The Family That Removes Its Stomachs Together...

Nick Gillespie | June 20, 2006

...lives longer and healthier lives together.

At least for the clan described in this AP story, "Cousins at Risk of Cancer Give Up Stomachs." The members of this extended family, which is at risk for a rare form of stomach cancer, used genetic testing to figure out who was at risk for the disease and then acted, well, proactively:

Determined to outsmart the cancer, they turned to genetic testing. Upon learning they had inherited Grandmother Golda Bradfield's flawed gene, these were their options:

Risk the odds that they might not develop cancer, with a 70 percent chance they would; or have their stomachs removed. The latter would mean a challenging life of eating very little, very often.

All the cousins chose the life-changing operation. Doctors say they're the largest family to have preventive surgery to protect themselves from hereditary stomach cancer.

Chew on this, too: When surgeons checked the removed stomachs--all of which appeared healthy at the time of removal--they actually found early or pre-tumorous growths.

Here's to the future of such proactive medicine:

Experts say that someday, doctors may do DNA tests as routinely as they check cholesterol levels now, spotting disease risks that can be lowered. That day isn't here yet, but progress is being made.

"We do not yet have a general DNA test that fits into that category, but we're headed for it at a pretty good clip," said Dr. Francis Collins, head of the National Human Genome Research Institute.

For more details--and a sense of exactly how people can survive without their stomachs--go here.

In many ways, this story is the adult version of Ron Bailey's earlier blog post about the new breakthrough in diagnosing pre-implantation embryos. There seems little doubt that we are gaining increasing control over our bodies, which is surely a good thing to all but the most ardent pro-death critics of human life.

Back in our January issue, Reason ran a discussion with Ron Bailey, Radical Evolution author Joel Garreau, and the Ethics and Public Policy Center's Eric Cohen on the question of "Who's Afraid of Human Enhancement?" Cohen, for one, was, and part of his comments are worth thinking about, I think, in the context of pre-implantation interventions:

If you take that principle seriously and if you take basic biology seriously, then embryos are embryonic human lives, and we're now talking about using them in research. We already abort children with Down syndrome. Those are ways we're saying these people are not good enough. We're not going to welcome them in our society. We're going to eliminate them, and so from that perspective equality has been hurt. Technology has created a mind-set that has made us more inegalitarian even as it's served the cause of equality. I think both things are happening at once.

The whole discussion is here. I think that Ron Bailey has answered convincingly the question of whether unimplanted embryos are in fact equivalent to human life and thus worthy of the same protections. Ron has also foregrounded the notion that biotechnology will certainly force a rethinking of when human life begins. But I remain curious what other readers think on the subject.

Comments

|6.20.06 @ 2:01PM|#

Would the surgery be covered in state-managed care? Heck would the testing?

|6.20.06 @ 2:05PM|#

I think that Ron Bailey has answered convincingly the question of whether unimplanted embryos are in fact equivalent to human life and thus worthy of the same protections.

If the article linked constitutes that answer, it is clear that some are far more easily convinced than others.

Dave W.|6.20.06 @ 2:09PM|#

I don't think the concepts of right or wrong exist within science.

Asking a scientist about right and wrong is akin to asking a Baptist preacher to interpret what the fossil record means for you. Not only will he not be equipped to know, but he will impose extraneous agendas on his agenda, such as the everpresent agenda about filling up the collection plate those guys seem to have.

|6.20.06 @ 2:14PM|#

The members of this family act as though they've achieved eternal life. In fact, all they've done is delayed death for a little while. And in the mean time, they get to live out a miserable existence.

This seems to be the mantra of the health nannies... it's better to live a crappy life longer than have an enjoyable life and die earlier. No thanks, I'll just enjoy myself along the way.

And the grandmother seemed to live long enough to see grandkids. So she probably saw all of her best days and then some, even without cancer.

|6.20.06 @ 2:18PM|#

"The members of this family act as though they've achieved eternal life. In fact, all they've done is delayed death for a little while. And in the mean time, they get to live out a miserable existence."

Gee, they'll have to eat more frequently. What misery. :)

|6.20.06 @ 2:23PM|#

I think that Ron Bailey has answered convincingly the question of whether unimplanted embryos are in fact equivalent to human life and thus worthy of the same protections.

I think that it is impossible to answer either way. That answer disatisies lots of people I am sure.

|6.20.06 @ 2:28PM|#

If that's your idea of fun, by all means have at it. This is libertarian forum, after all. If you want to sell a kidney, go for that too.

