Thursday, March 29, 2012

Ideology may hinder contraceptives information

Reprint of "HHS Info Contradicts FDA on Plan B’s Abortifacient Nature," commentary published in, March 16, 2012:

by Jonathan Imbody, CMA VP for Government Relations

Washington, DC--A review of U.S. Dept. of Health and Human Services (HHS) documents on contraceptives raises questions as to why HHS is apparently:
(a) contradicting Food and Drug Administration (FDA) labeling in an HHS Office of Women’s Health document on emergency contraception, and

(b) leaving out vital information, in an HHS Office of Population Affairs document, about the drug’s post-fertilization, life-ending effect
–and whether ideological considerations are driving those decisions.

A recently revised web-based fact sheet published by the HHS Office of Women’s Health appears to contradict FDA labeling on emergency contraception pills (levonorgestrel, also known as “Plan B,” “Plan B One-Step,” “Next Choice” and the “morning-after pill”). FDA labeling indicates that emergency contraception can end the life of a developing human embryo by preventing implantation.

The FDA notes, “Plan B One-Step is believed to act as an emergency contraceptive principally by preventing ovulation or fertilization (by altering tubal transport of sperm and/or ova). In addition, it may inhibit implantation (by altering the endometrium).”

In other words, the drug may prevent a living, developing human embryo from implanting in the womb, thus ending the life of the embryo. Because that information is a key concern for any women with pro-life conscience concerns, it must be presented to allow women fully informed consent in making their medical choices.

However, a recently revised version of the HHS Office of Women’s Health fact sheet casts the post-fertilization issue much differently than the FDA, asserting, “While it is possible that ECPs [emergency contraception pills] might work by keeping a fertilized egg from attaching to the uterus, the most up-to-date research suggests that ECPs do not work in this way.” The fact sheet does not provide any scientific references to back up what is asserted to be “the most up-to-date research.”

A previous version of the HHS Office of Women’s Health fact sheet had included a distinct section entitled, “How does emergency contraception work?” The previous fact sheet noted, “Emergency contraception can keep you from becoming pregnant by: Keeping the egg from leaving the ovary; OR Keeping the sperm from meeting the egg, OR Keeping the fertilized egg from attaching to the uterus (womb).”

The newly revised HHS document also refers readers for more information to (a) the FDA, (b) and (c) Planned Parenthood. Both the original and revised HHS documents state that they were reviewed by James Trussell, PhD, Director of Office of Population Research at Princeton and a member of an FDA advisory panel that in 2003 recommended that Plan B be sold over the counter.

Another HHS fact sheet on emergency contraception, produced by the agency’s Office of Population Affairs, notes only that “Emergency contraception prevents pregnancy mainly by keeping the ovaries from releasing eggs. Emergency contraception also works by causing the cervical mucus to thicken, which blocks sperm from meeting with and fertilizing an egg.” The fact sheet does not mention at all the potential post-fertilization, life-ending effect of the drug.

Since 2002, the HHS Office of Public Health and Science has provided a process by which individuals and organizations can protest and request correction of wrong or incomplete public information disseminated by HHS.
The conspicuous omission of vital medical information needed to provide women with fully informed consent regarding emergency contraception, coupled with unsubstantiated assertions that contradict FDA labeling, lay the administration open to charges that it is advancing abortion ideology over science and violating President Obama’s barbed pledge in his inaugural address to “restore science to its rightful place.”

CMDA Ethics Statement: Abortion

Views contrast as Supreme Court tackles health care la

Excerpted from "Supreme Court begins review of health care law," The Washington Post, March 26, 2012: The Supreme Court opened its historic review of the national health care overhaul Monday with an indication that it will be able to decide the constitutional question of whether Congress exceeded its powers despite arguments that the challenge was brought too soon. The court began the first of three days of oral arguments on the 2010 law by examining a statute that keeps courts from hearing tax challenges before they go into effect.

