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The Point - February 13, 2014

In this edition of The Point:

Article #1

Excerpted from “Religion, Spirituality May Build Resilience Against Depression by Toughening the Brain, Study Suggests,”Psychiatric News Alert. January 9, 2014 — The reason that religion or spirituality appears to protect people with a familial risk of depression from developing the illness may be because religion or spirituality thickens the cortices of the brain, Columbia University researchers Lisa Miller, PhD, Myrna Weissman, PhD, and colleagues report in JAMA Psychiatry.

Their study included 103 adults who were either at high familial risk or low familial risk for depression. The importance they placed on religion or spirituality was evaluated at two time points during a five-year period. The thickness of their brain cortices was measured with MRI at the second time point. The researchers found that the brain cortices of subjects who placed a high importance on religion or spirituality were thicker than the brain cortices of those who did not, but that, in addition, the cortices were especially strong in those individuals who placed a high importance on religion or spirituality and who had a high risk of depression.

"This study points to measurable, beneficial effects of presumably healthy spirituality, especially for individuals with biological predispositions to depression," Mary Lynn Dell, MD, told Psychiatric News. The study, she continued, "adds to substantial and growing evidence that psychiatrists should support healthy development in that sphere of patients' lives. Studies such as these may also inform the particular ways and methodologies religious professionals...employ to care for and work with depressed individuals, while at the same time staying true to their particular religious beliefs and traditions."

Commentary #1

Executive Vice President, CMDA Gene Rudd, MD: “A single study finding that the cerebral cortex is thicker in people who place a high priority on religion or spirituality obviously requires additional investigation. But it is only one new addition to the large amount of literature linking many positive health outcomes with religion and spirituality. That accumulative data is impressive – more than 1,500 studies and counting.

“So if faith is so good for health, why are we not introducing it more in clinical care? In surveying Christian doctors, we found that the great majority have a desire to engage the spiritual lives of their patients, but the obstacles that prevent them are 1) concerns about time, 2) fear of ethical concerns, and 3) ignorance of how to appropriately do so. Would it surprise you to know that there are excellent answers and solutions to each of these concerns?

“To help Christian doctors overcome the obstacles, effectively engage the spiritual needs of patients and improve overall healthcare delivery, CMDA has developed a curriculum called Grace Prescriptions. Visit to find information as to where and when these seminars will be held in the coming months. While the live seminar experience is the best way to gain this knowledge and skill, we are also developing a video curriculum that can be used by groups in their local communities. The video curriculum is expected to be released by summer 2014.

“As a means of honoring Christ’s command that we be salt and light, and as a means of broadening the scope of healing care for your patients, we hope you will join us in learning how to provide Grace Prescriptions.”

Article #2

Excerpted from “Brain-dead Texas woman taken off ventilator,” CNN Health. January 27, 2014 — A wrenching court fight—about who is alive, who is dead and how the presence of a fetus changes the equation—came to an end Sunday, January 26 when a brain-dead, pregnant Texas woman was taken off a ventilator. The devices that had kept Marlise Munoz's heart and lungs working for two months were switched off about 11:30 a.m. Sunday, her family's attorneys announced.

Munoz was 14 weeks pregnant with the couple's second child when her husband found her unconscious on their kitchen floor November 26. Though doctors had pronounced her brain dead and her family had said she did not want to have machines keep her body alive, officials at John Peter Smith Hospital in Fort Worth had said state law required them to maintain life-sustaining treatment for a pregnant patient.

Sunday's announcement came two days after a judge in Fort Worth ordered the hospital to remove any artificial means of life support from Munoz by 5 p.m. Monday. The hospital acknowledged Friday that Munoz, 33, had been brain dead since November 28 and that the fetus she carried was not viable. Her husband, Erick Munoz, had argued that sustaining her body artificially amounted to "the cruel and obscene mutilation of a deceased body" against her wishes and those of her family. Marlise Munoz didn't leave any written directives regarding end-of-life care, but her husband and other family members said she had told them she didn't want machines to keep her blood pumping.

Commentary #2-A

CMDA CEO David Stevens, MD, MA (Ethics):"While the medical technology being applied to Mrs. Munoz’s body might be considered “organ support” for her, it was “life support” for her unborn child. At the time of her death the baby was a few days from reaching 24-weeks gestation when survival rates approach 50%. Every day of continued life support improved the odds of the baby’s survival.

"A few days ago, on February 9th, Robyn Benson had a premature baby boy. Just after Christmas she suffered a cerebral hemorrhage resulting in her own brain death. She was maintained on life support until her baby was delivered. The ventilator was disconnected the day after her child was born. According to reports, the baby is doing well in the NICU.