I'd just pass on it myself. When I eat, I like to eat large amounts. (But I have a good metabolism, so I still stay under 160.)

|6.20.06 @ 2:49PM|#

kmw:

I'm with you, man. We humans are psychotic when it comes to death. It is a profound event that every one of us will experience, yet most of us wet our pants even thinking about it.

Taking out a healthy organ... that is fucking disgusting. I wonder if it's even ethical for a doctor to do this.

Yeah, I feel the same looking at the picture of that family with their smug smiles. You're still gonna die, folks. Some day. Maybe sooner than later.

Enjoy your protein paste.

Robert|6.20.06 @ 2:56PM|#

I think it's OK to kill anything that doesn't mind being killed.

|6.20.06 @ 2:58PM|#

Ron has also foregrounded the notion that biotechnology will certainly force a rethinking of when human life begins. But I remain curious what other readers think on the subject.

I think others on this forum have rephrased the question to 'what is a human being?' One can argue that, left to 'natural' actions, embryos are the beginning of life because they will grow into human beings. But when do they become human? Personally, it doesnt follow that I must accord the same rights an embryo as a human.

I think the pro-life contingent has conflated life with humanity and it will be a sticky wicket to pull the two back apart.

|6.20.06 @ 2:59PM|#

Mr. Nice Guy,

I suppose next you're going to tear into women who have BRCA mutations and choose to have a prophylactic mastectomy. After all, what's the value of a human life measured against a pair of nice titties?

People are free to make their own choices. You don't have to live with the consequences, so mind your own damn business.

And with that BS about "taking out a healthy organ..." What's next? Are you going to start complaining about vasectomies?

|6.20.06 @ 3:05PM|#

I have no real opinion one where life starts, except that I agree with Woody Allen about not wanting it to end. If someone came to me and said: "take this pill and you can live forever" I'd take it in heartbeat. I am interested in the implications of a world where humans don't die, however. And, that longevity and sex are potentially linked makes me very happy indeed.

|6.20.06 @ 3:12PM|#

APL:

These people agreed to enter the public domain with their story. So they're not minding their own business. Why should I?

Vasectomies are about enjoying life. They are not based on fear. Removing a healthy organ out of some delusion to "cheat death" is nothing but fear. It is weak.

"After all, what's the value of a human life measured against a pair of nice titties?"

Survey says...

|6.20.06 @ 3:26PM|#

Taking out a healthy organ... that is fucking disgusting.

Good job reading the article, especially the part where it points out that when the removed stomachs were examined, doctors found precancerous or early stage cancerous tumors. In case you're incapable of translating that I'll do it for you: the organs weren't healthy, they were in the earliest stages of a disease that is usually irreversable by the time you start having symptoms.

|6.20.06 @ 3:31PM|#

Those are ways we're saying these people are not good enough. We're not going to welcome them in our society.

Let's come right out and say it: those people aren't good enough. Why should we welcome them? Maybe Dr. Cohen would like to step up and help take care of the ones that aren't aborted or "enhanced?" The ones that financially drain and prematurely age their parents? The ones who can't ever be left unsupervised? The ones who may never be able to earn their own ways?

I seethe at this Puritanical BS, this "suffering is the One True Path™ to righteousness" douche drip. Ah, yes. Parents should just welcome gimpy flipper-kids into their lives with rapt, humble, Marian expressions of gratitude. They should regard the sacrifice and expense as a blessing. It sure sounds all warm and up-with-people for Dr. Cohen to coo over Down's infants and other circus freaks. Let's let him take care of one for a week or two.

We're going to eliminate them, and so from that perspective equality has been hurt.

Equality isn't built by Puritanical, cultish self-denial. Equality is built by choice.

|6.20.06 @ 3:39PM|#

Jania:

Good job accepting a total fluff piece on face value and not (you the reader) asking hard questions.

Let's try one:

It is worth grossly mutilating oneself because one MIGHT get a CERTAIN disease?

|6.20.06 @ 3:46PM|#

MIGHT and CERTAIN.

70% chance of a deadly disease. If you'll take those odd you're welcome to them.

"mutilate" = small incision + gastric bypass?