As the review began, hundreds of supporters and opponents of the health care law marched outside the Supreme Court. The demonstrations highlighted the contentiousness of President Obama’s signature domestic initiative, which was signed into law two years ago and continues to galvanize his opponents. The 26 states challenging the Affordable Care Act (ACA), as well as the private organization and individuals who are party to the challenge, also want the court to act now.

Excerpted from "Pelosi on Obamacare: ‘Ironclad constitutionally,’ honors the ‘vows of our founders,’" The Daily Caller, March 22, 2012: As the Democrats’ health care law heads to the Supreme Court, House Minority Leader Nancy Pelosi said the legislation honors the “vows of our founders,” declaring it “ironclad constitutionally.” Alongside Reps. Steny Hoyer of Maryland and James Clyburn of South Carolina at a ceremony on Capitol Hill, Pelosi said, “After 100 years of trying, finally we passed health care for all Americans as a right for all — not just a privilege for a few. It honored the vows of our founders: Of life, a healthier life; liberty; the freedom to pursue our own happinesses.”

Regarding the health care law Supreme Court case, Pelosi was asked how the highest court in the land would rule on the individual mandate.

“We knew what we were doing when we passed this bill. It is ironclad constitutionally. What happens in the courts is another matter but we believe that we’re in pretty good shape going into the court,” Pelosi responded.

A recent Rasmussen poll shows that 56 percent of Americans “somewhat favor” the repeal of the health care law while 46 percent “strongly favor” it, which represents an eight-month high.

Excerpted from Senator Roy Blunt’s Statement On ObamaCare Supreme Court Hearings, March 26, 2012: “As the Supreme Court begins to hear arguments regarding the constitutionality of the President’s health care law, it’s clear to the majority of Americans that this burdensome and costly legislation is bad for families, seniors, and job creators.

"No matter what the Supreme Court ultimately decides, I believe the President’s health care takeover represents an unmitigated intrusion into Americans’ fundamental rights and freedom. That’s why we must work together to repeal this flawed law and enact common-sense bipartisan solutions that will put patients and doctors in control of their health care – not Washington bureaucrats. Twenty-six states have challenged this law and a number of federal judges have already deemed the individual mandate unconstitutional. I hope the Supreme Court will come to the same conclusion.”

CEO David Stevens, MD, MD (Ethics): "CMDA is working with the Bioethics Defense Fund and other groups, and we submitted an amici brief to the Supreme Court on an overlooked aspect of the Affordable Care Act (ACA) that includes an 'abortion premium mandate.'
"As the brief reads, Found in Section 1303 of the Act, the infringing provisions impose inescapable requirements upon millions of Americans who will be, even unwittingly, enrolled in employer or individual health plans that happen to include elective abortion coverage. Such enrollees are compelled by the Act to pay a separate premium from their own pocket to the insurer’s actuarial fund designated solely for the purpose of paying for other people’s elective abortions.

"Later it says, Section I(C) of this brief outlines our nation’s deeply-rooted history of respecting and protecting the conscience rights of individuals to avoid being forced into the practice or funding of elective abortion. Amici emphasize how these provisions strike at and undermine their most basic principles of morality and religion that call them to respect and protect vulnerable unborn children and to avoid collaborating in the moral evil of directly paying for elective abortion.

"There is no doubt that apart from the Court striking down the law, the Affordable Care Act already has begun to and would continue to impose enormous changes to U.S. health care. CMDA members have varying opinions on how they hope the Supreme Court will rule. As an organization, we don’t have an official position on the ACA, but we have and will continue to speak clearly to the media and the courts on components of the Act that violate our ethical and moral positions on abortion and right of conscience.

"All of us should pray that God’s will would be done on this issue which will affect each of us professionally and personally in the years ahead. God has the power to influence kings, pharaohs and Supreme Court Justices. He has commanded us to pray for those in authority over us.

"Let’s get down on our knees and pray, 'not my will but thine be done.'”

