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Notebook Medicine



Disaster medicine

Medical establishment circles its wagons around New Orleans physician who administered lethal drugs

Legally speaking, Anna Pou, the doctor accused of performing "mercy killings" during Hurricane Katrina, is off the hook. A New Orleans grand jury chose last month not to indict her for murder in the deaths of nine elderly hospital patients. Now Pou faces the public trial of her reputation, pitting the medical establishment against Louisiana's attorney general.

Until Sept. 1, 2005, Pou was a hero. She stayed behind in storm-wracked New Orleans to care for patients at Memorial Medical Center with no electricity, ventilation, or running water. Four days into holing up, Pou took some nurses up to the hospital's LifeCare unit for terminally ill patients who, doctors believed, would not survive an evacuation. Louisiana attorney general Charles Foti alleges that Pou ordered lethal doses of morphine and another sedative for four patients who died in the same three-hour period that day.

Because grand jury proceedings are not public, it is not clear who saw what on the seventh floor of Memorial Hospital, but Pou was arrested last summer along with two nurses. The nurses avoided prosecution by agreeing to testify against Pou. Foti built his case on witnesses' testimonies and the opinions of five nationally known experts who said the four patients' deaths were homicides.

The case had one major weakness: The Orleans Parish coroner said he could not determine the causes of death. During grand jury proceedings Orleans Parish prosecutor Eddie Jordan did not call any of the five experts to testify.

Among the experts was Art Caplan, a bioethicist who provides commentary for MSNBC and is pro-abortion, pro--embryonic stem-cell research, and sided with Michael Schiavo in the Teri Schiavo case. Here he did not give Pou the benefit of the doubt.

"Each person died with massive doses of narcotic drugs in their bodies," Caplan told The Advocate newspaper of Baton Rouge. "There is no evidence of consent. There is no documentation or record of any request on the part of any patient for assistance in dying." Caplan said he believed there was more than enough evidence to justify a criminal trial.

Pou lawyer Rick Simmons mounted an emotional defense that capitalized on the public support of New Orleans doctors, nurses, and hurricane survivors. The American Medical Association (AMA) also sided with Pou. After the grand jury decision, it released a statement saying, "The AMA continues to be very concerned about criminalizing decisions about patient care, especially those made during the chaotic aftermath of a disaster."

But Foti does not buy the argument, or the grand jury's decision. A day after the decision, Foti filed a petition to unseal records that his office filed with the grand jury. He also released his experts' reports to the press, along with a narrative of what his investigators thought happened on Sept. 1, 2005. Foti told reporters, "While I have a deep respect for the grand jury, I think they erred."

Stem-cell payback

Pro-life Missouri politicians have retaliated against last year's passage of a pro-cloning, anti-embryo amendment to the state constitution. The amendment prevented state legislators from passing any law that limits embryonic stem-cell research or the cloning of embryos for experimentation. Since they could not burst the research bubble, pro-life legislators let the air out of a $425 million plan to bolster life-science research around the state. The move stripped funding for the projects and let down not only researchers but also Republican Gov. Matt Blunt, who made the science and business of bio-research an essential part of his economic plans for the state.

In June, one of the state's most prominent private research firms announced it is postponing a $300 million expansion project. Stowers Institute blamed the continuing opposition to embryonic stem-cell research in Missouri for its inability to recruit more researchers to fill new labs.

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Ryan and Brianna Morrison meet their daughter Lucia for the first time on June 11

(Ryan and Brianna Morrison meet their daughter Lucia for the first time on June 11)


Deadly drugs

Babies' deaths raise debate about fertility treatments

Sextuplets Bennet, Tryg, Lincoln, Cadence, Lucia, and Sylas Morrison were famous before they were born. The Minneapolis CBS news affiliate created a web page where viewers could follow their mother's pregnancy, watch interviews, and even view her ultrasound photo. Parents Ryan and Brianna Morrison also had their own internet site, as well as a nonprofit organization called "Morrison Multiples Corporation" that collected donations for the family.

Twenty-two weeks into the pregnancy, the Morrisons went from being a local human-interest story to a national spectacle when the deaths of four of the babies followed their extremely premature births on June 10. The surprise of seeing a multiple-birth story turn from entertainment to tragedy led onlookers to try to place blame for the unhappy ending. Pro-aborts have criticized the Morrisons for not "selectively reducing," a.k.a. killing in utero, some of the babies early in the pregnancy.

Others have blamed medicine, saying today's fertility treatments are both too risky and too tempting for desperate couples. The infant mortality rate of twins and other multiples is more than five times higher than that of single births, according to the Centers for Disease Control and Prevention. Despite the added risk, births of triplets and higher-numbered multiples in the United States have quintupled in number since the advent of fertility drugs in 1980. Since then, prime-time specials featuring siblings such as the Dilley sextuplets have brought mega-multiples into the mainstream. Triplets and quadruplets now seem commonplace.

