To me atleast, the hippocratic oath is the guide to the essential ethical principles that one should follow while practicing medicine.
One could reason that spending $10,000 on one sick child brings harm to those 1000 children that will die from mumps/measles/rubella when that $10,000 could have easily paid for their vaccinations.
Of course I don't agree with the above statement because noone has the right to say what a human life is worth (even in relation to other human lives).
Actually your story is more of a non-story. If you count organs as these German surgeons did, then Tzakis actually performed a 9 organ transplant. The duodenum is considered a part of the small intestines (and a part Tzakis most definately took).
Furthermore, counting the adrenal gland as an organ is dubious at best. Tzakis might very well have taken the adrenals also (a small gland that lies on top of each kidney), increasing his total to 11. Hell if the adrenal is consired an organ then the gall bladder and appendix should be also, bringing Tzakis' total to 13.
1. The number of organs transplanted is NOT an indication of the pre-op condition/prognosis of the baby or an indicator of post-op "quality of life".
Her disorder is a single disease process that happens to affect most of her vital organs. All other things being equal, a baby born with several disorders, requiring fewer organs transplanted (even as little as 1 or 2), actually could be considered "sicker", have a much lesser chance of survival and be a greater "burden on society".
2. Of the eight organs transplanted, some might not have actually been "diseased" (more on this later).
3. The greater the number of organs transplanted is not proportional to the surgical difficulty.
Not to take away from Dr. Tzakis' great achievement, but technically the surgery might have been easier than transplanting a few non-contiguous organs. Here is why:
If you ask any transplant surgeon, the most difficult aspect of the surgery is doing the anastamoses (or "rejoinings"). Essentially taking the entire foregut and midgut en bloc significantly decreases the number of "rejoinings" one has to perform.
Tzakis likely only had to join this single unit of organs (the liver+stomach+pancreas+spleen+small bowel+large bowel) at two points (those being #1 the original esophagus-to-new stomach and #2 the new large bowel-to-original rectum) for complete continuity of the gastrointestinal tract and then probably about another 4 anastamoses for blood supply.
The entire blood supply for all the aforementioned organs (minus the kidneys) originate from only 2-3 arteries arising from the aorta. To leave the original pancreas and spleen (which are not significantly affected by her disorder) would have been several times more difficult than taking the "whole package" because the vascular supply for each organ would have to be dissected and reanastomed individually. This is more difficult because it's more vessels to join and the vessels are smaller i.e. more difficult to work with.
Transplanting even only 3 of these organs in non-continuity would have required 1-2 GI tract and 2+ vascular anastamoses for EACH organ. If you do the math you can quickly realize why it was probably easier to take all the organs, even if some were not diseased.
4. Transplanting both kidneys is NOT the transplant surgery standard of care. The baby would have done fine with one kidney and there has yet to be any studies proving that transplanting two kidneys vs. one improves a patient's post-op outcome. But if Tzakis did not take both kidneys he would be stuck at 7 and we wouldn't be talking about this whole topic right now (take it however you want).
So to make a long story short:
1. The baby was not as sick or doomed as one might think.
2. It's a great accomplishment but it wasn't "pushing the envelope".
3. The ethical issues raised are no different than those for any other medical procedure or treatment: should society help the inherently weak at the expense of the strong or should we fall into the Darwinian model of society were it's survival of the fittest? Or is there a middle-ground as to how much help we give the weak and who/what determines how much and what is too much help to give?
I think it is finally time that the notion that you can only own one console (and in accordance, that console thus becomes the BEST console ever in existence) can finally die. At these prices, it is not implausible to own the top three consoles on the market for around the same price it would take most peopleto make a decent game rig out of their PC.
On a different note, with the whole PS2/Linux thing, is their any possibility of seeing emulators (2600, NES, SNES, Genesis) comig out for it?
I don't understand why the time it takes a pirated movie to hit the streets is such a big deal. What difference does it make that the bootleg came out within 1 minute or 1 month of the release?
There are three groups that obtain bootlegs: those that didn't care enough for the movie to go pay and see it in the theater, those that loved the movie so much after seeing it (legally) that they want something (the bootleg) to hold onto and cherish marking that momentous occassion, and those that are shut-ins that can't make it to the theater.
The way I see it, the Industry isn't losing money on the first or the third group. They are probably making money off these people because if they actually liked it, they would probably get so fed up with the picture quality of the bootleg that they would jump at the chance to get the (legal) DVD when it's released or even dare to go see it in the theater.
