Friday, April 30, 2010

More on the science of fetal pain

I'd like to add an interesting addendum to yesterday's post on Nebraska's Fetal Pain Law. A little more geared toward the science, this time. Dr. Anand asserts that the anatomical capacity for feeling pain begins to develop at about 7 weeks gestation, with the appearance of pain receptors around the mouth which then spread throughout the body, having completely populated the surface by week 20. Preceding the emergence of these pain receptors at the surface is the migration of the nerve fibers necessary to transmit impulses back to the spinal cord, where sensory information is integrated and directed to the appropriate brain structure for processing. In short, the presence of the surface pain receptor implies the presence of the appropriate neural circuitry to relay the sensory information that it collects back to the spinal cord. I'll spare you the fancy anatomical jargon of the brainstem nuclei and cortical connections that collect and relay sensory information collected by the spinal cord, but suffice it to say that the basic brainstem-level processing circuitry, relay circuitry, subcortical and cortical structures of the brain that are necessary for pain sensation and perception, including reflex responses to painful stimuli, all seem to be present and accounted for by the 20 week mark - if not sooner.

The major puzzle piece that is missing, however, is the modulatory circuitry responsible for inhibiting pain impulses, which doesn't even begin to develop until 32-34 weeks gestation. In practical terms, what this means is that the body's ability to deaden, numb, or mute pain signals is missing until late in the third trimester. Anyone who has endured any kind of acutely painful injury, say a broken bone for instance, has experienced this "numbing" effect. When our pain threshold is reached, our bodies begin to compensate for the shock to the nervous system by inhibiting the transmission of pain signals at various levels of the neural circuitry, effectively muting our perception of the painful stimulus, like turning down a dimmer switch. The absence of this inhibitory system in the fetus implies that not only can a 20-week-old fetus perceive pain, but that it most likely feels it far more intensely than a newborn or small child can. The system has developed the capacity to relay excitatory information (pain), but lacks the ability to transmit inhibitory information to restrain that excitation.

The science also demonstrates that the typical anesthetic doses given to mothers during abortion procedures are not even remotely sufficient to appropriately anesthetize the fetus. Typical nerve block methods (such as epidural anesthesia) confer no pain relief to the fetus whatsoever, because they only block maternal nerves below a certain spinal level. And general anesthetics, while they can cross the placenta and fetal blood-brain barrier to provide some level of relief, have been shown time and time again to require significantly higher doses to achieve the same effect in the fetus as in the adult. Levels of anesthetic high enough to realistically ensure that a sufficient amount successfully escapes breakdown by the maternal liver, crosses the placenta and anesthetizes the fetus would be toxic to the mother.

Further evidence for the ability of the fetus to feel pain is provided by hormonal studies carried out on fetuses that required intrauterine blood transfusion, accomplished by piercing the fetal abdominal cavity with a needle and placing it in the intrahepatic vein (in the liver). Stress hormone levels (cortisol, catecholamines and beta-endorphin) as well as heart rate rapidly increased in these subjects following insertion of the needle, but the magnitude of the response was greatly reduced following administration of the opiate pain-killer fentanyl. Furthermore, fetuses transfused through the umbilical cord (which is not innervated) showed no change in stress hormone levels at all, indicating that the response was not induced by the transfusion itself, but specifically by the perception of pain.

Most of this information was gleaned from one review article (http://www.nrlc.org/abortion/fetal_Pain/AnandPainReport.pdf), but like I said, search PubMed and you will find that Dr. Anand is not the only scientist that is doing this work and reaching these disturbing conclusions. It's time to accept the fact that a developing fetus is more than just a human-shaped lump of tissue - it's a feeling, perceiving, reacting, experiencing human child. A child who deserves a chance, and needs someone to step up and fight for his or her rights too.

Thursday, April 29, 2010

Nebraska's Fetal Pain Law


If we’re gonna do this, let’s do it right, shall we? Why not start off with something nice and contentious, a real juicy issue, like, say… abortion? I’ll probably lose some friends tonight – especially those whom I’ve duped into believing that I am a staunch liberal ;] I may harbor many classically “liberal” views, but this ain’t one of ‘em.

First things first – let me clarify my general position on the issue. Abortion is absolutely wrong, all the time, in every circumstance, without exception. Utterly tragic as rape and incest are, they do not justify the murder of an innocent child. Life begins at conception. Conception means fertilization – the merging of egg and sperm. These foundational points are not arguable for me – I’ve thought them through and I stand firmly on them. I will add the disclaimer that I do not consider every individual who has ever had or considered an abortion to be a morally bankrupt person. Circumstances are powerful, and we are all human. I will, however, often challenge the morality of certain justifications and lines of reasoning employed by pro-choice advocates.

