rug. Crispr is most often
described as molecular scissors, but doctors like
Majahan tend to think of it more like a drug. And the
more successes Crispr has—like curing mouse
blindness—the more doctors start asking the next
logical questions about things like dosing and
formulations and side effects. How long can you have
the enzyme floating around your cells before it cuts
somewhere it shouldn’t? What’s the right enzyme for
the job?
Matthew Taliaferro, who studies gene expression and
gene editing at MIT, thinks the paper will get more
scientists thinking about those kinds of questions.
“Crispr definitely has off-targets. But a lot of people
use it assuming no other mutations get introduced
during the process,” he says. “So getting people to talk
about the need for controls is a good outcome of this
whole thing.” And while he was surprised by the lack
of some straightforward controls, Taliaferro is
aware that his initial reactions were colored by some
of the Twitter threads he’d already absorbed before
tracking down the paper himself. “I think the data is
perfectly fine,” he says. “It’s just the interpretation of
it that to me seems odd.” Namely, that every Crispr
application is deeply flawed.
Which was never Majahan’s intention in the first
place. “We didn’t write the headlines,” he says. “We
don’t think Crispr is bad, we think it’s great.” But he
didn’t get the opportunity to tell people that, because
for one thing, he’s not on Twitter. When asked how he
was responding to the criticisms from the scientific
community, he laughed and said, “Can you read some
to me? I’ve heard there’s some nasty stuff out there.”
The amplifications (and denigrations) of those
interpretations around Science Twitter may not have
been as knee-jerk as all the “Crispr Is Terrible and
Broken Forever” headlines. But still, they were an
overreaction—because after all, this was just a single
paper. No one should presume a standalone study can
predict the future of an entire technique. At most, it
indicates that Crispr is entering its inevitable
adolescence, when shiny silver bullet technologies get
banged up and battle worn by new data. That doesn’t
mean it isn’t the real deal. Just that it should be looked
at real hard every step of the way.
Chinese scientists raise
ethical questions with
first gene-edited babies
A Chinese scientist’s surprise announcement on the
eve of an international human gene-editing summit
that he has already created the world’s first gene-
edited babies has led to swift condemnation.
Jiankui He is expected to discuss his work November
28 in Hong Kong at the second International Summit
on Human Genome Editing. But in an interview with
the Associated Press, and in a video posted November
25, He announced that twin girls with an edited gene
that reduces the risk of contracting HIV “came crying
into this world as healthy as any other babies a few
weeks ago.”
That announcement sparked outrage from many
researchers and ethicists who say implanting edited
embryos to create babies is premature and exposes the
children to unnecessary health risks. Opponents also
fear the creation of “designer babies,” children edited
to enhance their intelligence, athleticism or other
traits.
He, on unpaid leave from the Southern University of
Science and Technology of China in Shenzhen since
February, objects to the term designer baby. “Call
them ‘gene surgery babies’ if one must or better yet
ordinary people who have had surgery to save their
life or prevent a disease,” He and colleagues wrote in
a perspective published online November 26 in the
CRISPR Journal. But in the video, He said that he
realizes his work will be controversial, and he’s
willing to take the criticism. Some families need the
technology to have healthy children, He said, adding
that enhancing intelligence or changing hair or eye
color are “not things loving parents do” and should be
banned.
Yet many researchers and ethicists argue that He’s
editing of the twin’s DNA was not lifesaving nor does
it prevent disease. Although the girls’ father has HIV,
there are safer ways to protect someone from
contracting the virus, which makes the engineering
both unnecessary and unethical.
The scientists involved in the announcement “have
knowingly violated the ethical norms surrounding this
technology,” says Josephine Johnston, a lawyer and
bioethicist at the Hastings Center, a bioethics research
institute in Garrison, N.Y. The researchers are aware
that the scientific community thinks that gene editing
is still not safe or appropriate for use in human
embryos. “You could even wonder whether they’re
doing this for attention,” she says.
At least one prominent gene-editing researcher, Feng
Zhang of the Broad Institute of MIT and Harvard, has
now called for a moratorium on producing gene-edited
babies until researchers can establish safety
requirements. Hundreds of Chinese scientists have
signed letters condemning the work and calling for
greater oversight of gene-editing experiments.
Chinese authorities are also questioning the research.
Shenzhen City Medical Ethics Expert Board said in a
statement that it is investigating the case, and the
hospital cited in documents describing the experiment
has denied that the work was done there. He’s
university said in a statement November 26 that the
work “seriously violates academic ethics and
academic norms,” and announced that it will launch an
investigation.
He could not be reached for comment.
Disabling a gene
In another video, He said that his group used the gene-
editing tool CRISPR/Cas9 to disable the CCR5 gene in
the fertilized eggs that produced the babies, called
“Lulu” and “Nana” (not their real names). CCR5
produces a protein that allows the most common
version of the HIV virus to enter cells. Some people
naturally have mutations in the gene that help protect
them from HIV infection. Such “gene surgery” has
already proven safe in adults with HIV, He said in the
video. HIV infection is still a deadly disease and in the
developing world, “discrimination increases the
devastation,” He said. Gene editing could spare such
children from their parents’ fate, He claims.
