Take a Bow, America

Today's breaking news was, of course, that the U.S. Supreme Court has upheld the Affordable Care Act, otherwise known as "Obamacare". In what will doubtless go down in American history as a "Dewey Defeats Truman" moment, both CNN and Fox incorrectly stated initially that the law had been struck down, giving rise to one of the better memes in recent memory.

I have to admit, going into today's ruling, I was pessimistic - possibly the Tempter had a hand on my shoulder again. I thought the most likely scenario was a 5-4 vote to strike down the mandate and uphold the rest of the law. As it happens, I was wrong in both directions: Chief Justice John Roberts, appointed by George W. Bush, unexpectedly broke away from the conservative bloc and voted with the four liberal justices (though he upheld the mandate based on Congress' taxing power, while the others upheld it based on the commerce clause). Meanwhile, four conservative justices voted not just to strike down the mandate, but to throw out the entire law - and there are hints that Scalia's opinion was originally intended to be the court's verdict, suggesting that Roberts had been prepared to vote with them at one point and switched sides at the last minute. It gives me a chill to think how close we might have come to that outcome, which would have been an unmitigated catastrophe.

But this is a huge, huge victory, and I'll gladly accept it as such. The ACA is hardly perfect; it will need fixes and improvements. (If nothing else, it needs a public option, which was shamefully omitted to appease the conservatives who voted en masse against it anyway.) But compared to what came before, it's tremendous. For the first time in American history, we've enshrined in law the principle that every person should have access to routine medical care. Considering this is a problem that virtually every other First World democracy has already solved, it's a national embarrassment that it took us this long, but it's far better late than never.

For years now, the American health-care system has been a litany of Kafkaesque horror stories. The spiraling costs of insurance have made basic medical treatment unaffordable to tens of millions of people. Free mobile clinics in poorer regions of the country routinely witness Third World levels of need: hundreds of people waiting overnight just for basic dental or vision care. There have been stories of people with cancer, or in one case a broken ankle, who couldn't get medical care. One unemployed woman, in pain and desperation, shot herself in the shoulder in the hope of getting treatment for a different injury.

This has never touched me directly, thank goodness: I've never had any serious health problems, and if I did, I have an employer that provides excellent coverage. But I've seen its effects on my friends: even people who have insurance often end up struggling with medical bills. I'm happy to help where I can, as I did on that occasion; but decent medical care shouldn't depend on someone having friends who can afford to be generous!

Even the most minimal amount of human decency and compassion ought to lead us to the conclusion that we shouldn't permit things like this to happen. We shouldn't let anyone suffer from easily treatable ailments; we shouldn't force people to bankrupt themselves to pay for ordinary care. This would be true in any case, but it's especially true in America, the wealthiest nation in the world.

But what plumbs the depths of outrageousness is that some people - by which I mean Republicans - not only had no intention of doing anything about this problem, they were fighting tooth and nail to prevent it from being fixed. The libertarian Cato Institute, for example, launched an "Anti-Universal Coverage Club" to argue against efforts to provide everyone with access to health care. The right-wing economist Tyler Cowen said that "we need to accept the principle that sometimes poor people will die just because they are poor" and unable to afford medical care. And in the bitterest irony of all, some of the most diehard, fervent opponents of ACA were conservative Christians: you know, the people who claim to follow a religious figure who said, "Whatever you did not do for one of the least of these, you did not do for me." The Catholic bishops, though they didn't join in the lawsuit, also opposed the ACA because it made it too easy for women to get health care.

Between now and the election, the Democrats' job is clear: now that the ACA has been upheld, they need to sell it to the public. The law as a whole has lackluster poll numbers, even though when people are asked about its individual components - lifting lifetime caps, mandating free coverage for basic preventive care, barring price discrimination for pre-existing conditions, requiring insurance companies to spend at least 80% of their premiums on providing care and not on administrative overhead, and many more - most of them prove wildly popular, which can be attributed to conservative fearmongering and misinformation. The Republicans doubtless know that as more of the law's provisions kick in, it will become increasingly popular, which is why this lawsuit was by far their best shot at defeating it. Now that they've failed, the Democrats need to step up. President Obama's speech today did a good job of listing these benefits, but much more needs to be done to get the word out.

But regardless of all that, tonight I feel a deep sense of relief. Just as I said recently, progress comes slowly, but it does come. With this milestone, we're just a little bit better than we were yesterday, a little bit closer to a truly decent and compassionate society. There will be more work to do, more outrage, more setbacks, more disappointments ahead; but tonight, the good guys won, and it feels good. Take a bow, America. You earned it!

I'm on Twitter now! Follow me at @DaylightAtheism.

Image credit: bayasaa, released under CC BY 2.0 license

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In truth, so much of what happens to us in life is random – we are pawns at the mercy of Lady Luck. To take ownership of our experiences and exert a feeling of control over our future, we tell stories about ourselves that weave meaning and continuity into our personal identity.

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Yale scientists restore brain function to 32 clinically dead pigs

Researchers hope the technology will further our understanding of the brain, but lawmakers may not be ready for the ethical challenges.

Still from John Stephenson's 1999 rendition of Animal Farm.
Surprising Science
  • Researchers at the Yale School of Medicine successfully restored some functions to pig brains that had been dead for hours.
  • They hope the technology will advance our understanding of the brain, potentially developing new treatments for debilitating diseases and disorders.
  • The research raises many ethical questions and puts to the test our current understanding of death.

