Switched [Sex] at Birth
Gender, like so many things, is occasionally in a gray area. And that's okay.
This article originally appeared on the Newton blog at RealClearScience. You can read the original here.
Male? Female? Neither?
For centuries, society has pigeonholed itself into a traditional, two-dimensional view of gender. Adam and Eve, Jack and Jill, Sonny and Cher, Mork and Mindy: There's always a ying to a yang, a male to a female, never room for a third. Yet biology doesn't give a damn about our idealized views of gender normalcy. Every so often, it throws us for a loop.
About 1 out of every 4,000 babies are born "intersex," with both male and female sexual traits. The prevalence has been estimated to be both higher and lower, but that's a number right in the middle. Intersexuality encompasses a wide variety of conditions, however, it's most often tied to a hormone malfunction. Chromosomal females (XX) exposed to excessive virilizing hormones in the womb will develop overly large penis-like clitorises, and maybe even other typical male features -- facial hair, for example. On the other hand, chromosomal males (XY) that are insensitive to androgens -- male hormones -- may be born with miniscule micropenises or even vaginas.
It was in these ambiguous gender situations that -- for many years -- rigid cultural stereotypes of sexuality seeped into the hospital. Birth certificates demanded a "male" or "female" classification, and doctors desired to deliver. Thus, when a newborn's sex was unclear, physicians would perform gender reassignment surgery. For boys with penises smaller than one-inch when stretched, this meant getting turned into girls. They would be castrated, and have a "vagina" fashioned out of extra skin or colon. On the other hand, girls born with large clitorises would have them trimmed to a less prominent size. In these situations, surgeries were often conducted hastily, with little time for parents to consider the ramifications of such a decision. Needless to say, the young individuals being operated on were never consulted. Moreover, the procedures weren't without physical repercussions. Often, they would render the baby infertile and severely limit sensations of sexual pleasure.
"For a constructed vagina to be considered acceptable by surgeons specializing in intersexuality, it basically just has to be a hole big enough to fit a typical-sized penis. It is not required to be self-lubricating or even to be at all sensitive," Northwestern
University bioethicist Alice Dreger wrote.
Thanks in part to the efforts of Dreger, who's penned three books on the subject, gender reassignment surgery is rarely performed anymore. Instead, intersex babies are allowed to remain in their neutral status so that they may choose their sex for themselves at a later date. This is surely preferable to "cutting first" and asking questions later.
"The well-being of the child and of the future adult has to be fostered," a team of German ethicists concluded in an article published to the European Journal of Pediatrics in summer 2010. "It is important to note that the surgical creation of unambiguous external genitalia is neither necessary nor sufficient criterion for well-being and is sometimes impossible to achieve; bodily integrity and quality of life, particularly with respect to reproductive capability as well as the ability to experience sex, and the free development of the child's personality have also to be taken into account."
Gender, like so many things, is occasionally in a gray area. And that's okay.
(Image: Gender Line via Shutterstock)
Upstreamism advocate Rishi Manchanda calls us to understand health not as a "personal responsibility" but a "common good."
- Upstreamism tasks health care professionals to combat unhealthy social and cultural influences that exist outside — or upstream — of medical facilities.
- Patients from low-income neighborhoods are most at risk of negative health impacts.
- Thankfully, health care professionals are not alone. Upstreamism is increasingly part of our cultural consciousness.
- A huge segment of America's population — the Baby Boom generation — is aging and will live longer than any American generation in history.
- The story we read about in the news? Their drain on social services like Social Security and Medicare.
- But increased longevity is a cause for celebration, says Ashton Applewhite, not doom and gloom.
Can you make solar power work when the sun goes down? You can, and Dubai is about to run a city that way.
- A new concentrated solar plant is under construction in Dubai.
- When it opens next year, it will be the largest plant of its kind on Earth.
- Concentrated solar power solves the problem of how to store electricity in ways that solar pannels cannot.
Researchers hope the technology will further our understanding of the brain, but lawmakers may not be ready for the ethical challenges.
- 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. Think a dialysis machine for the mind. 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.
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