Now, on to the issue at hand. I’d like to address a recent legislative move by Nebraska Governor Dave Heineman – you may have heard the buzz, since the news is already two weeks old. Governor Heineman recently signed into law the “Pain Capable Unborn Child Protection Act”, which reduces the threshold for legal abortion to 20 weeks gestational age. The change comes in response to mounting scientific evidence suggesting that unborn fetuses may develop the capacity for sensing pain as early as 17 weeks. The legislation was enacted as a defensive measure when Dr. LeRoy Carhart, friend and colleague of the murdered late-term abortionist Dr. George Tiller, vowed to carry on Tiller’s work in his Nebraska clinic. In an attempt to avoid becoming “the country’s late-term abortion capital”, the Nebraska legislature voted 44-5 in favor of the Act.

Pro-choice activists have already leapt at the collective throat of the Nebraska legislature with accusations of ideological agenda-pushing, and claims that the science is shaky at best. Of course, they do have good reason to rally the troops and put on their defensive hats – the Act challenges the very foundation of Roe v. Wade, in that it shifts the criteria for establishing legislative guidelines from viability (the point at which a fetus can survive outside the womb) to the ability to feel pain. Viability is not a set point determined by law – though 22-24 weeks is the generally accepted threshold range, the final determination is left up to the discretion of individual physicians. The ability to feel pain on the other hand, being so heavily dependent upon scientific inquiry into the complex neural circuitry of the developing fetus, really requires a mutually agreed upon set point in order to be practically applied as a criterion.

This shift signals not only the lowering of a long-standing threshold for legal abortion, but also the enforcement of a true absolute. Absolutes, unfortunately, are no friends of the pro-choice movement. Being a future physician myself doesn’t disconnect me from the reality that there may exist a pro-choice OB/GYN or two that will fudge the limit in the absence of an absolute, “for the benefit of the patient” of course ;]

The pro-choicers also bemoan the bill’s failure to include an exception for the risk of injury to the mental or psychological health of the mother. [Stunned pause]. Seriously?! Now making a woman cry is sufficient justification for infanticide? I suppose we should start seeking the death penalty for every mean kid who pushes a little girl down on the playground. I jest, of course, but talk about avoiding absolutes – that’s about as broad a grey area as I can imagine. Just how “upset” do you have to appear, as an expectant mother, to qualify for a later-term abortion on these grounds? Allow me let you in on the real bottom line here: What really upsets the pro-choicers is the fact that this omission leaves no loop hole for murdering handicapped babies beyond 20 weeks. If the expectant mother’s psychological fortitude is just so fragile that it couldn’t possibly withstand the hassle of dealing with a disabled child, shouldn’t she have the right to spare herself the trouble? Ugh. And here we meet our true foe in the abortion debate – moral relativism. I can’t even make an argument for the INSANITY of the statement that I just made, because doing so would assume a common moral compass that just doesn’t exist anymore. The concept that a woman’s “psychological health” should trump a baby’s right to life is just about as morally bankrupt as the Holocaust. You may disagree, but there’s just no way to truly argue that point in itself. We are at an impasse, my friend.

The truest danger of this piece of legislation lies in the fact that it broaches the subject of fetal rights in a big way, and comes down on the side of the child. It not only introduces the concept of fetal pain, but it also assumes that an entity that feels pain should have a right to be spared of that pain. It humanizes the fetus in a way that seriously endangers the core of the pro-choice platform – namely that a fetus is not in fact a life that is due any rights or protection.

It’s easy to draw arbitrary lines in the sand concerning the definition of “life”. The very fact that these lines are broadly defined (i.e. “22 to 24” weeks for viability), to me, highlights their arbitrariness. If it could be 22 or 24, then maybe it could be 21, or maybe 20 and a half… how far does it go? Or for others who define life at implantation, what makes it any less “alive” the previous day? ARBITRARY DEFINITIONS.

The definition of life as “viability” also begs the question, should what constitutes “life” be defined by the limits of technology? There was a time when 28 weeks was the lower limit of realistic viability for premature babies, but technological advances have brought us to 22 weeks. 50 years from now, when that limit is even lower, will 18-week-old fetuses suddenly be more “alive” than they are today? Should our ability to sustain life outside the womb determine whether or not an entity is in fact “alive” inside the womb? The idea that something is somehow less alive within the confines of an amniotic sac than outside it just boggles my mind in and of itself. If we had to somehow technologically “breathe life” into the fetus as it emerged, I’d understand. But it already has “life” – our technologies only sustain what it already has, in the case that its organ systems are underdeveloped. If the ability of certain organ systems to sustain life is what defines life, then God help the poor patients on transplant lists.

