Humanity’s Moral Development

As you know, Russia has invaded its democratic neighboring country, Ukraine–the first such territorial violation of a sovereign state since World War II.

We’ll continue to monitor the situation as it develops, since it changes moment by moment, but for now we can at least say that this certainly gives the lie to any theories that wars will now be outsourced by proxy to the global south to be fought among “those squabbling poor countries”—but never ever again in “civilized” Europe. And yes, it’s the women and the children, in Ukraine and in Russia, too, who will pay the price for this invasion.

In the meanwhile, we are going to proceed with the blog post planned for today, since life–and news–continues around the world. The Ukraine is not the only international story. Colombia’s constitutional court has voted to decriminalize abortion in the first 24 weeks of pregnancy, which is a seismic shift for that majority Catholic country, and yet another heartening sign of changing times across the South and Latin American region.

Here at home, more good news. First, a federal jury has found three White men guilty of committing a hate crime and other violations when they chased and killed Ahmaud Arbery two years ago, determining they were motivated by racial animus because he was Black. The trial, some small comfort for the Arbery family and a triumph for the Justice Department, focused on a history of racist statements from Gregory McMichael, 66, Travis McMichael, 36, and William “Roddie” Bryan, 52. All three men were convicted of murder last fall and sentenced to life in prison, with Bryan eligible for parole after 30 years. (An interesting aside in terms of motivation, at least for Roddie Bryan: Four days before Arbery was shot, the prosecutor said, Bryan used the n-word to refer to his daughter’s boyfriend, who is Black. Then, in another text conversation the same day, someone passed on a message from the daughter. “Yes, he’s Black. … But honestly, it’s just a color,” she said, according to the messages read in court. “It doesn’t define him or make me love him any less.” I find that deeply touching and encouraging, especially coming from a young woman who is the daughter of a racist killer.)

In another story about justice overdue, after years of fighting for their economic rights, last Tuesday the U.S. women’s national soccer team reached a historic settlement with the U.S. Soccer Federation in their long-running lawsuit over unequal pay with the men’s national team. The agreement includes a $24 million payment to the women players, and a promise from the Federation that the women and men’s teams will be paid at an equal rate going forward in all friendlies and tournaments, including the World Cup. And while we’re on sports, hats off to our beloved Billie Jean King and Martina and the Women’s Tennis Association for refusing to let China off the hook after that nation censored, silenced, and virtually “disappeared” Chinese tennis star Peng Shuai in the wake of her #MeToo public denunciation, posted on Weibo, accusing a retired Vice Premier of China, Zhang Gaoli, of sexual assault. This was not a cheap or easy decision for the WTA to boycott China: more than one-third of the WTA’s roughly $100 annual million in revenue comes from its dealings in China.

And then there’s this, possibly the most crucial, long-term influencing news yet: President Joe Biden’s nomination of federal judge Khatanji Brown Jackson to replace retiring Justice Stephen G. Breyer, a historic choice that fulfills Biden’s pledge to nominate the first Black woman to the Supreme Court. It would make Jackson, only 51, just the third African-American and the first African-American woman in the high court’s 233 year history. A former public defender, Judge Jackson served as a trial court judge in Washington for eight years before Biden elevated her last year to the influential US Court of Appeals for the DC circuit. She was confirmed to that court after a relatively uncontentious Senate hearing and with the backing of three Republican lawmakers. Congratulations to Justice-to-be-Jackson, and to all American women!

Today, we’re also going to spend some time looking at developments that are hopeful and helpful: modern medicine, and its genuinely transformative technological advances.

The February 15th headline read “a woman is cured of HIV using a novel treatment.” the article went on to state that she was the third person ever to be cured of HIV. Researchers announced that the new approach holds the potential for curing more people of racially diverse backgrounds, since the woman was a person of mixed race. The cure used a new transplant method involving umbilical cord blood, that opened up the possibility of curing more people of diverse racial backgrounds than previously possible. The sex and race backgrounds of the new case mark a significant step forward in developing a cure. HIV is thought to progress differently in women than in men, but while women account for more than half of HIV cases in the world, we make up only 11 percent of participants in cure trials–apalling. In the only two known cases of an HIV cure so far, the men received bone marrow transplants from donors who carried a mutation that blocks HIV infection, and the mutation was identified in only about 20,000 donors, most of whom are of northern European descent. By contrast, the woman in the latest case was spared the brutal side effects of a typical bone marrow transplant–which is risky, highly invasive, and very difficult to obtain–by the combination of umbilical cord blood and a relative’s blood containing haplo cells, to give her body temporary immune defenses. Furthermore, the donor of the cord blood was only partially matched, instead of the typical practice of finding a bone marrow donor of close race and ethnicity. This marks a substantial step forward. (It made me smile, because it seemed to imply that female people and particularly female people of color would be in the best position, for once, to survive. So much for the White boy chant, “You will not replace us”!)