But the chance that Lulu and Nana would get HIV
from their father when their mother doesn’t have the
virus is “almost zero. In fact, probably zero,” says
Anthony Fauci, director of the U.S. National Institute
of Allergy and Infectious Diseases in Bethesda, Md.
The children could easily avoid HIV infection by other
means, so “to put them through the risk of editing their
genes as embryos to protect them from infection they
can easily prevent themselves, in my mind, is
inappropriate at best and unethical at worst.”
Potential complications
Fauci and others are concerned that gene editing may
sometimes go astray, damaging other important genes,
which could lead to health problems such as cancer
later in life. The babies aren’t even guaranteed to
escape HIV either: People who have defective CCR5
genes may still be infected with a less common form
of the virus. And people with missing or defective
CCR5 genes are more susceptible to serious
complications from West Nile virus infections, Fauci
says.
Even if Lulu and Nana don’t end up with any health
problems as a result of He’s genetic tinkering, the
experiment is still bad science, says Julian Savulescu,
a bioethicist at the University of Oxford. “I liken it to
Russian roulette. You can pull the trigger and not kill,
but that doesn’t mean what you did was right.”
If He’s claims are true, the work is “monstrous” and
could set back gene-editing research, says Savulescu,
a self-described fan of the technology. Savulescu has
argued that parents may one day have a moral
obligation to edit their children’s genes (SN Online:
11/28/17). But this experiment gives no real advantage
to the babies and puts them at significant risk of harm,
he says. “The risk just wasn’t reasonable in this case.
It’s a bad scientific study.”
For now, it’s difficult for researchers to assess how
successful the gene editing was.
Determining success
He’s work has not been published in a scientific
journal, and other researchers have not gotten access
to any data or DNA samples that could confirm He’s
claim. Previous claims of successful gene editing in
human embryos in lab dishes have also been met with
skepticism (SN Online: 8/8/18).
Verifying the editing would require thoroughly
examining, or sequencing, the DNA of the twins and
their parents, says Arthur Beaudet, a geneticist at
Baylor College of Medicine in Houston. That
verification might be possible because the Chinese
researchers say that the embryos were sequenced
before being implanted into the mother’s uterus and
again after birth. But it may be harder to determine
whether CRISPR/Cas9 has caused any mutations that
may later harm the children, Beaudet says.
Children often naturally develop DNA changes that
their parents don’t carry. Beaudet and colleagues are
conducting experiments with mice to determine
whether gene editing leads to more of these new
mutations than usual, he says. Such animal research
and work on human embryos that won’t be used to
create a pregnancy are necessary before researchers
should even consider making gene-edited babies, he
says.
Legal issues
Laws governing gene editing vary, with some
countries banning it outright and others, including
China, having no or less clear policies. In the United
States, the Food and Drug Administration cannot
accept applications for research in which human
embryos are made to have heritable DNA changes.
That provision effectively bans the use of the
technology to make gene-edited babies or “three-
parent babies” who have a small amount of DNA from
an egg donor (SN: 12/24/16, p. 22).
Organizers of the first human gene editing summit,
held in Washington, D.C., in 2015, said then that
gene-editing research on human embryos could go
ahead, but only if no babies resulted from the
experiments (SN: 12/26/15, p. 12). Since then, other
ethics committees have softened that stance saying
that if gene editing were shown to be safe, it would
ethical to use the technology to correct diseases, but
not to enhance health, intelligence or other traits (SN:
3/18/17, p. 7). Public opinion in the United States has
also been swinging in favor of gene editing to correct
diseases, but not to enhance intelligence (SN Online:
7/26/18).
People have worried for decades that the ability to
modify people’s genes could lead to disparities
between genetic haves and have-nots, says Marcy
Darnovsky, executive director of the Center for
Genetics and Society, a nonprofit social justice
organization in Berkeley, Calif. She argues that
countries should immediately take steps to ban the use
of human embryo editing. “We’re living in a time
when racism and socioeconomic disparities are
increasing dramatically,” Darnovsky says. “The last
thing we need is for some biological procedure to fuel
the false idea that some groups are biologically
superior to others.”
Pro and Con: Should
Gene Editing Be
Performed on Human
Embryos?
The most potent use of the new gene editing
technique CRISPR is also the most
controversial: tweaking the genomes of
human embryos to eliminate genes that
cause disease. We don’t allow it now. Should
we ever?
On November 25, 2018, geneticist He Jiankui of China's
Southern University of Science and Technology announced
that his lab had successfully used the Crispr-Cas9 gene-
editing system to make the world's first genetically edited
human babies. Outside scientists haven't verified his
claims, and his home university is planning to investigate
him for academic violations. But if the results hold, the
experiment would mark a scientific milestone— and raise
profound ethical issues. In the August 2016 issue of
National Geographic magazine, we invited contributors to
weigh the ethics of making edits to the human genome
that future generations would inherit.
