James C Bobrow | PubMed Health

PubMed2005

The ethics and politics of stem cell research.

INTRODUCTION: Because of the many ocular diseases that may benefit from genetic alteration, ophthalmology will be embroiled in the controversy over the ethics of stem cell research. In preparation for a major academic symposium at the Washington University School of Medicine, the direct and indirect effects of political efforts to determine whether this research should be funded were explored. METHODS: A symposium was held at Washington University School of Medicine sponsored by the Barnes-Jewish Hospital Medical Staff Association to discuss the scientific basis of stem cell research. The forces arrayed on either side of the argument are presented as well as the political context in which they are being played out. RESULTS: Two kinds of effects are expected from this controversy: direct effects on current and proposed research efforts from both within and outside the academic milieu and indirect effects on research funding from state and federal sources influenced by the political process. CONCLUSION: This report serves to document the efforts of one scientific community to deal with a legislative initiative to criminalize stem cell research for both the scientist and the patient. The process and interim conclusions may be instructive for those involved in this endeavor to recognize the dynamics of the interaction between society and science when ethical issues influence how decisions are made.

Bioethical Issues↗

PubMed2002

Clinical decision making based on data from GDx: one-year observations.

PURPOSE: To determine whether information derived from the GDx scanning laser polarimeter aids in the clinical decision-making process for patients with various types of glaucoma. METHODS: Over a 4-month period, 342 consecutive patients with primary open-angle glaucoma, ocular hypertension, angle-closure glaucoma, or secondary glaucomas or in whom the diagnosis of glaucoma was uncertain were evaluated with the GDx scanning laser. After 1 year, 153 patients with glaucoma underwent GDx analysis again. Chart review revealed that 42 of the 153 patients had a change in therapy as a result of the GDx evaluation combined with analysis of visual fields, optic disc cupping, and intraocular pressure (IOP). Outcomes were then compared. RESULTS: The group who had a change in therapy had a higher average GDx number (51.5 +/- 26.1 vs 37.0 +/- 23.5 [P = .001]) at the initial visit and higher IOP (18.2 +/- 4.6 vs 16.0 +/- 3.2 mm Hg [P = .005]). In spite of a change in therapy, at an average of 344 days later, IOP was unchanged (18.3 +/- 5.3 vs 15.7 +/- 3.2 mm Hg [P = .001]) and GDx values in the altered therapy group were higher than at baseline (57.3 +/- 27.9 vs 36.7 +/- 23.4 [P = .001]), although the differences within each group did not achieve statistical significance. CONCLUSION: GDx analysis may be helpful in determining patients at risk for damage from glaucoma, even in eyes in which cup-disc ratio and field loss have not progressed. Changing medications without significantly reducing IOP may be insufficient to halt increases in GDx numbers and may indicate a need for more aggressive therapy.

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