CMDA webcast: 7 Key principles of healthcare reform

Thursday, March 22, 2012

Genome mapping with DNA

Excerpt from "Curing Cancer Relies on Genome Mapping With DNA Evidence Guiding Treatment," Bloomberg, by John Lauerman. January 23, 2012--A decade after the first draft of the human genome was published, hospitals and clinics are using DNA sequencing to generate better treatments and diagnoses for patients with rare childhood diseases, cancers and other mysterious conditions. Using new technology that can effectively print out an individual’s genome -- the instruction manual for making all the body’s cells -- doctors are examining individual components, called bases, to slow intractable cancers and treat one-of-a-kind diseases in children. “This is going to be transformative to medicine,” said John Niederhuber, former director of the U.S. National Cancer Institute from 2005-2010, and now executive vice president of the Inova Health System hospital chain in northern Virginia.

Using faster, more accurate technologies, doctors are combing through ever-wider swaths of the human genome to pinpoint and counteract the causes of disease. Cancer is among the most promising targets because it is essentially a disease in which damaged genes let cells grow without restraint, said Barrett Rollins, chief scientific officer of the Harvard University-affiliated Dana Farber Cancer Institute in Boston.

While the price of genome sequencing is falling to $1,000 and research money will sometimes pay for these procedures, they aren’t routinely covered by insurance. Some patients are paying out of pocket to have their genomes sequenced, and not all of them can be helped by the procedure because their tumors have so many genetic abnormalities. While gene sequencers around the world churn out millions of gigabytes of genetic data, most of the human genome remains unexplored and incomprehensible even to the savviest scientists, let alone practitioners caring for families. With so much unknown, sequencing doesn’t hold answers for every patient.

Jimmy Lin, MDPresident of Rare Genomics Institute, and CMDA Member Jimmy Cheng-Ho Lin, MHS, PhD: "Medicine is transforming right before our eyes. Recently, both Illumina and Life Technologies announced platforms to sequence human genomes for $1,000. In addition, Oxford Nanopore revealed its USB drive-sized disposable sequencer that will cost less than $900. With these new technologies and prices, genome sequencing is quickly becoming a reality as part of the healthcare system. Already, lives of children, such as Nic Volker at the Medical College of Wisconsin and the Berry twins at Baylor College of Medicine, have been dramatically transformed or even saved through this technology. While the age of genomic medicine is upon us, the ethical implications are still to be determined.

"Because genomic information is potentially very powerful and contains one’s genetic fingerprint, careful thought must be applied to both the potential positive and negative consequences. While public sharing of this information will facilitate research and bring forth scientific advances, genetic information could be used in discriminatory or prejudiced manner if in the wrong hands. In addition, while some diseases genes can be identified more easily, the interpretation of genetic profiles is still developing as a field and many of the implications in terms of health are yet to be understood. In the midst of this complexity even among experts, it is thus an additional challenge to educate and engage the average patient to understand the consequences of this data. While the technology and equipment may change, ultimately the role of the physician modeled after the Great Physician remains the same - as advocate, educator, interpreter, servant, guide and friend."

Standards4Life information on the Human Genome Projec

Responsible development of nanotechnology

Excerpt from "The Responsible Development of Nanotechnology: Challenges and Perspectives," March 10, 2012--Nanotechnology is a rapidly evolving field expanding in the worldwide context of globalization. Yet no international framework has emerged for the regulation and governance of nanotechnologies. This phenomenon may be explained by several factors: diversity of nanoparticles and their properties; complexity of risk assessment; differing expectations of economic impact; strategic partnerships between universities, industry and government; conflicting politico-economic agendas; race toward innovation and patent application; and political hesitation between public education and forums of public consultation.

The big players -USA, the European Economic Community, Japan, China- are working toward various forms of regulation and supervision, as these constitute the necessary conditions for scientific, economic and social development of nanotechnologies. Other countries seem to have adopted a wait-and-see approach, which is often detrimental to the national development of nanotechnology, such that nano products are consequently imported and the general public remains in the dark as to matters of social, environmental and economic concern.

Furthermore, a lack of regulation and the geographic variability in rules and regulations drive the outsourcing of innovation and possibly a shift in responsibility regarding innovative development.