Pro: Research on Gene Editing in Humans
Must Continue
By John Harris
John Harris is professor emeritus in science ethics at
University of Manchester, U.K., and the author of How to
be Good, Oxford University Press 2016.
In February of this year, the Human Fertilization and
Embryology Authority in the United Kingdom
approved a request by the Francis Crick Institute in
London to modify human embryos using the new gene
editing technique CRISPR-Cas9. This is the second
time human embryos have been employed in such
research, and the first time their use has been
sanctioned by a national regulatory authority. The
scientists at the Institute hope to cast light on early
embryo development—work which may eventually
lead to safer and more successful fertility treatments.
The embryos, provided by patients undergoing in vitro
fertilization, will not be allowed to develop beyond
seven days. But in theory—and eventually in
practice—CRISPR could be used to modify disease-
causing genes in embryos brought to term, removing
the faulty script from the genetic code of that person’s
future descendants as well. Proponents of such
“human germline editing” argue that it could
potentially decrease, or even eliminate, the incidence
of many serious genetic diseases, reducing human
suffering worldwide. Opponents say that modifying
human embryos is dangerous and unnatural, and does
not take into account the consent of future generations.
Who is right?
Let’s start with the objection that embryo modification
is unnatural, or amounts to playing God. This
argument rests on the premise that natural is inherently
good. But diseases are natural, and humans by the
millions fall ill and die prematurely—all perfectly
naturally. If we protected natural creatures and natural
phenomena simply because they are natural, we would
not be able to use antibiotics to kill bacteria or
otherwise practice medicine, or combat drought,
famine, or pestilence. The health care systems
maintained by every developed nation can aptly be
characterized as a part of what I have previously
called “a comprehensive attempt to frustrate the
course of nature.” What’s natural is neither good nor
bad. Natural substances or natural therapies are only
better that unnatural ones if the evidence supports such
a conclusion.
The matter of consent has been raised by Francis
Collins, director of the National Institutes of Health.
“Ethical issues presented by altering the germline in a
way that affects the next generation without their
consent,” he has said, constitute “strong arguments
against engaging in” gene editing.
This makes no sense at all. We have literally no choice
but to make decisions for future people without
considering their consent. All parents do this all the
time, either because the children are too young to
consent, or because they do not yet exist. George
Bernard Shaw and Isadora Duncan knew this. When,
allegedly, she said to him “why don’t we make a baby
together … with my looks and your brains it cannot
fail” she was proposing a deliberate germline
determining decision in the hope of affecting their
future child. Shaw’s more sober response—“Yes but
what if it has my looks and your brains!”—identifies a
different possible, but from the child’s perspective
equally non-consensual, outcome. Rightly, neither
Shaw nor his possible partner thought their decision
needed to wait for the consent of the resulting child.
DNA Hacking Tool Enables Shortcut to Evolution
Needless to say, parents and scientists should think
responsibly, based on the best available combination
of evidence and argument, about how their decisions
will affect future generations. However, their decision-
making simply cannot include the consent of the
future children.
Finally, there’s the argument that modifying genomes
is inherently dangerous because we can’t know all the
ways it will affect the individual. But those who fear
the risks of gene editing don’t take into account the
inherent dangers in the “natural” way we reproduce.
Two-thirds of human embryos fail to develop
successfully, most of them within the first month of
pregnancy. And every year, 7.9 million children—6
percent of total births worldwide—are born with a
serious defect of genetic or partially genetic origin.
Indeed so risky is unprotected sex that, had it been
invented as a reproductive technology rather than
found as part of our evolved biology, it is highly
doubtful it would ever have been licensed for human
use.
Certainly we need to know as much as possible about
the risks of gene-editing human embryos before such
research can proceed. But when the suffering and
death caused by such terrible single-gene disorders as
cystic fibrosis and Huntington’s disease might be
averted, the decision to delay such research should not
be made lightly. Just as justice delayed is justice
denied, so, too, therapy delayed is therapy denied.
That denial costs human lives, day after day.
Con: Do Not Open the Door to Editing Genes
in Future Humans
By Marcy Darnovsky
Marcy Darnovsky, Ph.D., is executive director of the Center
for Genetics and Society. She speaks and writes on the
politics of human biotechnology.
The gene editing tool known as CRISPR catapulted
into scientific laboratories and headlines a few short
years ago. Fast on its heels came the reemergence of a
profoundly consequential controversy: Should these
new techniques be used to engineer the traits of future
children, who would pass their altered genes to all the
generations that follow?
This is not an entirely new question. The prospect of
creating genetically modified humans was openly
debated back in the late 1990s, more than a decade
and a half before CRISPR came on the scene and
several years before the human genome had been fully
mapped.