Apparently you believe in the wisdom of repugnance(squeamishness)

|6.20.06 @ 3:47PM|#

MNG,
Is it worth grossly mutilating oneself because you want to? Body modification and piercing, tatoos, self amputation for not reason other than "because" are common today. You want to bitch because somebody thinks they can cheat death for a while based on scientific testing?

My family has a history of heart disease and cancer. Personally, for me, I will take my chances that I won't die from a heart attack and will continue eating steak. But that is MY choice. Others may choose to eat only chicken and low-fat soy shakes. That is THIER choice. It isn't an ethical or a moral choice, it is a personal one.

|6.20.06 @ 3:53PM|#

Hey, speaking of extraneous agendas being imposed onto discussions, I'm kinda surprised that Dave W failed to cite the link between stomach cancer and HFCS... ;-)

|6.20.06 @ 3:57PM|#

SM:

How did they come up with that 70% probability? Who is doing the math? Has this projection gone through a rigorous process with independent entities? I'm not going to accept that figure just because some ding-dong "journalist" prints it.

Mutilate=ripping out your fucking stomach!! ;)

Kwix: Dude, I agree with you. If someone wants to stick a nail through their head, more power to them. But I still will call them a dumbass.

|6.20.06 @ 4:05PM|#

Preventive gastrectomy in patients with gastric cancer risk due to genetic alterations of the E-cadherin gene defect.

Schwarz A.

Department of General Surgery, University of Ulm, Steinhoevelstrasse 9, 89075 Ulm, Germany. [e-mail]

BACKGROUND: Germline mutations in the E-cadherin gene CDH1 have recently been described that seem to be responsible for the development of hereditary diffuse gastric cancer. METHODS: The world literature on familial gastric cancer is reviewed in terms of mutations of the E-cadherin gene CDH1. RESULTS: There are reports of 18 families worldwide with hereditary diffuse gastric cancer due to germline mutations of the E-cadherin gene CDH1. Germline mutations of the E-cadherin gene CDH1 lead to hereditary diffuse gastric cancer with a penetrance of about 70%. An early onset with an average age of 38 years in men and women is typical for this autosomal dominant inherited disease. Until now preventive total gastrectomies with hereditary diffuse gastric cancer have been reported in five patients. CONCLUSIONS: Preventive total gastrectomy should be the procedure of choice in patients with a germline mutation of the E-cadherin gene CDH1. Patients with a genetic risk for familial gastric cancer who reject preventive total gastrectomy must be followed-up intensively by endoscopy every 6-12 months.

--

But hey, Mr. Nice Guy, that's just thinking with our heads. You go on doing what your gut tells you.

|6.20.06 @ 4:26PM|#

Meyer:

My ever-expanding gut tells me to be skeptical, even towards our holy and infallible scientists and doctors, because they are still human.

My gut also tells me to be skeptical of drastic measures that are born out of raw fear and/or anger.

|6.20.06 @ 4:33PM|#

Mr. Nice Guy,


You're making some pretty silly statments. Such as commenting that this family is "weak" because they "fear death."

I suppose that someone who wears a motorcycle helmet or seat belt is also "weak" for "fearing death" from a vehicle accident?

I don't know what my chances are of getting in a severe motorcycle accident, but I doubt that it's 70%, and yet I still wear a helmet. And if I had this genetic syndrome, and a 70% chance of dying froma particularly painful cancer, I'd get the surgery, too. There's more to life than being able to eat a whole pizza at one sitting.
Your commentary is pompous and uninformed.

|6.20.06 @ 4:52PM|#

Wonder when the last time was that Mr. Nice Guy denounced stomach stapling for the obese as drastic, barbaric, and sick. Nobody cares if fat people mutilate themselves in a desperate bid to be pretty, do they.

Dave W.|6.20.06 @ 6:12PM|#

the link between stomach cancer and HFCS

If you remember from last month, stomach cancer is more of a salt/kimchee thing. I came on the thd and said I didn't care because stomach cancer was rare enough in the general population.

|6.20.06 @ 7:40PM|#

...said I didn't care because stomach cancer was rare enough in the general population.

You vicious, uncaring bastard, you. Now I wish there were a link to HFCS, just to make you care...

|6.20.06 @ 7:48PM|#

Dude, I'm so with you. What's with all these cancer patients taking radiation therapy or chemotherapy and losing their hair, throwing up, etc? Why would anybody do that to themselves? That's perfectly good hair they're losing!

|6.20.06 @ 8:13PM|#

Matt:

The question goes deeper than that. Do human beings have rights because they are human and such rights are inherent in their nature, or are rights something granted by people more powerful than they?