David Prentice PhDSenior Fellow for Life Sciences, Center for Human Life and Bioethics, and CMDA Member David A. Prentice, PhD: "The announcement of this conference on The Responsible Development of Nanotechnology is an opportunity for people to learn more about this developing technology. For those unfamiliar with nanotechnology, it involves fabrication of particles, including machines, that are microscopic or smaller (nano-scopic) in size. The older among us may remember the movie Fantastic Voyage, where a submarine and crew were shrunk to the size of a blood cell and injected into a patient; fans of Star Trek may think of the Borg, who injected nano-sized machines that remade the human body. While nanotechnology is not yet that advanced, there are already publications using nanoparticles to track and visualize specific cells; for vital imaging of tissues; cell-specific targeting of cancer chemotherapy and antibodies; gene delivery and expression in specific tissues; anofiber scaffolds for cell growth and tissue regeneration; and construction of molecular machines smaller than a human cell.

"Commercial use of nanoparticles already includes cosmetics and sunscreens, paints and electronics. Several journals are devoted to the topic, including recent focus collections of papers related to the still-unresolved issue of 'nanotoxicology'. The ethics and regulation of nanotechnology is also still unsettled, even though the research is more than two decades old. Significant issues regarding safety in production and use of nanotechnology, as well as potential uses for modifying the human genome or breaching privacy, have yet to be addressed. It is past time that we become more aware of this burgeoning area, and imperative that as Christians we weigh in on guidance for development of nanotechnology, channeling it into ethical and useful paths."

CMDA Ethics Statement: Christian Physician's Oath
CMDA Ethics Statement: Moral Complicity with Evil

Nanotube and Medical Diagnostics

Excerpt from "Nanotube technology leading to fast, lower-cost medical diagnostics," Physorg March 9, 2012--Researchers at Oregon State University have tapped into the extraordinary power of carbon “nanotubes” to increase the speed of biological sensors, a technology that might one day allow a doctor to routinely perform lab tests in minutes, speeding diagnosis and treatment while reducing costs.

The new findings have almost tripled the speed of prototype nano-biosensors, and should find applications not only in medicine but in toxicology, environmental monitoring, new drug development and other fields. “With these types of sensors, it should be possible to do many medical lab tests in minutes, allowing the doctor to make a diagnosis during a single office visit,” said Ethan Minot, an OSU assistant professor of physics. “Many existing tests take days, cost quite a bit and require trained laboratory technicians. “This approach should accomplish the same thing with a hand-held sensor, and might cut the cost of an existing $50 lab test to about $1,” he said.

The key to the new technology, the researchers say, is the unusual capability of carbon nanotubes. An outgrowth of nanotechnology, which deals with extraordinarily small particles near the molecular level, these nanotubes are long, hollow structures that have unique mechanical, optical and electronic properties, and are finding many applications. In this case, carbon nanotubes can be used to detect a protein on the surface of a sensor. The nanotubes change their electrical resistance when a protein lands on them, and the extent of this change can be measured to determine the presence of a particular protein – such as serum and ductal protein biomarkers that may be indicators of breast cancer.

Further work is needed to improve the selective binding of proteins, the scientists said, before it is ready to develop into commercial biosensors. “Electronic detection of blood-borne biomarker proteins offers the exciting possibility of point-of-care medical diagnostics,” the researchers wrote in their study. “Ideally such electronic biosensor devices would be low-cost and would quantify multiple biomarkers within a few minutes.”

Don Thompson, MDDirector of Global Health Outreach Don Thompson, MD: "These nanotube-based diagnostics move us closer to Star Trek’s 'tricorder' multifunction handheld device. There are also DNA chip-based diagnostics in testing phases that have been developed by the military for use in rapid diagnosis; for example, to diagnose a fever of unknown origin in a patient who may have been exposed to an exotic natural or manmade pathogen. These technologies will go far to helping clinicians as the point of care in ruling out many potential diagnoses, and will help us focus on the unknowns.