It wasn’t long before we saw provocative headlines
about designer babies. Princeton mouse biologist Lee
Silver, writing in Time magazine in 1999, imagined a
fertility clinic of the near future that offered “Organic
Enhancement” for everyone, including people with
“no fertility problems at all.” He even wrote the ad
copy: “Keep in mind, you must act before you get
pregnant. Don't be sorry after she's born. This really is
a once-in-a-lifetime opportunity for your child-to-be.”
During the same millennial shift, policymakers in
dozens of countries came to a very different
conclusion about the genetic possibilities on the
horizon. They wholeheartedly supported gene
therapies that scientists hoped (and are still hoping)
can safely, effectively, and affordably target a wide a
range of diseases. But they rejected human germline
modification—using genetically altered embryos or
gametes to produce a child—and in some 40 countries,
passed laws against it.
The issue of human germline modification stayed on a
slow simmer during the first decade of the 21st
century. But it roared to a boil in April 2015, when
researchers at Sun Yat-sen University announced they
had used CRISPR to edit the genomes of nonviable
human embryos. Their experiment was not very
successful in technical terms, but it did focus the
world’s attention.
In December 2015, controversy about using CRISPR
to produce children was a key agenda item at the
International Summit on Human Gene Editing
organized by the national science academies of the
United States, the United Kingdom, and China. Nearly
every speaker agreed that at present, making
irreversible changes to every cell in the bodies of
future children and all their descendants would
constitute extraordinarily risky human
experimentation. By all accounts, far too much is
unknown about issues including off-target mutations
(unintentional edits to the genome), persistent editing
effects, genetic mechanisms in embryonic and fetal
development, and longer-term health and safety
consequences.
Conversations about putting new gene editing tools
into fertility clinics need to begin with an obvious but
often overlooked point: By definition, germline gene
editing would not treat any existing person’s medical
needs. At best, supporters can say that it might re-
weight the genetic lottery in favor of different
outcomes for future people—but the unknown
mechanisms of both CRISPR and human biology
suggest that unforeseeable outcomes are close to
inevitable.
Beyond technical issues are profound social and
political questions. Would germline gene editing be
justifiable, in spite of the risks, for parents who might
transmit an inherited disease? It’s certainly not
necessary. Parents can have children unaffected by the
disease they have or carry by using third-party eggs or
sperm, an increasingly common way to form families.
Some heterosexual couples may hesitate to use this
option because they want a child who is not just
spared a deleterious gene in their lineage, but is also
genetically related to both of them. They can do that
too, with the embryo screening technique called pre-
implantation genetic diagnosis (PGD), a widely
available procedure used in conjunction with in vitro
fertilization.
PGD itself raises social and ethical concerns about
what kind of traits should be selected or de-selected.
These questions are particularly important from a
disability rights perspective (which means they’re
important for all of us). But screening embryos for
disease is far safer for resulting children than
engineering new traits with germline gene editing
would be. Yet this existing alternative is often omitted
from accounts of the controversy about gene editing
for reproduction.
It is true that a few couples—a very small number—
would not be able to produce unaffected embryos, and
so could not use PGD to prevent disease inheritance.
Should we permit germline gene editing for their
sake? If we did, could we limit its use to cases of
serious disease risk?
From a policy perspective, how would we draw the
distinction between a medical and enhancement
purpose for germline modification? In which category
would we put short stature, for example? We know
that taller people tend to earn more money. So do
people with paler skins. Should arranging for children
with financially or socially “efficient” varieties of
height and complexion be considered medical
intervention?
Think back to the hypothetical fertility clinic offering
“Organic Enhancement” as a “once-in-a-lifetime
opportunity for your child-to-be.” Think back to the
1997 movie Gattaca, about a society in which the
genetically enhanced—merely perceived to be
biologically superior—are born into the physical
reality of those whom we might now call the one
percent. These are fictional accounts, but they are also
warnings of a possible human (or not so human)
future. The kinds of social changes they foresee, once
set in motion, could be as difficult to reverse as the
genetic changes we’re talking about.
In opening the door to one kind of germline
modification, we are likely opening it to all kinds.
Permitting human germline gene editing for any
reason would likely lead to its escape from regulatory
limits, to its adoption for enhancement purposes, and
to the emergence of a market-based eugenics that
would exacerbate already existing discrimination,
inequality, and conflict. We need not and should not
risk these outcomes.
Research Highlights:
CRISPR
The ability to precisely edit the genome of a living cell
holds enormous potential to accelerate life science
research, improve biotechnology, and even treat
human disease.
Methods for genome editing — primarily zinc finger
nucleases and Transcription Activator-Like Effector
(TALE) Nucleases — have existed for several years,
but in 2013 these were quickly eclipsed by the
efficiency, effectiveness and precision of the
engineered CRISPR-Cas9 system that was first
harnessed for mammalian genome editing by Feng
Zhang of the Broad Institute and MIT.