I can see how revenue is lost from the second group because if it wasn't for the bootleg, they would probably go to the theater and see the movie again. But honestly, how many of us know freaks like these or actually ever liked a movie enough to go see it twice?
I'm surprised no-one has mentioned the speed cameras (NOT the red light cameras) located in DC. For those unfamiliar with how speed cameras are implemented in DC:
They (Metro PD) take about two dozen slick-top unmarked (usually black) Crown Vics specially equipped with a front radar and flash camera, to one of about 60 designated areas throughout the district (a full list of zones can be found on MPD's site at "http://mpdc.dc.gov/info/traffic/speedlocation_map . htm").
These cars (with cop inside) are usually parallel parked next to the curb just like other vehicles or sometimes on the sidewalk (either way it is usually very hard to see them until you've just passed them) and if you pass them doing over the speeding "threshold" (the speed limit in DC is 25mph unless otherwise posted) you see a nice flash and get a ticket in the mail (no points).
You might want to check out their handy FAQ at "http://mpdc.dc.gov/info/traffic/speedfaq.shtm" (it has a link to the DC Code that supposedly allows for automated traffic enforcement).
They also have some statistics ("http://mpdc.dc.gov/info/traffic/speedresults_tex t.shtm") touting the effectiveness of these cameras.
What I don't understand is if speeding is such a danger to district residents then why doesn't the cop in the speed camera car actually pull the person over and act as a deterent to further speeding for atleast that moment? On a sunny day you can't see the flash and would probably continue speeding down the road further endangering lives. Well one might say it's better the car stay put and catch more speeders. But then, what if one of those cars ticketed but didn't know it goes on to plow down an old lady crossing the street a block away? Is it to the greater good of society that more speeders were fined at the cost of someone's life?
Anyways, I quote their site:
"Please contact the MPDC to recommend a photo radar location."
The e-mail address is pburke@mpdc.org for the HTML challenged. Why not everyone let them know exactly where they can put those damn cameras.
RCA makes several VCRs that boast "Commercial Advance" (my brother actually has one of these POS). RCA's parent company is GE. Same goes for NBC. Now that's a lawsuit I'd love to see. It's like Plymouth suing Dodge...
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To me atleast, the hippocratic oath is the guide to the essential ethical principles that one should follow while practicing medicine.
One could reason that spending $10,000 on one sick child brings harm to those 1000 children that will die from mumps/measles/rubella when that $10,000 could have easily paid for their vaccinations.
Of course I don't agree with the above statement because noone has the right to say what a human life is worth (even in relation to other human lives).
Actually your story is more of a non-story. If you count organs as these German surgeons did, then Tzakis actually performed a 9 organ transplant. The duodenum is considered a part of the small intestines (and a part Tzakis most definately took).
Furthermore, counting the adrenal gland as an organ is dubious at best. Tzakis might very well have taken the adrenals also (a small gland that lies on top of each kidney), increasing his total to 11. Hell if the adrenal is consired an organ then the gall bladder and appendix should be also, bringing Tzakis' total to 13.
In other words:
Germany 6
US 8
1. The number of organs transplanted is NOT an indication of the pre-op condition/prognosis of the baby or an indicator of post-op "quality of life".
Her disorder is a single disease process that happens to affect most of her vital organs. All other things being equal, a baby born with several disorders, requiring fewer organs transplanted (even as little as 1 or 2), actually could be considered "sicker", have a much lesser chance of survival and be a greater "burden on society".
2. Of the eight organs transplanted, some might not have actually been "diseased" (more on this later).
3. The greater the number of organs transplanted is not proportional to the surgical difficulty.
Not to take away from Dr. Tzakis' great achievement, but technically the surgery might have been easier than transplanting a few non-contiguous organs. Here is why:
If you ask any transplant surgeon, the most difficult aspect of the surgery is doing the anastamoses (or "rejoinings"). Essentially taking the entire foregut and midgut en bloc significantly decreases the number of "rejoinings" one has to perform.
Tzakis likely only had to join this single unit of organs (the liver+stomach+pancreas+spleen+small bowel+large bowel) at two points (those being #1 the original esophagus-to-new stomach and #2 the new large bowel-to-original rectum) for complete continuity of the gastrointestinal tract and then probably about another 4 anastamoses for blood supply.