"Don’t worry, we are unlikely to be out of a job anytime soon from these technologies. They are unlikely to provide much help in diagnosing anything beyond the biological realm. We will still practice our art and science on the psychological, social and spiritual realms that make up this fantastic creation called the human being. We must still come alongside each and every patient and pray for healing, and reassure our patients that when God withholds healing power, He provides suffering power. When God withholds delivering power, He provides dying power. These powers are unlikely to become available from nanotubes! "

Christian Doctor's Digest: Dr. James Tour - Nanotechnology and Faith (mp3)

Thursday, March 8, 2012

Doctors accused of taking bribes

Excerpt from "Montreal doctors accused of taking bribes," CBC News. February 21, 2012--Two Montreal cardiologists are facing disciplinary action over allegations they received hefty kickbacks to push patients to the top of the waiting list, the Quebec College of Physicians says. The college's investigation uncovered at least two doctors who were allegedly taking envelopes of cash in exchange for providing faster service, Dr. Charles Bernard told CBC News.

The investigation was triggered 14 months ago, when a Montreal woman told the news media she had paid a $2,000 cash "incentive" to have her mother bumped to the top of a waiting list. After the investigation, the college said two cardiologists from Montreal would face a disciplinary hearing later this year in connection with such incidents. Bernard would not discuss the details of the cases, as nothing yet has been proved.

Dr. Gaetan Barrette, the head of Quebec's federation of specialist doctors, said he hoped the college would send a clear message that the alleged behavior is unacceptable. "It's disgusting for the medical profession," he told CBC News. "There are no other reasons I can think of other than greed for those doctors to go in that direction." Barrette said the two cardiologists could be suspended, but it is unlikely they will be prohibited from practicing permanently. A sanction that harsh is typically reserved for extreme cases, such as sexual assault of a patient, he said. Jean-Pierre Ménard, a lawyer who specializes in health law and patients’ rights, said there is little incentive for those who know about these practices to bring them to light. "When the patient is offering cash to the doctor, and the doctor is accepting the cash … both of them have an interest not to tell the story," he told CBC News.

David Stevens, MDCMDA CEO David Stevens, MD, MA (Ethics): "Bribery is possible when those entrusted with power use it for personal gain.

"Medical bribery is now common around the world. Mahajan V. relates that patients in India have to pay bribes to get the bodies of their dead relatives released from the hospital mortuary.1 Transparency International reports that surveys showed 95 percent of Pakistanis think the health system is corrupt and 96 percent of people had paid a healthcare provider (they don’t merit the term 'professional') a bribe.2 I know first-hand stories of patients routinely bribing doctors in Russia to get even basic services. The Chronicle of Higher Education in July documents the corruption in medical services that is literally killing Russia. Students bribe their way into medical school and then bribe their professors for their grades.3

"The China Daily wrote last month of the 'commercial bribery in the country's hospitals and medical institutions' and the demands made on the government to curb it.4 The 'five biggest public hospitals in Hanoi banned their staff from taking ‘envelope’ (tip or black money) from patients in September 2011.' These tips are a common practice to avoid getting a 'chilly response' from healthcare providers.

"I don’t know if the doctors accused in Canada are guilty or whether corruption is widespread in the Canadian health system. I do know the conditions that lead healthcare professionals to break their covenant with patients. Corruption thrives when personnel are underpaid and overworked, and when resources considered very valuable are limited or rationed. We are rapidly moving down that path in the U.S. Like a cancer, corruption starts small but rapidly grows until it becomes endemic in these conditions.

"The best defense against corruption is the character and integrity of the individual physician or dentist. Simply teaching ethics does not produce trustworthy doctors; character development begins long before medical and dental school. That's why it is so important to screen for character as well as intellect when interviewing prospective students. Upright students must then learn, through worthy mentors and courses emphasizing ethics, what it means to be a true and trustworthy professional.

"If not, we may all have to pay bribes in the not so distant future to get the healthcare we need."

  1. Mahajan V. White coated corruption. Indian J Med Ethics 2010; 7: 18-20. Available from URL:
  2. Transparency International. Corruption in public services; perceived corruption in health sector. Berlin, Germany: Transparency International, 2002.