The CRISPR system
Like zinc fingers and TALEs, CRISPR systems are
natural products. However, CRISPR-Cas differs from
zinc fingers and TALEs in one crucial aspect that
makes it superior for genome editing applications:
whereas zinc fingers and TALEs bind to DNA through
a direct protein-DNA interaction, requiring the protein
to be redesigned for each new target DNA site,
CRISPR-Cas achieves target specificity through a
small RNA that can easily be swapped for other RNAs
targeting new sites.
In nature, CRISPR-Cas systems help bacteria defend
against attacking viruses (known as bacteriophage or
just phage). They consist of two components, the
CRISPR (clustered, regularly interspaced palindromic
repeats) array and Cas (CRISPR-associated) proteins.
CRISPR sequences bookend short stretches of DNA
that bacteria have copied from invading phages,
preserving a memory of the viruses that have attacked
them in the past. These sequences are then transcribed
into short RNAs that guide Cas proteins to matching
viral sequences. The Cas proteins destroy the
matching viral DNA by cutting it. There are a number
of different types of CRISPR-Cas systems in nature,
which vary in their components; the CRISPR-Cas9
system uses just a single protein, Cas9, to find and
destroy target DNA. In 2015, Zhang and colleagues
successfully harnessed a second system, called
CRISPR-Cpf1, which has the potential for even
simpler and more precise genome engineering.
Engineering the CRISPR toolbox
In early 2011, Feng Zhang was just starting his own
research group at the Broad Institute and MIT, where
he is an investigator at the McGovern Institute for
Brain Research and a faculty member in the
departments of Brain and Cognitive Sciences and
Biological Engineering. After learning about existing
CRISPR research at a scientific meeting at the Broad,
he quickly realized that the system, with a single
RNA-guided protein, could be a game changer in
genome editing technology. He was already working
on DNA targeting methods, having helped to develop
the TALE system as a Junior Fellow at Harvard. This
system could target and activate genes in mammalian
genomes.
Zhang and his team focused on harnessing CRISPR-
Cas9 for use in human cells. In January 2013, he
reported the first successful demonstration of Cas9-
based genome editing in human cells in what has
become the most-cited CRISPR paper (Cong et al.,
Science, 2013). Researchers from George Church’s
lab at Harvard University reported similar findings in
the same issue of Science (Mali et al., Science, 2013).
The Zhang and Church papers showed that Cas9 could
be targeted to a specific location in the human genome
and cut the DNA there. The cut DNA was then
repaired by inserting a new stretch of DNA, supplied
by the researchers, essentially achieving “find and
replace” functionality in the human genome.
In September, 2015, Zhang and partners described a
different system, Cpf1, which appears to have
significant implications for research and
therapeutics. The Cpf1 system is simpler in that it
requires only a single RNA. The Cpf1 enzyme is also
smaller than the standard SpCas9, making it easier to
deliver into cells and tissues.
Refining and sharing CRISPR tools
The CRISPR toolbox is continuing to expand rapidly,
opening new avenues for biomedical research. Since
the first publications in early 2013, the Zhang lab and
other researchers have engineered a number of
improvements to the system. For example, Cas9 has
been modified so that instead of cutting the target
DNA, it can turn gene expression on by recruiting
transcriptional activators to its genomic location
(Konermann, et al., Nature, 2014).
At the Broad Institute, the system has also been used
for genome-wide screens to identify genes involved in
resistance to cancer drugs and dissect immune
regulatory networks. CRISPR has been used to rapidly
create mouse models of cancer that arise from multiple
gene alterations (Platt et al., Cell, 2014). In 2015,
Zhang and his team reported success with Cas9
derived from a different bacterium, Staphylococcus
aureus (SaCas9). SaCas9 is smaller than the original
Cas9, which has advantages for gene therapy (Ran et
al., Nature, 2015).
The Zhang lab has trained thousands of researchers in
the use of CRISPR-Cas9 genome editing technology
through direct education and by sharing more than
40,000 CRISPR-Cas9 components with academic
laboratories around the world to help accelerate global
research that will benefit human health. In September
2015, the Zhang lab also began to share Cpf1
components.
Users can obtain guide sequences for knock-outs and
transcriptional activation as well as information about
genome-wide libraries for CRISPR-based screening.
The Zhang lab plasmids can be obtained via Addgene,
a non-profit plasmid repository dedicated to improving
life science research. Additional information about
materials can be found on the Zhang
laboratory website.
Genetically modified
babies given go ahead by
UK ethics body
The Nuffield Council on Bioethics says changing the DNA of
a human embryo could be ‘morally permissible’ if it is in
the child’s best interests
The creation of babies whose DNA has been altered to
give them what parents perceive to be the best chances
in life has received a cautious green light in a
landmark report from a leading UK ethics body.
The Nuffield Council on Bioethics said that changing
the DNA of a human embryo could be “morally
permissible” if it was in the future child’s interests and
did not add to the kinds of inequalities that already
divide society.
The report does not call for a change in UK law to
permit genetically altered babies, but instead urges
research into the safety and effectiveness of the
approach, its societal impact, and a widespread debate
of its implications.