The entire blood supply for all the aforementioned organs (minus the kidneys) originate from only 2-3 arteries arising from the aorta. To leave the original pancreas and spleen (which are not significantly affected by her disorder) would have been several times more difficult than taking the "whole package" because the vascular supply for each organ would have to be dissected and reanastomed individually. This is more difficult because it's more vessels to join and the vessels are smaller i.e. more difficult to work with.
Transplanting even only 3 of these organs in non-continuity would have required 1-2 GI tract and 2+ vascular anastamoses for EACH organ. If you do the math you can quickly realize why it was probably easier to take all the organs, even if some were not diseased.
4. Transplanting both kidneys is NOT the transplant surgery standard of care. The baby would have done fine with one kidney and there has yet to be any studies proving that transplanting two kidneys vs. one improves a patient's post-op outcome. But if Tzakis did not take both kidneys he would be stuck at 7 and we wouldn't be talking about this whole topic right now (take it however you want).
So to make a long story short:
1. The baby was not as sick or doomed as one might think.
2. It's a great accomplishment but it wasn't "pushing the envelope".
3. The ethical issues raised are no different than those for any other medical procedure or treatment: should society help the inherently weak at the expense of the strong or should we fall into the Darwinian model of society were it's survival of the fittest? Or is there a middle-ground as to how much help we give the weak and who/what determines how much and what is too much help to give?
On a different note, with the whole PS2/Linux thing, is their any possibility of seeing emulators (2600, NES, SNES, Genesis) comig out for it?
There are three groups that obtain bootlegs: those that didn't care enough for the movie to go pay and see it in the theater, those that loved the movie so much after seeing it (legally) that they want something (the bootleg) to hold onto and cherish marking that momentous occassion, and those that are shut-ins that can't make it to the theater.
The way I see it, the Industry isn't losing money on the first or the third group. They are probably making money off these people because if they actually liked it, they would probably get so fed up with the picture quality of the bootleg that they would jump at the chance to get the (legal) DVD when it's released or even dare to go see it in the theater.
I can see how revenue is lost from the second group because if it wasn't for the bootleg, they would probably go to the theater and see the movie again. But honestly, how many of us know freaks like these or actually ever liked a movie enough to go see it twice?
It was (is) a rather common commercial product for a lot of the other cartridge based systems, it's a wonder the 2600 got skipped over...
Is there any hardware out there that allows this?
I'm surprised no-one has mentioned the speed cameras (NOT the red light cameras) located in DC. For those unfamiliar with how speed cameras are implemented in DC: They (Metro PD) take about two dozen slick-top unmarked (usually black) Crown Vics specially equipped with a front radar and flash camera, to one of about 60 designated areas throughout the district (a full list of zones can be found on MPD's site at "http://mpdc.dc.gov/info/traffic/speedlocation_map . htm").
These cars (with cop inside) are usually parallel parked next to the curb just like other vehicles or sometimes on the sidewalk (either way it is usually very hard to see them until you've just passed them) and if you pass them doing over the speeding "threshold" (the speed limit in DC is 25mph unless otherwise posted) you see a nice flash and get a ticket in the mail (no points).
You might want to check out their handy FAQ at "http://mpdc.dc.gov/info/traffic/speedfaq.shtm" (it has a link to the DC Code that supposedly allows for automated traffic enforcement).
They also have some statistics ("http://mpdc.dc.gov/info/traffic/speedresults_tex t.shtm") touting the effectiveness of these cameras.
What I don't understand is if speeding is such a danger to district residents then why doesn't the cop in the speed camera car actually pull the person over and act as a deterent to further speeding for atleast that moment? On a sunny day you can't see the flash and would probably continue speeding down the road further endangering lives. Well one might say it's better the car stay put and catch more speeders. But then, what if one of those cars ticketed but didn't know it goes on to plow down an old lady crossing the street a block away? Is it to the greater good of society that more speeders were fined at the cost of someone's life?
Anyways, I quote their site:
"Please contact the MPDC to recommend a photo radar location."
The e-mail address is pburke@mpdc.org for the HTML challenged. Why not everyone let them know exactly where they can put those damn cameras.
RCA makes several VCRs that boast "Commercial Advance" (my brother actually has one of these POS). RCA's parent company is GE. Same goes for NBC. Now that's a lawsuit I'd love to see. It's like Plymouth suing Dodge...