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Health, Politics & Foreign Affairs, Society

Presidential Bioethics: Valuing Product and Process

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As we reach the height of the political season, we are inundated with pundit opinions, news commentaries, and our own questions about the impact of the Presidential election. In the healthcare sphere, the future of the Affordable Care Act, funding for biomedical research and the cancer moonshot, cost containment, and prescription drug pricing are central issues, and it is truly important to know where each candidate stands. However, our analysis cannot end there. Given the rapid pace of scientific and technological advancement, it is equally important to consider how each candidate would identify and evaluate prospective medical, scientific and technological questions as they emerge.

Put another way, we need to understand each candidate’s framework for bioethical decision making.

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Photo Credit: By Krassotkin (derivative), Gage Skidmore (Donald Trump), Gage Skidmore (Hillary Clinton) [CC BY-SA 3.0], via Wikimedia Commons

Easier said than done, right? In the era of skimmed newsfeeds and 140 character sound bytes, it is rare to catch a glimpse of the evaluative process that belies a polished campaign bullet point. However, one such opportunity arose at the CNN Democratic Town Hall in February 2016. A man with a self-described terminal cancer diagnosis asked how Hillary Clinton would lead “the respectful conversation that is needed around” the issue of death with dignity. Secretary Clinton’s response offers some insight into how she considers issues with significant moral, legal and social implications:

“So I don’t have any easy or glib answer for you. I think I would want to really immerse myself in the . . . ethical writings, the health writings, the scientific writings, the religious writings. I know some other countries . . . have a quite open approach. I’d like to know what their experience has been.”

medical-bioethics

Photo Credit: CCO Public Domain

As noted in a Hasting’s Center blog post, a Washington Post reporter described Secretary Clinton’s answer as “circuitous” and “vague”. Certainly, Clinton’s answer does not offer a clear position. However, it does show how she would evaluate an issue with significant moral, religious, medical and legal components. Death with dignity laws have passed in a handful of states (i.e., CA, OR, VT, WA) and are under consideration in many others. We are far from reaching a nation-wide consensus, and getting to that point – if possible – will be a long and complex process.

Recognizing that an issue is one where reasonable minds can differ, committing to respectful dialogue, accounting for moral, religious, and psychological perspectives, seeking out medical facts, calling for expert input, and analyzing practical experience will be essential to moving forward.

Related article: “IMPAKTER ESSAY: VACCINATION, MEDICAL TOURISM, AND THE EXPANSION OF GLOBAL BIOETHICS” 

The importance of a sound bioethical decision-making process was recently underscored in a report of the Presidential Commission for the Study of Bioethical Issues (Commission), an expert advisory body established by President Obama. Comprised of experts in medicine, science, religion, law and engineering, the Commission investigates specific subjects at the request of the Executive Office of the President. Similar bioethics advisory panels were established by President Bill Clinton and President George W. Bush during their terms of office. However, this is not required. It will be up to the next President to decide whether to establish a bioethics advisory panel, who to appoint, and what topics to address.

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Photo Credit: CCO Public Domain

In recent years the Commission reported on genetic privacy, direct-to-consumer diagnostic testing, human subjects research protection, and ethical responses to public health epidemics. However, as Election Day draws closer, the Commission’s report on “Bioethics for Every Generation: Deliberation and Education in Health, Science and Technology,” resonates most of all.

In this report the Commission posits that both open, democratic deliberation and strong ethics education are essential to the development of dynamic, practical and morally based solutions required in bioethics.  The report, even includes a road map for effective deliberation that starts with an open policy question, allows time for democratic debate and expert input, and concludes with practical, actionable recommendations.

Though the Commission’s recommendations are set in the context of bioethical decision-making, they seem appropriate for many subject areas in which reasonable people can disagree.  Patience, open mindedness, and tolerance for other points of view are the hallmarks of an effective leader, regardless of subject matter or party affiliation.

Will the next President keep this framework in mind when addressing the challenging questions the country faces today, and will face in years to come?  One can only hope and, of course, vote.

Recommended reading: “BIOEDGE: SHOULD PSYCHIATRISTS TELL VOTERS WHAT THEY THINK ABOUT TRUMP” 

EDITOR’S NOTE: THE OPINIONS EXPRESSED HERE BY IMPAKTER.COM COLUMNISTS ARE THEIR OWN, NOT THOSE OF IMPAKTER.COM.
Feature Photo Credit: Courtesy of eideard.com – Patients campaign for the Death with Dignity Act.
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About the Author /

Courtney first discovered her love of writing about moral issues during her undergraduate years at the University of Pennsylvania (CAS ’00). She went on to earn her Master’s Degree in Bioethics at Penn (MBE ’02), followed by her law degree at Cardozo Law School (JD ’05). Upon graduating, Courtney worked for the American Society of Clinical Oncology, focusing on ethics issues related to clinical cancer research. She is an author of peer-reviewed publications on topics ranging from financial conflicts of interest to the medical and legal implications of cancer genetic and genomic testing, as well as several vignettes addressing ethics in oncology practice. Courtney also served on the National Cancer Institute’s Institutional Review Board (IRB) for Intramural Research, and worked at the National Institutes of Health (NIH) Office of Biotechnology Activities and the Department of Health and Human Services Office of Human Research Protections. Courtney currently resides with her family in Northern Virginia and is the proud mom of her young son and daughter.

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Food, Impact, Uncategorized

The food industry is coming under increasing scrutiny for its environmental impact, from greenhouse gas emissions, to excessive and detrimental land and water usage, to chemical pollution. Given the challenge of feeding a growing world population whilst simultaneously needing to drastically reduce greenhouse gas emissions and other environmental impacts, clearly we need to look at alternatives to “dinner as usual”. The contribution of livestock to global greenhouse emissions is estimated at between 14.5 – 18%. Fortunately, there are companies who are tackling this challenge head on and looking at how emissions from food production can be reduced. With consumer interest increasing in alternatives to meat and other protein sources, we’ve spoken to the founders of three companies. From the seemingly futuristic to the rediscovery of superfood trees, each company tackles this new drive in consumer interest in different ways.