And as for the science (check out my follow-up post on the science), I’ll leave you to search PubMed for “fetal pain” and observe the “dearth of scientific evidence to back up the fetal pain issue” that the pro-choicers claim. Please. Of particular note is a review article by famed veteran fetal pain researcher and pediatrician Dr. Kanwaljeet Anand, one of the giants of the field: http://www.nrlc.org/abortion/fetal_Pain/AnandPainReport.pdf. The science is there. I’m sure that there are lots of researchers who make opposing claims (News flash: MOST of what you hear on the news about “scientific breakthroughs” is still heavily contested within its field – the media simply relies on the fact that most of us are either too lazy or too busy to look into it), but that doesn’t erase the work of Dr. Anand and many others. And I for one am just fine with erring on the side of caution in the case of causing pain to innocent unborn children – if there’s any indication that the last sensation an aborted baby feels is agonizing pain, we as a society ought to proceed carefully in how we handle that information. To ignore it, again, would be about as morally bankrupt as the Holocaust.


For more information, feel free to consult a few of my sources:

http://www.washingtonpost.com/wp-dyn/content/article/2010/04/19/AR2010041902082.html



Wednesday, April 28, 2010

A Whole New Bloooooooooggggg


Are you bored with my blog? I'm bored with my blog.

Quite honestly, my life is simply not interesting enough to be blogged about. At least not very often. It was quasi-interesting when I was simultaneously planning a wedding and applying to medical school, and it may recover "interesting" status one day when I finally become "Mommy, MD". But for now, all I do is study all day. And no one wants to listen to me bitch about studying all day. That's just a downer.

So, I've decided to take this whole blogging thing in a new direction. Inspired by a Blogger-extraordinaire friend of mine (*cough* Laura Cooke *cough* *cough*), I've decided to use this space as an outlet to express my opinions and my perspective on "issues" that interest me. This could cover a very broad range of topics - who knows where we'll end up - but quite frankly, I need it. I NEED to think about things beyond the scope of the day's medical lecture topics. I really love to write (as you may have noticed), and everyone needs a hobby (even medical students who "don't really have time" for such trivial personal indulgences), so I'm converting this blog into a more structured "hobby". I don't expect to develop a large and devoted following - I might even lose readers if I get boring enough (though really, what could be more boring that what I've been writing about? And YOU'RE still here. I'm talking to no one, aren't I. Faaabulous). But I think this will be a healthy outlet, and I hope that I stick with it.

That said, I've got some ideas and I hope to start composing some "structured rants" very soon. I hope to be stepping up the quality of my writing, and including research and links to support my views and promote active interest. I'll emphasize again that these posts will be heavily opinion-based, but being a scientist at heart (and by trade, I suppose) I usually don't assert strong opinions without having some sort of concrete basis for them, so hopefully I won't make a complete ass of myself.

And fear not - I won't completely shut down the "personal update" portion of my blogging. Those of you who actually enjoy listening to me bitch about studying all day will still get your fix, maybe once every week or two - I haven't quite decided on frequency. But rest assured, I got ya covered ;]


Ye Be Warned...

Major blog overhaul in progress. Possibly involving a title change. Just didn't want anyone to be confused when they couldn't find "My Better Half". Like lots of people follow me ;]

Wednesday, April 21, 2010

Eh.

I don't really like this new class (Neuroscience). Does anyone really feel like sitting around trying to identify all the little swirls and squiggles and shapes, anything that's shaded slightly differently from what's near it...? Not this girl, I'll tell you that much! Every bump and line on the surface of the brain has it's own name (though they're all connected to each other, of course). And I don't care what that name is. But, ya know, I have to care. I'm paying someone to force me to care.

Since I'm already feeling HIGHLY apathetic about the material, and I have a super-pregnant sister in law just waiting to pop, my "study sessions" have been rather abbreviated this week ;] Em is now past her due date (which was two days ago), but it seems like she's about two WEEKS past her due date, since the midwife told her two weeks ago that she was making progress and probably wouldn't make it to her due date (so naturally we've all been waiting and watching ever since). But she's done working, and Josh needs to save his leave for when the baby does come, so she'd be home by herself just waiting... and I just have a hard time standing for that. So we've been taking walks and running errands and chatting up a storm all week, just trying to pass the time and hope for some action. Which is SO much better than studying this stupid crap. She went for a foot massage earlier this evening, so here's hoping...