The Morrisons, both children of pastors, met at Bethany College of Missions in Minneapolis. They married in 2005. After struggling with infertility, they conceived with the help of the ovulation-inducing drug Follistim. They said that they knew the risks-but nothing prepared them for the shock of finding out Brianna Morrison was pregnant with sextuplets.

"Brianna sobbed quietly on the exam table, and I, playing the part of the strong husband, told her that everything was going to be OK," Ryan Morrison wrote in an online journal entry. "The truth is that I had never been so overwhelmed."

The Morrisons refused doctors' advice to abort some of the babies to give the remaining children a better chance of survival. "We understand that the risk is high, but we also understand that these little ones are much more than six fetuses," Ryan Morrison wrote before the babies' births. "Each one of them is a miracle given to us by God."

Sign up or pay up

A law requiring residents of Massachusetts to have health insurance just took effect, but an estimated 160,000 people remained uninsured after the deadline. By July 1, the state expected anyone without health insurance to have taken advantage of one of three options: Medicaid, state-subsidized insurance, or private plans, depending on a family's income.

The deadline was really more of a guideline; residents have until the end of the year to get insurance. Anyone who fails to do so will face an income tax penalty of around $220 next year. The state estimates that 130,000 individuals have signed up for either Medicaid or the state subsidies. Most of the remaining uninsured people, many of them healthy young adults, do not qualify for the state-sponsored plans but also do not want to pay for private insurance.

First fruits

A study of about 241,000 IQ test results found that first-born children on average scored 2.8 points higher than second-born children and four points higher than third-born children.

The study analyzed the IQs of Norwegian men who took intelligence tests for military conscription. The study was published in the June 22 issue of Science. The scientists adjusted their data to account for other factors that affect intelligence, including parents' education levels, the number of children in a family, and the age of the children's mothers.

The scientists based their analyses on the average score of each birth group, so within individual families, younger children could have had higher IQs than their older siblings. Another finding of the study added a layer to the nature-versus-nurture debate. Children born after the death of an oldest sibling had the same IQ advantage as true first-borns. That fact suggests that family environment, not biology, causes birth-order differences between children.

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Honeymoon's over

Scare over groom's TB is just the beginning for fellow travelers

Whether Andrew Speaker goes down in history as a 21st-century Typhoid Mary depends on the health of about 80 airline passengers whom he exposed to extensively drug-resistant tuberculosis (XDR) traveling to and from his wedding and honeymoon. Since his transatlantic travel ended in late May, the Centers for Disease Control and Prevention (CDC) worked with governments around the world to track down passengers from Speaker's flights to and from Europe, as well as his family and co-workers, to urge them to be tested for TB.

Meanwhile, members of the press accused Speaker and the health officials who knew about his infection of neglecting public safety.

"In many ways we balance individual freedoms and public good," said Martin Cetron, CDC director of global migration and quarantine. "And we depend on a covenant of trust, and not every one of these situations, in fact, the vast, vast minority of situations of infectious tuberculosis drug resistant or otherwise, require legal restraining orders in order to keep people from moving, in order to encourage them to do the right thing."

The CDC and the World Health Organization recently publicized the dangers of XDR on World TB Day, March 24. An outbreak of XDR killed all but one of more than 50 infected hospital patients in 2005-2006 in South Africa.

Now the CDC is working through the kind of scenario it warned might happen if global TB surveillance did not improve. In a May 30 press conference, CDC officials talked about the challenges in Speaker's case of coordinating between several countries' public-health systems and getting access to international airline passenger information.

TB is a bacterial infection that slowly settles in the lungs, gradually damaging them over time. The disease only spreads from person to person after hours of contact in close quarters. Treatment requires at least a six-month course of antibiotics, many of which are not effective against XDR. A person can have TB for a long time without experiencing any signs or symptoms of the disease. So-called "latent TB" is not contagious.

But Speaker did not have latent TB; signs of the disease showed up on a chest X-ray that doctors originally took for an unrelated reason. It can take weeks to determine whether a case of TB is drug resistant, and tests were still underway when Speaker left May 12 for his wedding in Greece. Speaker's family claimed in news interviews that doctors advised him before his wedding that he was not contagious, but he should still not travel. He found out about his XDR status while honeymooning in Italy.

Stem-cell arsenal

Georgia Gov. Sonny Perdue on May 24 enacted a law requiring the state to stockpile donated stem cells. A network of state-sponsored banks would collect donated postnatal tissue, including umbilical cords and placentas, and use stem cells from them for research and treatment. Researchers believe those stem cells have properties similar to stem cells harvested from embryos, which can develop into almost any kind of tissue in the body. Some scientists believe embryonic stem cells will one day yield cures for disease, but embryos are destroyed during research for those cures. The Georgia act promotes stem cells from postnatal tissue as a pro-life alternative to those from embryos. The law requires doctors to tell all pregnant women, starting in mid-2009, about the stem-cell banks and the benefits and risks of donating umbilical cords and placentas. The state also will give Georgia residents the opportunity to donate to the stem-cell banks when they file their income tax returns.

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