The image of an undead brain coming back to live again is the stuff of science fiction. Not just any science fiction, specifically B-grade sci fi. What instantly springs to mind is the black-and-white horrors of films like Fiend Without a Face. Bad acting. Plastic monstrosities. Visible strings. And a spinal cord that, for some reason, is also a tentacle?

But like any good science fiction, it's only a matter of time before some manner of it seeps into our reality. This week's Nature published the findings of researchers who managed to restore function to pigs' brains that were clinically dead. At least, what we once thought of as dead.

What's dead may never die, it seems

The researchers did not hail from House Greyjoy — "What is dead may never die" — but came largely from the Yale School of Medicine. They connected 32 pig brains to a system called BrainEx. BrainEx is an artificial perfusion system — that is, a system that takes over the functions normally regulated by the organ. The pigs had been killed four hours earlier at a U.S. Department of Agriculture slaughterhouse; their brains completely removed from the skulls.

BrainEx pumped an experiment solution into the brain that essentially mimic blood flow. It brought oxygen and nutrients to the tissues, giving brain cells the resources to begin many normal functions. The cells began consuming and metabolizing sugars. The brains' immune systems kicked in. Neuron samples could carry an electrical signal. Some brain cells even responded to drugs.

The researchers have managed to keep some brains alive for up to 36 hours, and currently do not know if BrainEx can have sustained the brains longer. "It is conceivable we are just preventing the inevitable, and the brain won't be able to recover," said Nenad Sestan, Yale neuroscientist and the lead researcher.

As a control, other brains received either a fake solution or no solution at all. None revived brain activity and deteriorated as normal.

The researchers hope the technology can enhance our ability to study the brain and its cellular functions. One of the main avenues of such studies would be brain disorders and diseases. This could point the way to developing new of treatments for the likes of brain injuries, Alzheimer's, Huntington's, and neurodegenerative conditions.

"This is an extraordinary and very promising breakthrough for neuroscience. It immediately offers a much better model for studying the human brain, which is extraordinarily important, given the vast amount of human suffering from diseases of the mind [and] brain," Nita Farahany, the bioethicists at the Duke University School of Law who wrote the study's commentary, told National Geographic.

An ethical gray matter

Before anyone gets an Island of Dr. Moreau vibe, it's worth noting that the brains did not approach neural activity anywhere near consciousness.

The BrainEx solution contained chemicals that prevented neurons from firing. To be extra cautious, the researchers also monitored the brains for any such activity and were prepared to administer an anesthetic should they have seen signs of consciousness.

Even so, the research signals a massive debate to come regarding medical ethics and our definition of death.

Most countries define death, clinically speaking, as the irreversible loss of brain or circulatory function. This definition was already at odds with some folk- and value-centric understandings, but where do we go if it becomes possible to reverse clinical death with artificial perfusion?

"This is wild," Jonathan Moreno, a bioethicist at the University of Pennsylvania, told the New York Times. "If ever there was an issue that merited big public deliberation on the ethics of science and medicine, this is one."

One possible consequence involves organ donations. Some European countries require emergency responders to use a process that preserves organs when they cannot resuscitate a person. They continue to pump blood throughout the body, but use a "thoracic aortic occlusion balloon" to prevent that blood from reaching the brain.

The system is already controversial because it raises concerns about what caused the patient's death. But what happens when brain death becomes readily reversible? Stuart Younger, a bioethicist at Case Western Reserve University, told Nature that if BrainEx were to become widely available, it could shrink the pool of eligible donors.

"There's a potential conflict here between the interests of potential donors — who might not even be donors — and people who are waiting for organs," he said.

It will be a while before such experiments go anywhere near human subjects. A more immediate ethical question relates to how such experiments harm animal subjects.

Ethical review boards evaluate research protocols and can reject any that causes undue pain, suffering, or distress. Since dead animals feel no pain, suffer no trauma, they are typically approved as subjects. But how do such boards make a judgement regarding the suffering of a "cellularly active" brain? The distress of a partially alive brain?

The dilemma is unprecedented.

Setting new boundaries

Another science fiction story that comes to mind when discussing this story is, of course, Frankenstein. As Farahany told National Geographic: "It is definitely has [sic] a good science-fiction element to it, and it is restoring cellular function where we previously thought impossible. But to have Frankenstein, you need some degree of consciousness, some 'there' there. [The researchers] did not recover any form of consciousness in this study, and it is still unclear if we ever could. But we are one step closer to that possibility."

She's right. The researchers undertook their research for the betterment of humanity, and we may one day reap some unimaginable medical benefits from it. The ethical questions, however, remain as unsettling as the stories they remind us of.

Ashes of cat named Pikachu to be launched into space

A space memorial company plans to launch the ashes of "Pikachu," a well-loved Tabby, into space.

GoFundMe/Steve Munt
Culture & Religion
  • Steve Munt, Pikachu's owner, created a GoFundMe page to raise money for the mission.
  • If all goes according to plan, Pikachu will be the second cat to enter space, the first being a French feline named Felicette.
  • It might seem frivolous, but the cat-lovers commenting on Munt's GoFundMe page would likely disagree.
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