In other news... Ben and I have completely fallen off the healthy wagon, but I'm not too worried about it. We usually climb back up with little difficulty, after sufficient lazy time. Maybe after the baby comes. I mean, I don't want to be on the elliptical when Em calls, ya know? He's been approved to work a bunch of overtime for these next two weeks, which is pretty great! It sucks for us spending time together (he's always WIPED when he gets home, after getting up at 4:15 and working 12 hours!), but we can always use the money. ALWAYS. Oh, and did I mention that I'm running for President of my school's Emergency Medicine Interest Group (which I may refer to from here on out as EMIG)? Well, I am. I'm running against two guys, so I'm hoping to take the female vote (since these things are usually, at the end of the day, a popularity contest!). Voting is open til the 28th or something ridiculous like that, so I have to wait FOREVER to find out. Ugh.

I think that's really it. As usual, most of "my news" is really other people's news, because my life is super-boring. This is reason #452 why I should have babies. STAT. ;]



Tuesday, April 6, 2010

Just keep swimming, just keep swimming...


Hello, friends :] Do you believe I had an entire week OFF and didn't blog? I was just so busy... you know... doing NOTHING. It almost felt sacrilegious to DO something during my week of rest, so I didn't ;] I watched A LOT of movies (being home by myself all day every day), had lunch with a few friends here and there, caught up with family... it was lovely. Of course, all good things must come to an end, and Spring Break is no exception. So here I am, back at it.
I've been making good on my commitment to attend class everyday, with a few exceptions here and there (today may or may not be included in the "exception" category... ;]). I'm fine with exceptions, because everyone needs to maintain their sanity, and everyone needs to sleep in on occasion. Of course, not everyone has that luxury, and quite frankly I would be morally remiss if I were to ignore that gift of freedom with which God has blessed me for this season of my life. It'll be gone before I know it, and to waste it would be just plain WRONG! I don't allow myself to slack for two days in a row however, because I know myself well enough to know that sleeping in is a very slippery slope. Maybe two days in one week on a rare occasion, but NEVER two days in a row. That's just bad news.

So, in short, I'm plugging along and doing well. Reminds me of Dory from Finding Nemo... "just keep swimming, just keep swimming..." That's what I do. One step at a time, one day at a time, never letting my mind run too far ahead of me, and living in the moment.

There's really nothing exciting to report around here, though. I guess since my life is so wrapped up in school, very little else comes to mind when I blog! Of course we're still anxiously awaiting the arrival of our new niece :] "Exciting" doesn't even begin to describe the arrival of a new BABY! I told Em the other day though, seeing her full-term belly sorta worries me... I try to extrapolate the size of that thing onto my body, and I just don't know where I'd ever house a full-term child. I know it's possible, but I fear that I'll have one of those torpedo bellies that sticks straight out and clears shelves when you turn too quickly in the grocery store. Ugh. I just really don't have much of a torso. Oh well, at least I have no shortage of hip width.

Speaking of hip width, my most recent weight loss endeavor is failing miserably. It's really depressing. I must be doing something horribly wrong that I don't even realize. I've been working out quite religiously for over three months, usually 4 times a week (and sometimes even more!). I really work hard at the gym, I do toning workouts at home, and I practically starve myself during the week. I do tend to cheat on the weekends, I will admit, and over the past few months there have been two or three weeks (not all together) where I didn't work out much due to sickness or tests or whatever. But holy crap. Ben has lost 15 pounds and at best I had lost 3 pounds (though some days my weight is only a pound lower than it was in January). And he eats Burger King about once a week! If I ate Burger King once a MONTH I'd probably gain 5 pounds! Ugh. I exaggerate, but it definitely feels like my weight is SUPER sensitive, and any small slip sets me back to square one. It doesn't help that I just feel SURROUNDED by skinny people at school. Jerks. ;]

Alright, I gotta head down to Owings Mills before my return trip becomes a traffic nightmare. I was recently diagnosed with some nearsightedness (thanks a lot, college and med school) and my glasses are in, so I need to go pick them up. I'll really only be using them during class (the screen gets blurry for me with all the switching back and forth between my bright computer screen and the big screen at the front), and maybe for driving at night or something. We'll see where they help out the most. But I shouldn't need them full-time. Anyway, I'm out!