Nor is that is the only medical “miracle” on the horizon. The rapidity and effectiveness of the discovery of vaccines against COVID-19 and Omicron (and possibly other variants) has been astonishing. Previously, the fastest discovery in history of a vaccine was for mumps, and that took four years. Moreover, therapeutics for Covid in all its forms have shifted the disease from being an almost certain death sentence into one that ranges from mild to severe, although still threatening.

One new technology that’s getting attention is a 64-slice cardiac CT scan, able to capture images of a human heart in just five heartbeats. The scan can help identify coronary heart disease, the nation’s number one killer of both women and men. The scanner also enables physicians to non-invasively capture the image of any organ in one second and perform a whole body trauma scan in less than 10 seconds. This technology is already here. The high-speed CT scanner was introduced to the medical community and patients in May of 2005 and is now available in almost every major city of the United states.

Then there’s the Pill-Cam ESO, recently cleared by the FDA. It’s a camera in a pill that allows doctors to evaluate and diagnose diseases of the esophagus, including GERD or chronic heartburn, esophagitis, and Barrett’s esophagus, a precancerous condition. It’s a smooth plastic capsule with two tiny cameras one on each end capable of taking 2600 pictures–14 per second–of the esophagus. Images are transmitted to a recording device which is then plugged into a desktop computer, and in just 20 minutes doctors have enough images to make a diagnosis. Patients don’t have to be sedated as they do with traditional endoscopy.

The aerospace industry has been using simulators to train pilots for 15 years. They’re now being used to train doctors without risking complications to a patient. For example, the Cardiac Catheterization Simulator Bus goes from location to location and looks like a true cardiac catheterization lab. The simulator gives trainees a tactile feel, acting like a real patient. If you do something wrong, the patient says Ouch; if the doctor makes a mistake the computer starts a sequence of complications to which the doctor must respond.

It was already almost seven years ago when the FDA approved the first 3-D printed drug. There haven’t been many others since, partly due to the fact that medications can be 3D printed for a specific purpose (e.g., to make the drug dissolve faster), and most purposes still don’t require the use of that technology. However, with technological innovation, we expect to have 3D printers in pharmacies someday, printing our own personalized medication in a matter of minutes. Related to this is the at-home lab test, for which the way was paved by the evolution of COVID-19 rapid tests. At-home lab tests do present concerns over usage, since such technology will have to be tackled by policymakers. Nevertheless, The United Kingdom-based company FAB RX aims to commercialize printed tablets in 5 to 10 years and foresees that 3D printing will become available in every major hospital in the next decade. They claim to “envision a system where medicines are going to be prepared from raw materials in the same way you use a Nespresso machine to prepare coffee.”

Telemedicine itself has come of age in terms of doctors appointments–that we know. But a study on continuous glucose monitoring (CGM) and telemedicine visits for patients with type one and type 2 diabetes concluded that the use of telemedicine patient consults and remote monitoring of GC and insulin data can significantly improve glycemic control. And of course this is not to speak of smart phones and smart watches and other wearable health devices which offer readouts of your EKG, your EEG, your pulse, blood pressure, your heartbeat, your oxygen level, your body temperature, your weight, your body fat index, whether or not you have fallen, and more.

Fetal surgery and pre-natal medicine also are growing by leaps and bounds. So is pain control technology. Nor does any of this include, as surely it must, augmented reality during surgery, personal genomics services tailored to your own individual genome, portable diagnostic devices, medical drones, remote care apps, robots used for rehabilitation purposes, robot companions, voice-to-text apps, longevity research, portable ultrasound devices, artificial intelligence used in diagnostics, and artificial intelligence based prosthetics. This last is a stunner, and not only because of its use by the late Stephen Hawking. AI-based prosthetics tell us that the mind is so powerful it can send signals to not just a phantom limb that has been amputated but to a prosthetic limb, even unto fine feelings of touch, and even to a paralyzed limb or spine.

All of these advances, in another age, would have been considered demonic or magical. Even in our own time, some of them seem like pronouncements sputtered by Dr. McCoy on Star Trek. And that, in turn, is not even to speak of xenotransplantation, for instance–the first successful transplantation of a pig heart into a human being, only recently successfully accomplished. Gene editing, or CRSPR technology, is another wonder straight out of alchemy or fiction. But it’s real. Comparable advances are being researched and soon made available in other medical specialties, in sight, in hearing, in cancer research, in neurological and neuromuscular diseases and disorders, and indeed in all other fields of medicine.

If the planet can survive this generation and the next, humans may well look back on our age as the dawning of the golden age of medical science. Yes, such advances will require vigilance on the part of human beings: ethical considerations (toward each other and toward animals used for experimentation), compassionate and considerate delivery systems which in themselves would require that health services be regarded as a human right, and an absolute end to systemically embedded discriminations of any sort against patients requiring and deserving care.

As Einstein noted, “Science has provided the possibility of liberation for human beings . . . , but science itself is not a liberator. It creates means, not goals. . . .When the ideals of humanity are war and conquest, those tools become as dangerous as a razor in the hands of a child of three. . . . The fate of humanity is entirely dependent upon its moral development.”