CMDA Ethics Statement: Health Care Delivery
CMDA Ethics Statement: Principles of Christian Excellence in Medical & Dental Practice
CMDA Ethics Statement: Christian Physician's Oath

After-Birth Abortions

Excerpt from "New National Sex-Education Standards Stir Controversy," LifeNews, by Steven Ertelt. February 28, 2012--Two “ethicists” who are college professors in Australia are furthering the pro-infanticide arguments of American professor Peter Singer by calling for so-called “after-birth abortions.” Alberto Giubilini with Monash University in Melbourne and Francesca Minerva at the Centre for Applied Philosophy and Public Ethics at the University of Melbourne write that in “circumstances occur[ing] after birth such that they would have justified abortion, what we call after-birth abortion should be permissible.” The two are quick to note that they prefer the term “after-birth abortion" as opposed to ”infanticide.” Why? Because it “[emphasizes] that the moral status of the individual killed is comparable with that of a fetus (on which ‘abortions’ in the traditional sense are performed) rather than to that of a child.” The authors also do not agree with the term euthanasia for this practice as the best interest of the person who would be killed is not necessarily the primary reason his or her life is being terminated. In other words, it may be in the parents’ best interest to terminate the life, not the newborns.

The circumstances, the authors’ state, where after-birth abortion should be considered acceptable include instances where the newborn would be putting the well-being of the family at risk, even if it had the potential for an “acceptable” life. The authors cite Downs Syndrome as an example, stating that while the quality of life of individuals with Downs is often reported as happy, “such children might be an unbearable burden on the family and on society as a whole, when the state economically provides for their care.” This means a newborn whose family (or society) that could be socially, economically or psychologically burdened or damaged by the newborn should have the ability to seek out an after-birth abortion. They state that after-birth abortions are not preferable over early-term abortions of fetuses but should circumstances change with the family or the fetus in the womb, then they advocate that this option should be made available. Giubilini and Minerva say that merely being a human being is not enough to warrant a respect for a person’s right to life.

The second we allow ourselves to become the arbiters of who is human and who isn’t, this is the calamitous yet inevitable end. Once you say all human life is not sacred, the rest is just drawing random lines in the sand. It’s almost a pro-life argument in that it highlights the absurdity of the pro-abortion argument. These two “ethicists” seem to draw the distinction I’ve seen elsewhere of “self-awareness.” But isn’t that a sliding scale? Isn’t that a bit of a judgment call? Doesn’t this also put the crosshairs on the mentally disabled or those who have suffered brain injuries? They throw around this term “potential person” like it’s a real thing. As if it’s science. But there’s no such thing as potential persons. It’s anti-science. There’s defenseless people. Maybe that’s what they mean. In fact, isn’t that really the point? There’s defenseless people and indefensible ethicists.

And Wesley J. Smith, the prominent American bioethics attorney, says bioethics now contains no ethics whatsoever. Or to put it another way, too often bioethics isn’t. On the other hand, to be fair, the ancient Romans exposed inconvenient infants on hills. These authors may want to take us back to those crass values, but I assume they would urge a quicker death.

Dr. Gene RuddCMDA Senior Vice President Gene Rudd, MD: "Res ipsa loquitur: quotes from the article by Giubilini and Minerva:
  • “After-birth abortion (killing a newborn) should be permissible in all cases where abortion is, including cases where the newborn is not disabled."
  • “We propose to call this practice ‘after-birth abortion’, rather than ‘infanticide’ to emphasis that the moral status of the individual killed is comparable with that of the fetus.”
  • “It should be permissible to practice an after-birth abortion on a healthy newborn too, given that she has not formed any aim yet.”
  • “Both a fetus and a newborn certainly are human beings and potential persons, but neither is a ‘person’ in the sense of ‘subject of a moral right to life.’”
  • “Merely being a human being is not in itself a reason for ascribing someone a right to life.”
  • “A consequence of this position is that the interests of actual people over-ride the interests of merely potential people to become actual ones.”
  • “since non-persons have no moral rights to life, there are no reasons for banning after-birth abortions.”
  • “We do not put forward any claim about the moment at which after-birth abortion would no longer be permissible.”
  • “In cases where after-birth abortion were requested for non-medical reason, we do not suggest any threshold.”