“It is our view that genome editing is not morally
unacceptable in itself,” said Karen Yeung, chair of the
Nuffield working group and professor of law, ethics
and informatics at the University of Birmingham.
“There is no reason to rule it out in principle.”
But the report drew immediate criticism from some
quarters, with one lobby group accusing the authors of
opening the door to the unrestricted use of heritable
genetic engineering, and an age of genetic haves and
have-nots.
Recent advances in genetic technology have given
scientists the tools to rewrite the DNA bound up in
living cells, letter by letter. With the procedures in
hand, scientists can in principle tweak the genetic code
in sperm, eggs and embryos, and change dramatically
how future children develop.
While laws in the UK and some other countries
currently ban the creation of genetically altered babies,
a handful of experiments around the world have
shown that DNA editing could, in principle, prevent
children from inheriting serious diseases caused by
faulty genes.
/science/2016/jun/07/sign-up-for-lab-notes-the-
guardians-weekly-science-update
The prospect of modifying genes in human embryos
has long been controversial though. For a start, the
procedure has yet to be proven safe. In a study
published in Nature Biotechnology on Monday,
British researchers found that the most popular tool for
genome editing, Crispr-Cas9, caused more damage to
DNA than previously thought. If the scientists are
right, gene editing could disrupt healthy genes when it
is meant only to fix faulty ones.
Another consideration is that any changes made to an
embryo’s DNA would affect all of its cells, including
the sperm or eggs, meaning that genetic modifications
would be passed down to all future generations. Also,
in the vast majority of cases alternative procedures,
such as preimplantation genetic testing, can be used to
screen embryos for harmful DNA.
DNA editing also raises the possibility of “designer
babies”, where the genetic code of embryos created
through standard IVF is rewritten so that children have
traits the parents find desirable. The Nuffield report
does not rule out any specific uses of genome editing,
but says that to be ethical, any applications must
follow the principles of being in the child’s interests,
and have no ill-effects for society.
Jackie Leach Scully, professor of social ethics and
bioethics at Newcastle University, and a co-author on
the report, said heritable genome editing may one day
become an option for parents “to try and secure what
they think is the best start in life” for their future
children.
But she warned that there could be unintended
consequences if the law were changed to allow gene
editing of human embryos. While the technology
could potentially reduce the number of people affected
by certain genetic disorders, it could leave those with
the diseases feeling more marginalised and with less
medical support.
The report urges government to set up a new body to
ensure that as many voices as possible are involved in
public discussions about what should and should not
be permissible. “We are very clear that what we need
to have is as wide a discussion about this issue as
possible,” Leach Scully said. In the event that the law
is changed, gene editing of human embryos should be
considered on a case-by-case basis by the fertility
regulator, the Human Fertilisation and Embryology
Authority, the report adds.
George Church, a geneticist at Harvard University
who was not involved in the report, said he agreed
with the report’s guiding principle that gene editing
“should not be expected to increase disadvantage,
discrimination, or division in society,” adding that this
would be aided by lower costs and better public
dialogue and education. Making changes to common
gene variants in sperm and eggs could save roughly
5% of babies from painful diseases he said.
But Marcy Darnovsky at the Center for Genetics and
Society in California said that the report recognised
that if reproductive gene editing was permitted, it
would be used for enhancement and cosmetic
purposes. “They dispense with the usual pretence that
this could – or, in their estimation, should – be
prevented. They acknowledge that this may worsen
inequality and social division, but don’t believe that
should stand in the way. In practical terms, they have
thrown down a red carpet for unrestricted use of
inheritable genetic engineering, and a gilded age in
which some are treated as genetic ‘haves’ and the rest
of us as ‘have-nots’.”
Designer babies: Picking
traits for non-medical
reasons could be 'morally

permissible', says UK
ethics group
Letting parents choose preferred
characteristics of offspring to
avoid disease or otherwise, could
be acceptable if it doesn’t
entrench disadvantages, says
Nuffield Council on Bioethics
Letting parents use new gene-editing technology to
pick characteristics of their unborn child can be
“morally acceptable” as long as it doesn’t increase
social inequalities, an influential medical ethics group
has said.
In a major report on the looming frontier of human
gene-editing, the Nuffield Council on Bioethics
(NCB) said it did not believe there was an ethical red
line in tinkering with the genetic material that will be
passed to future generations.
It also did not draw a distinction between using these
techniques to tackle genetic diseases and for
enhancing desirable physical or intellectual traits, so-
called “designer babies”, so long as it meets strict
ethical and regulatory tests.
The group, which appraises the ethical realities of new
technology, called for the government to
begin canvassing national opinion and said copies of
the report would be sent to ministers and civil
servants.
UK law does not currently permit any editing of
heritable DNA – genetic information contained in an
embryo, egg or sperm – though it is allowed for
strictly controlled research purposes.