"I don’t have access to the medical records in either of these cases, but a CNN article on the Benson case makes an inadequate effort to ethically differentiate between her baby’s situation and Mrs. Munoz’s. First, they let you know that one child was wanted by its father but the other was not. The worth of a human being does not depend on whether it is wanted or not. Secondly, the Munoz lawyer’s reported that an incomplete ultrasound had shown the baby had hydrocephalus and possibly other malformations. We should recognize that disposing of the disabled is unethical and simply eugenics. Who decides when a person is disabled enough for elimination?

"CMDA does not have an official ethics statement dealing with this complex issue. Maybe we should. You can contribute to the discussion of what it should say by clicking on the comment link below."

Commentary #2-B

Clinical Ethicist and CMDA Trustee Robert D. Orr, MD, CM:“Marlise Munoz was dead, but her 14-week old fetus was alive. If Mom’s organs could be successfully perfused for another 12-14 weeks, her unborn baby could survive and be delivered by C-section. It is possible, though clinically very challenging. But should it be done?

“Marlise’s family did not want artificial support continued, and they were convinced she would not want it. The hospital believed Texas law prohibited removing life support from a pregnant woman. The legal issue was straightforward: Marlise was dead, therefore the support was not ‘life support’ for her, but ‘organ support’ for the benefit of the fetus. Continued support was legally optional.

“But what about the ethical dilemma? Who should decide? What factors should be considered? Some believe it is morally obligatory to do everything possible to prevent fetal death. Others believe that ‘doing everything’ is not always obligatory, making this comparable to high risk, high burden prenatal fetal surgery, i.e., optional, decided by her family based on their understanding of her wishes and values.

“Not all believers will agree. We will agree that we are stewards of our lives, our bodies and our resources. And we will likely agree it is immoral to intentionally end prenatal life for trivial reasons. The intention in continuation was to possibly benefit a second life. The intention in stopping was to discontinue ineffective and unwanted treatment. I personally believe continued support in this case was discretionary. And I believe we should not harshly judge the Munoz family’s decision.”

Article #3

Excerpted from “Acid bath offers easy path to stem cells,” Nature. January 29, 2014 — In 2006, Japanese researchers reported1 a technique for creating cells that have the embryonic ability to turn into almost any cell type in the mammalian body — the now-famous induced pluripotent stem (iPS) cells. In papers published this week in Nature2, 3, another Japanese team says that it has come up with a surprisingly simple method — exposure to stress, including a low pH — that can make cells that are even more malleable than iPS cells, and do it faster and more efficiently.

“It’s amazing. I would have never thought external stress could have this effect,” says Yoshiki Sasai, a stem-cell researcher at the RIKEN Center for Developmental Biology in Kobe, Japan, and a co-author of the latest studies. It took Haruko Obokata, a young stem-cell biologist at the same centre, five years to develop the method and persuade Sasai and others that it works.

Obokata says that the idea that stressing cells might make them pluripotent came to her when she was culturing cells and noticed that some, after being squeezed through a capillary tube, would shrink to a size similar to that of stem cells. She decided to try applying different kinds of stress, including heat, starvation and a high-calcium environment. Three stressors — a bacterial toxin that perforates the cell membrane, exposure to low pH and physical squeezing — were each able to coax the cells to show markers of pluripotency.

Obokata has already reprogrammed a dozen cell types, including those from the brain, skin, lung and liver, hinting that the method will work with most, if not all, cell types. She now wants to use these results to examine how reprogramming in the body is related to the activity of stem cells. Obokata is also trying to make the method work with cells from adult mice and humans. “The findings are important to understand nuclear reprogramming,” says Shinya Yamanaka, who pioneered iPS cell research. “From a practical point of view toward clinical applications, I see this as a new approach to generate iPS-like cells.”

Commentary #3

CMDA Member and Senior Fellow for Family Research Council David Prentice, PhD: “Stress a Cell, Get a Stem Cell. It seems every time one turns around there’s a new non-embryonic stem cell discovery, each more amazing than the last. The latest in the journal Nature is no exception: simply stressing normal adult cells can transform them into embryonic-like stem cells, similar to the Nobel prize-winning induced pluripotent stem (iPS) cells made by Dr. Yamanaka. But unlike Yamanaka’s technique, these ‘STAP’ cells transform from mature mouse cells into stem cells under the influence of stressors such as acid or stretching, without genetic manipulation and in a much shorter time period. And don’t be confused by some of the stories, including the Nature news report. These are not adult stem cells as found in body tissues, nor are these new stem cells inherently embryos or able to form embryos, despite the fact that these mouse STAP stem cells can form placental as well as body tissue types. It takes more than haphazard production of all tissues to form an organism, as has already been seen with human embryonic stem cells. Dr. Maureen Condic has produced an in-depth review of the range of stem cell potency.

This new technique shows once again that there are many acceptable, ethical routes to stem cells, and absolutely no necessity for life destroying embryo research. Adult stem cells from tissues, which are the gold standard for patient treatment, as well as iPS cells and STAP cells, emphasize that ethical, life preserving science is also the best science.

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