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NEJM takes on a trio of controversies: Planned Parenthood, fetal tissue research and health care for transgender military personnel

Planned Parenthood
REUTERS/Mike Blake
A Planned Parenthood clinic in Vista, California.

A trio of commentaries in this week's issue of New England Journal of Medicine (NEJM) are going to displease many people on the political right.

First, in a blunt, no-holds-barred editorial, three doctors, including Dr. Jeffrey Drazen, NEJM's editor-in-chief, declare that Planned Parenthood and its physicians and researchers “should be praised, not damned” for their efforts to retrieve fetal tissue for medical research.

“It is shameful that a radical antichoice group whose goal is the destruction of Planned Parenthood continues to twist the facts to achieve its ends,” write Drazen and his co-authors, Dr. Michael Greene, chief of obstetrics at Massachusetts General Hospital, and Dr. George Topulos, a Boston-based anesthesiologist. “We thank the women who made the choice to help improve the human condition through their tissue donations; we applaud the people who make this work possible and those who use these materials to advance human health. We are outraged by those who debase these women, this work, and Planned Parenthood by distorting the facts for political ends.”

The three doctors also express their strong support for Planned Parenthood’s “other work as one of the country's largest providers of health care for women, especially poor women."

(As Topulos discloses at the end of the editorial, he has served as a volunteer member of medical committees for both Planned Parenthood League of Massachusetts and Planned Parenthood Federation of America.)

The editorial was written in response to the most recent Congressional efforts to defund Planned Parenthood. Those efforts were undertaken after the release by anti-abortion activists of secretly-taped videos showing Planned Parenthood staff discussing how aborted fetal blood and tissue samples, donated by women, is transferred (legally) to research laboratories. 

An ethical duty

A perspective article in the same issue of NEJM argues that society has an ethical duty to use the “precious resource” of aborted fetal tissue “to find new preventive and therapeutic interventions for devastating diseases.” The author of the article, R. Alta Charo, a professor of law and bioethics at the University of Wisconsin, explains why:

 Virtually every person in this country has benefited from research using fetal tissue. Every child who’s been spared the risks and misery of chickenpox, rubella, or polio can thank the Nobel Prize recipients and other scientists who used such tissue in research yielding the vaccines that protect us (and give even the unvaccinated the benefit of herd immunity). This work has been going on for nearly a century, and the vaccines it produced have been in use nearly as long. Any discussion of the ethics of fetal tissue research must begin with its unimpeachable claim to have saved the lives and health of millions of people.

And fetal tissue research promises to save even more lives, as Charo points out:

[It] has already let to investigational therapy for end-stage breast cancer and advances against cardiac disease, and transplantation research is actively being pursued for diabetes (using fetal pancreatic islet cells), amyotrophic lateral sclerosis (using neural fetal stem cells injected into the spine), and in a major European initiative, Parkinson’s disease (using fetal dopamine cells). 

Opponents of abortion argue that this research is beside the point because abortion is an immoral and evil act, and society should not benefit from it, even indirectly.

Yet those opponents, argues Charo, “have overwhelmingly partaken of the vaccines and treatments derived from fetal tissue research and give no indication that they will foreswear further benefits. Fairness and reciprocity alone would suggest they have a duty to support the work, or at least not to thwart it.”

Abortion critics are using “the public’s unfamiliarity with the history and realities of fetal tissue research as a back door for attacking Planned Parenthood,” she says.

It’s an attack, she adds, that “represents a betrayal of the people whose lives could be saved by the research and a violation of that most fundamental duty of medicine and health policy, the duty of care.”

Care for transgender troops

Yet another perspective article in this week's NEJM takes on the issue of the military’s recent lifting of its ban on service by transgender persons. Opponents of the announcement have claimed that providing gender transition-related medical care — hormone therapy and/or gender-affirming surgery — for transgender military personnel will be too costly.

It’s estimated that 12,800 transgender persons are currently serving in the U.S. armed forces.

But Aaron Belkin, a professor of political science at San Francisco State University and founding director of the Palm Center, a California-based gay-rights nonprofit, says the cost will be low — “ too low to warrant consideration in the current policy debate.”

After conducting a detailed analysis, he estimates that providing transition-related care will cost the military $5.6 million annually, or about 22 cents per member per month.

“Some observers may object to the concept that the military should pay for transition-related care, but doctors agree that such care is medically necessary,” he writes. “And though costs can be high per treated person, they are low as a percentage of total health spending, similar to the cost of many other treatments that the military provides.”

You can download and read the editorial and the two perspective articles on the NEJM website.

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