Even this, however, is hugely controversial and could
have implications for people with diseases or less
“desirable” traits if they become less common. Any
change to the law would have to be subject to a
national public debate and parliamentary legislation,
as well as extensive testing for the safety of gene
editing, the NCB said.
But a change is needed as we continue to expand our
understanding of the human genome, and which gene
instructions affect different diseases and traits. The
arrival of precision genetic editing techniques like
crispr has made correcting damaged or undesirable
genes a real possibility.
Professor Karen Yeung, chair of the NCB report
group, a law and ethics expert at the University of
Birmingham, said these advances could have
“profound consequences [which] affect the genetic
make-up of society".
“There was an enormous range of views, including
that we should not do this as to do this would be to
take a step humanity should not take,” Prof Yeung
said.
“We thought quite hard about this and came to the
view that, in and of itself, intervening in the heritable
genome would not be morally objectionable.”
This means “it should not be ruled out on principle”
but for any gene-editing to be ethically acceptable two
tests must be satisfied, the group said.
Firstly, changes must be made for the benefit of the
health or welfare of the future person whose DNA is
being edited.
UK panel says human
embryo editing ‘morally
permissible’
An independent ethics panel in the UK has concluded
that genome editing to influence the characteristics of
a future person could be “morally permissible”.
However, there would need to be a number of
measures put in place to ensure that genetic editing
“proceeds in ways that are ethically acceptable,” the
inquiry, by the Nuffield Council on Bioethics,
concluded.
Genome editing is not currently lawful in the UK
(unless for research purposes), but the practice could
theoretically be offered in future to parents wishing to
change the genetic characteristics of their future child,
such as excluding an heritable disease or a
predisposition to cancer in later life.
The Council stressed the possibilities this raises could
have “significant implications for individuals and for
all of society”, and before the law so there must be
action now “to support public debate and to put in
place appropriate governance”.
It recommends that two overarching principles should
be adhered to when considering use of heritable
genome editing interventions in order for them be
ethically acceptable: they must be intended to secure
the welfare of the future person; and they should not
increase disadvantage, discrimination or division in
society.
The Council also said the practice should only be
permitted after a “broad and inclusive public debate”
on its potential use and implications, further research
to establish standards of clinical safety, and an
assessment of the risks to individuals, groups and
society as a whole.
“Huge advances are happening in genomics research,
and whilst we have to acknowledge that genes alone
do not shape a person, the possibility of using genome
editing in reproduction to secure or avoid a
characteristic in a child offers a radically new
approach that is likely to appeal to some prospective
parents,” Professor Dave Archard, chair of the
Nuffield Council on Bioethics.
“There may be good reasons for allowing some
parental preferences to be met, but we need to be
careful that the use of genome editing to help parents
to exercise these preferences doesn’t increase social
disadvantage, discrimination or division and that close
attention is paid to the welfare of those involved,
especially any child born as a result.”
The field has long been surrounded by controversy,
with critics fearing that gene-editing could be used to
create a generation of so-called ‘designer’ babies.
Heritable genome
editing: action needed to
secure responsible way
forward
An independent inquiry by the Nuffield Council on
Bioethics has concluded that editing the DNA of a
human embryo, sperm, or egg to influence the
characteristics of a future person (‘heritable genome
editing’) could be morally permissible. If that is to
happen, a number of measures would need to be put in
place first to ensure that genome editing proceeds in
ways that are ethically acceptable.
The technique of genome editing – the deliberate
alteration of a targeted DNA sequence in a living cell
– could theoretically be used in assisted reproduction
to alter the DNA of a human embryo, before it is
transferred to the womb. This is not currently lawful in
the UK, but could, in time, become available as an
option for parents who wish to influence the genetic
characteristics of their future child (for example, to
exclude a heritable disease or a predisposition to
cancer in later life). The Council says that the
possibilities raised by this radical new approach to
reproductive choices could have significant
implications for individuals and for all of society, and
there must be action now to support public debate and
to put in place appropriate governance.
The new report, Genome editing and human
reproduction: social and ethical issues, sets out the
range of ethical issues that arise in relation to the
prospect of genome editing becoming available as a
reproductive option for prospective parents.
The Council recommends that two overarching
principles should guide the use of ‘heritable genome
editing interventions’ for them be ethically acceptable:
 they must be intended to secure, and be
consistent with, the welfare of the future person;
and
 they should not increase disadvantage,
discrimination or division in society
The Council further recommends that heritable
genome editing interventions should be permitted only
when:
 there has been a sufficient opportunity for broad
and inclusive public debate about its use and
possible implications
 further research has been carried out to establish
standards of clinical safety
 the risks of adverse effects for individuals, groups
and society as a whole have been appropriately
assessed and measures are in place to monitor
and review these
It adds that, if it were to be permitted, it should be:
 strictly regulated (by the HFEA in the UK)
 introduced only in the context of a clinical study,
with monitoring of the long-term effects on
individuals and groups
 licensed on a case-by-case basis
Further recommendations
In addition to these measures, the Council
recommends the establishment of an independent body
in the UK to promote broad and inclusive societal
debate on heritable genome editing interventions and
related scientific and medical developments.