Solar Foods, Finland

Dr Pasi Vainnika is the CEO and co-founder of Solar Foods. The slogan of the company is “Food out of thin air”. Pasi was formerly in charge of the single largest renewable energy program in Finland. However, when he found out that 20-25% of the emissions come from food, he realized that emissions from this sector needed to be addressed, as well as those in the energy sector. But with the growth in affordable and renewable energy – particularly solar energy– it led him and his team to question the possibility of producing food solely from energy, carbon dioxide, and water. It turns out, the answer is yes. Solein is a unique single cell protein. It is produced using a fully natural fermentation process like that of the production of yeast or lactic acid bacteria. The powder, which is produced from the process, is 50% protein, 5-10% fat and 20-25% carbohydrate. Most likely, the first product to reach the consumer market will be a replacement in existing plant-based foods. For example, using Solein in shakes or as an alternative to dairy in milks, yogurts, and even in breads and pasta. In the future, a lasagna could include the protein in all aspects of the recipe: the sauce, in the pasta sheets, and in the filling. Further into the future, there is also the possibility that it could be used as the basis for cultured meat production.
In the Photo: Solein Can be used in smoothies as a protein alternative. Photo Credit: Shawn Fields - Unsplash
To produce a kilo of the protein powder takes 10 liters of water in comparison to the 2500 liters of water for a kilo of soy or 15,500 liters for a kilo of beef. Electricity is the main raw material, and the plan is to source this from renewable energy sources. Additionally, Solein binds carbon dioxide rather than emitting it, easing pressure on land use. The product is currently going through regulatory checks and testing at the moment, with a plan to launch in 2021. NASA and the Soviet Union space programs had started to investigate in similar protein production for their expeditions in the past, but Solar Foods has brought it down to earth.

Higher Steaks, United Kingdom

Whilst some people are switching to plant-based diets and others have reduced their meat consumption, some others still want to keep meat in their diets but are looking for more environmentally friendly options. This is where lab-based meat comes in. Benjamina Bollag, CEO and co-founder of Higher Steaks, a UK-based company, believes that it is important to provide alternatives to meat with a lower carbon footprint, but that taste as close as possible to the real thing. She believes that the change required in human behavior to cut emissions will not happen fast enough otherwise. This approach is confirmed by research they have conducted. 52% of respondents confirmed that they would switch from conventional meat to the Higher Steaks alternative, with 21% saying they would prefer a plant-based diet. There are different ways of producing lab-based meat. The process that Higher Steaks is developing is based on pluripotent stem cells, which are taken from a small skin patch or blood sample. The meat that is grown is then shaped into products. Currently, Higher Steaks is working primarily on pork products.
In Photo: Higher Steaks will eventually release pork as its first lab-cultured meat. Photo Credit: Yvonne Lee Harijanto - Unsplash
The company has yet to conduct a lifecycle assessment of the lab-grown meat, but given the high levels of environmental impact from meat production, it should be safe to say that Higher Steaks products will be more sustainable. In addition, as Benjamina explains, other advantages include the avoidance of antibiotic use, resulting in a product which is better for the consumer as well. The level of fat can also be adjusted, depending on consumer preference. The company is working to have the first products in shops within 3-5 years.

Barukas, Brazil

Barukas proves that you don’t always to have to look to the future for more sustainable food sources. Sometimes it is about rediscovering and making available a food source which has been around for a long time to a wider audience. The baruzeiro tree, native to Brazil, has been a long-time source of nutrition for people living in the Cerrado, the vast savannah at the heart of Brazil. The tree produces a fruit, which contains the baru nut. It was the nutritional profile of the baru nut that initially attracted Seth Tuckerman, who had formerly been the COO of Beachbody, a fitness business. The nuts are high in protein, fiber, minerals, and are lower in fat than typical nuts. The taste is often described as a cross between peanuts and almonds. In fact, Tuckerman’s immediate thought on tasting them was “low calorie almonds”. Tuckerman’s passion is not only about the positive health benefits, but also about the trees and the mutual benefits for the communities where they grew.
In Photo: Baruzeiro tree. Photo Credit: Barukas
Tuckerman became a co-founder of Barukas Incorporated. They are on a mission to plant 20 million baruzeiro trees – as a start. The trees need little water and – as native trees – they are already ideally suited to the Cerrado conditions. First, Barukas must prove that there is a market for the fruit of the existing trees. As such, the company is encouraging those living in the Cerrado to collect the nuts by guaranteeing to buy them, then creating customer demand for the nuts. Collecting the fruit from existing trees helps to preserve them from being cleared for intensive and invasive agricultural methods such as soy plantations. Likewise, planting new trees helps to reverse the deforestation of Cerrado. A report by the Climate Observatory estimated that the destruction of surface vegetation in the Cerrado released 248 million tons of greenhouse gas emissions in 2016. This is roughly two-and-half times the annual tailpipe emissions from all cars in Brazil.
In Photo: Closer look at the baruzeiro tree. Photo Credit: Barukas.
From talking with these three pioneers, it is now clearer than ever that we need multiple solutions to address how to sustainably feed a growing population. We need to cut the carbon emissions and reduce other environmental impacts such as water and land use associated with food production. Some of these solutions are a little way off in the future, but others are available now. We are what we eat, but our choices will increasingly determine what kind of future we will live in as well.   EDITOR’S NOTE: The opinions expressed here by Impakter.com columnists are their own, not those of Impakter.com.
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