Browsing Date

July 2015


Hey, Hey, LBJ: How many Seniors did you Save Today?

July 31, 2015 • By

If you’re an endocrinologist who takes care of seniors with diabetes, you should say “Thank You!” to Lyndon B. Johnson.

Yesterday marked the 50th anniversary of Medicare (see: And while the politics and questions about this program continue (see:, it marked a healthcare ethics milestone in the United States.

Medicare has had an especially profound impact on ethical care for people with diabetes, and end-stage-renal disease (see:

But Oh — The Times They Are A-Changin’…

When Medicare was signed into law on July 30, 1965, just 1.2% of the population had diabetes, which translated then into 2.39 million Americans. In 2014, the CDC reported that 29.1 million Americans (9.3% of the population) have diabetes, but of those, 8.1 million remain undiagnosed (see: You can view the growth in diabetes prevalence from 1958-2013 here:

The sharp increase in diabetes was likely never foreseen, but we now know how much this is tied to obesity and our toxic diet, particularly the aggressive marketing of sugary drinks. (

Countless people with diabetes may not be diagnosed until they have access to primary care and health coverage, which is why last month’s SCOTUS ruling on the Affordable Care Act is so important. (

It was also reported yesterday that only 1 in 3 seniors are actually well controlled, and some of these reasons may have to do with continuing health disparities.

One thing is certain: LBJ did the right thing 50 years ago. And your patients are still benefiting.

Reproductive Endocrinology

Preimplantation Genetic Diagnosis: Safe Sex in a Gattacan World

July 24, 2015 • By

Earlier this month, 60 Minutes re-broadcast a segment called “Breeding out Disease” which discussed the ethical implications of preimplantation genetic diagnosis (PGD), a technique already in use for several adult onset diseases. You can watch the segment here:

This aired a day after Independence Day, perhaps to imply the ultimate in reproductive freedoms and procreative liberty. The ASRM Ethics Committee endorses the use of PGD for adult onset disorders in its 2013 Opinion under certain conditions, which most bioethicists would agree with (see: “Use of PGD for Serious Adult Onset Conditions” here:

But the recommendation by the experts interviewed for the 60 Minutes segment goes farther: that natural breeding should be discouraged in favor of using PGD to breed out known genetic diseases. Lee Silver, Co-Founder and Chief Science Officer of GenePeeks, stated: “ I see a future in which people will not use sex to reproduce. That’s a very dangerous thing to do.” This certainly puts a new spin on the term “safe sex”.

For years, I’ve been teaching the 1997 film, Gattaca ( as a springboard to discuss the unintended ethical, legal and social implications of “breeding out” natural breeding. In 1997, Gattaca spoke to cultural anxieties about the new reproductive technologies that were defining reproduction for millions, particularly in the areas of sex selection. The film was released before the complete mapping of the Human Genome. Here is the original 1997 New York Times review on the film’s release:

The slippery slope is that PGD could become eugenics “on steroids” once breeding out “undesirable traits” is on the menu. Endocrinologists are already familiar with parents who insist on medically inappropriate growth hormone so their children can be taller. What happens when we can identify specific genes on the autism spectrum? Would we be breeding out future Newtons, Einsteins, or Edisons — all reported to have had Asperger’s?

We already have a society in which the poor die of preventable diseases (note how many cases of renal failure are related to untreated and undiagnosed Type 2 diabetes). Imagine how the gap could widen where half the world selectively breeds using PGD and the other half throws the genetic dice through natural breeding (often unintended). That dystopian world may be closer than we think.

It’s certainly easy to see the benefits of preventing a harmed life; some bioethicists have argued that in select cases, it may even be “unethical” to have a baby if you’re knowingly passing on a terrible disease. In the endocrine world, PGD can have vast implications, including breeding out identified RET mutations in MEN 2 families (See Recommendation 12 in the 2015 MTC guidelines:

The President’s Commission on Bioethics provided an opinion on PGD in 2004:

This  opinion stands the test of time: “Biology is not destiny…The ability to affect the genetic make-up of the next generation may also exacerbate the tendency to assign too much importance to genetic make-up, and so may promote an excessively reductionist view of human life. These new practices may lend undue credence to the notion that human characteristics and conditions are simply or predominantly genetically determined—a too-narrow understanding of human freedom, agency, and experience, and a simplistic understanding of human biology.”