"Aghast? You should be. I was, even though this is not the first modern advocacy for infanticide. And even though many of us have predicted this to be the next decent on the slope upon which we slide.

"I hope you do not forget your visceral response to this. This idea will gain momentum. Moral boundaries are typically breeched subtly by having what was once shocking become debatable, then tolerant. We must allow a God-guided righteous indignation to motivate us to stand boldly against such an affront to life and our Creator.

"I have long resisted the strategy of likening Western civilization’s moral decline to that of Nazi Germany in the 1930s. I thought that comparison unkind, unhelpful and perhaps unfair. No longer! In his 1949 Nuremberg War Crime Trials report published in the New England Journal of Medicine, Dr. Leo Alexander, chief U.S. medical representative, commented, 'it became evident to all who investigated that they (the crimes) had started from small beginnings. The beginnings at first were merely a subtle shift of emphasis in the attitudes of physicians. It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as a life not worthy to be lived.'

"After first being shocked by this article, I now have a sense of foreboding, knowing this 'attitude' was accepted for publication in a prominent medical journal."

CMDA Ethics Statement: Abortion
Mental Health Risks of Abortion

Sex-changing treatment for kids?

Excerpt from "Sex-changing treatment for kids: It's on the rise,", by Lindsay Tanner. February 20, 2012--A small but growing number of teens and even younger children who think they were born the wrong sex are getting support from parents and from doctors who give them sex-changing treatments, according to reports in the medical journal Pediatrics.

It's an issue that raises ethical questions, and some experts urge caution in treating children with puberty-blocking drugs and hormones. Switching gender roles and occasionally pretending to be the opposite sex is common in young children. But these kids are different. They feel certain they were born with the wrong bodies. Some are labeled with "gender identity disorder," a psychiatric diagnosis. But Dr. Norman Spack, author of one of three reports published and director of one of the nation's first gender identity medical clinics, at Children's Hospital Boston is among doctors who think that's a misnomer. Emerging research suggests they may have brain differences more similar to the opposite sex.

"Offering sex-changing treatment to kids younger than 18 raises ethical concerns, and their parents' motives need to be closely examined," said Dr. Margaret Moon, a member of the American Academy of Pediatrics' bioethics committee. It's harmful "to have an irreversible treatment too early," Moon said. Doctors who provide the treatment say withholding it would be more harmful.

Dr. Patrick SternH. Patrick Stern, M.D. Professor of Pediatrics Chief, Section of Developmental/Behavioral ETSU Pediatrics: "Whether they are boys or girls, all children have some qualities of masculine and feminine behavior, with some displaying more evident behaviors of the opposite sex. Animal research demonstrates that animals castrated at birth and given physiological amounts of the hormone of the opposite sex will develop behaviors and physical characteristics of the opposite sex.

"Children may express that they believe that they are the opposite sex. Should children who state this belief be given the option to change their biological sex so that they are 'happy', or should the gender identity confusion be treated so that they will accept their biological gender? Sex change operations have anesthetic risk and the reconstruction of genitalia does not create normal functions. Hormones used to promote sexual behaviors and physical changes can cause serious, life-threatening side effects. Behavior modification techniques, especially when introduced during the preschool years, can promote acceptance of the biological gender identity of the child. Hormone supplementation determined by the biological sex of the child can promote normal sexual behavior and physical characteristics.

"Our culture promotes immediate, self-centered gratification regardless of the risk to the individual, other people and society. Children should not be given authority to make decisions because they want something; adults should make decisions based on the best interest of the child. Interventions targeted to help children accept their God-given sexual identities can cure what has been identified as a disorder and can teach children that applying biblical principles to manage stress can promote spiritual growth. Physicians sometimes think that they are wiser than God. God does not make mistakes."

Negative Health Consequences of Same Sex Sexual Behavior