Professor Karen Yeung, Chair of the working
party and Professor of Law, Ethics, and
Informatics at the University of Birmingham, said:
“There is potential for heritable genome editing
interventions to be used at some point in the future in
assisted human reproduction, as a means for people to
secure certain characteristics in their children.
Initially, this might involve preventing the inheritance
of a specific genetic disorder. However, if the
technology develops it has potential to become an
alternative strategy available to parents for achieving
a wider range of goals.
Other reproductive options that are currently available
to prospective parents who face the possibility of
passing on an inherited genetic disorder, which
genome editing might be considered alongside,
include pre-implantation genetic diagnosis, which
involves testing embryos for genetic characteristics
and selecting one/s with preferred characteristics.
Although the UK is one of the countries that permits
research on human embryos, the law does not
currently permit genome editing interventions on
embryos that are to be placed in a womb. The law
would therefore have to be changed in order to allow
the use of genome editing embryos, sperm or eggs for
reproduction.
The Council’s report sets out the ethical
considerations raised by the prospect of heritable
genome editing interventions in relation to the
interests of the people who would be affected by its
use, of others in society who may be indirectly
affected, and of human beings in general. One of the
main reasons heritable genome editing interventions
are controversial is that changes may be passed on to
future generations.
Professor Dave Archard, Chair of the Nuffield
Council on Bioethics said:
“Huge advances are happening in genomics research,
and whilst we have to acknowledge that genes alone
do not shape a person, the possibility of using genome
editing in reproduction to secure or avoid a
characteristic in a child offers a radically new
approach that is likely to appeal to some prospective
parents.
There may be good reasons for allowing some
parental preferences to be met, but we need to be
careful that the use of genome editing to help parents
to exercise these preferences doesn’t increase social
disadvantage, discrimination or division and that
close attention is paid to the welfare of those involved,
especially any child born as a result.”
NOTES TO EDITORS
1. Copies of the report are available in advance, on
request.
To request the report, or an advance interview, please
contact:
Sarah Walker-Robson,
Communications Manager
Nuffield Council on Bioethics
swalker-robson@nuffieldbioethics.org
(+44) 0207 681 9619 / (+44) 07551 159670
Genome editing and human reproduction: social and
ethical issues will be published on the Council’s
website on Tuesday 17 July 2018.
2. About genome editing
Genome editing is the deliberate alteration of a
selected DNA sequence in a living cell. Genome
editing techniques can be used to alter how a gene
functions, for example, by changing a variant of a
gene that may give rise to disease to one that does not.
CRISPR-Cas9 is an example of a method of genome
editing that is now widely used in research.
Heritable genome editing interventions are
interventions made to sperm, egg or embryo cells (or
their precursors). The ‘edited’ DNA sequence would
be present in all cells of any future person grown from
those cells – including their own sperm or eggs – so
may be passed on, in turn, to future generations).
3. About the project
This inquiry was initiated following publication of the
Nuffield Council on Bioethics’ previous report
Genome editing: an ethical review, in 2016. The
development of genome editing applications in human
reproduction was one of the areas identified in that
review as requiring further ethical scrutiny.
This inquiry was carried out by an
interdisciplinary working party that included members
with expertise in biology, human reproduction,
genome editing, law, and ethics.
To inform its deliberations, the working party received
contributions from a wide range of people, including
through an open call for evidence, an online
questionnaire, and a series of fact-finding meetings
and panel interviews.
4. About the working party
Members of the working party were appointed for
their personal knowledge and expertise, and do not
necessarily represent the views of their organisations.
Karen Yeung (Chair), Interdisciplinary Professorial
Fellow in Law, Ethics and Informatics, University of
Birmingham
Richard Ashcroft, Professor of Bioethics, Queen
Mary University of London
Neva Haites, Professor of Medical Genetics,
University of Aberdeen
Joyce Harper, Professor in Human Genetics and
Embryology, University College London
Julian Hitchcock, Partner, Marriott Harrison LLP
Jackie Leach Scully, Professor of Social Ethics and
Bioethics, PEALS (Policy, Ethics and Life Sciences)
Research Centre, Newcastle University
Tony Perry, Professor of Mammalian Molecular
Embryology, University of Bath
Christine Watson, Professor of Cell and Cancer
Biology, University of Cambridge and Member of the
Nuffield Council on Bioethics
5. About the Nuffield Council on Bioethics
The Nuffield Council on Bioethics examines ethical
issues raised by new developments in biology and
medicine. Established by the Nuffield Foundation in
1991, the Council is an independent body, funded
jointly by the Foundation, the Medical Research
Council and the Wellcome Trust. The Council has
achieved an international reputation for addressing
public concerns, and providing independent advice to
assist policy makers and stimulate debate in bioethics.
http://nuffieldbioethics.org/