The fact is that those embryos would, if left alone become people, makes your statement about your "granting" or "recognizing" rights dangerous. At what point do we recognize those rights? What are our criteria to do so? And is it rigth that we have the power to grant or deny rights to others?

It is not just because of sexual hang-ups nor obscurantism that the Catholic Church is opposed to that kind of exprimentation. It hinges on their theory of Natural Law, from which derives the postulate that rights are God-given and not somehitng that others grant or deny.

By the way, it was this theory which carried the day in the Spanish debates about the American Natives, that they had rights by virtue of being human.

Curiously, for thsoe who like to ponder paradoxes, this was the position of the "retrograde" medieval Thomists, while those devotees of the "New Learning" of the Rennaissaince who advocated that Indians had no rights that they did not want to recognizne.

(Let's not forget the immortal words of Judge Tanney "A black man has no rights that a white man has to respect")

|6.20.06 @ 9:01PM|#

Adriana,

The fact is that those embryos would, if left alone, die.

Besides, the religious argument is that those embryos already are people. That's why destroying them is a bad thing. That's what your argument hinges on.

|6.20.06 @ 9:03PM|#

Typical of these discussion, terminology is used inconsistently by the various participants. At the very least, it is necessary to come to some consensus on what the terms "human," "human being," "person" or "people", etc. are intended to mean (or, for the Wittginsteinian's among us, how they are to be used) before the moral status of human embryos can profitably be addressed.

Thus, for example, when Mr. Gillespie writes "whether unimplanted embryos are in fact equivalent to human life" and Adriana writes "those embryos would, if left alone become people" they are implying things about what it is to be a human or a person with which reasonable people will disagree if only because those terms both denote and connote different things to them.

Generally (though, alas, not consistently), discussion on this subject reserves the term "person" for moral beings; that is, for those entities about whom, if any sort of entity has moral rights, responsibilities, etc., they do. You and me, for example. "Human," by contrast, is inconsistently used. Some mean by it only species membership and thus would have little difficulty agreeing that the embryos we are discussing are human but would deny they should be considered persons. In other words, some would say human equals Homo sapiens while others would say human equals person. (For what it's worth, I fall on the "human equals person" side in my usage.)

The issue is complicated enough as is: at least provisional agreement on terminology is essential if differences are even to be understood, let alone resolved.

|6.20.06 @ 9:55PM|#

D.A.R.,

Perhaps not using loaded terms rather than attempting to define them would be a better approach. Simply don't use unadorned "human" or "human life" in such discussions. When people are talking about eight cell human embryos, they can say "eight cell human embryos".

Coming to a consensus on what the terms "human", "human being", "person" or "people" are intended to mean seems unlikely, but even if it's possible, it's certainly not necessary. If there are problem words, avoid using them without sufficient qualification; use more than one word if needed.

Of course once you do that, you're left with scientific terms, describing physical entities upon which some religions further believe there are spiritual components. It then becomes fairly clear that science knows a lot about the process of combining gametes and eventually getting a born child (with luck), and that there are sufficient terms to describe the various progressions from stimulated folicle and extracted sperm to newborn.

It may seem strange to hear the word "human" considered a loaded term, but in this context, that's exactly what it is. Dropping the loaded terminolog strips the facade off the religious arguments.

If a religion defines conception as the point when something happens beyond what biology shows us, that's fine. We already know that religions encourage belief in things for which we have no proof. Adherents of those religions can believe what they want and mind their embryos accordingly. There's no need to fight over the word "human".

|6.20.06 @ 10:21PM|#

anon2:

It certainly wasn't my intent to use, as you say, "loaded" terms except insofar as I explained whatever "load" I was using. However, for example, it seems stilted to say "Homo sapiens embryo" and, in fact, no one ever does say that in ordinary discourse. We say "human embryo" ordinarily insofar as we wish to make a point about the sort of embryos that we started life as and in opposition to, say, sheep embryos. But "human," as far as I can tell, is not a specifically or even particularly scientific term. The point being that we don't speak the same way scientists do when they are doing science. Of course, an ancillary point is that the terms used by scientists, however useful to science they may be, are not necessarily useful to moral discussions. In fact, they can needlessly complicate such discussions, suggesting that there may be moral implications to purely empirical distinctions when, upon closer analysis, it turns out that there are not.

You should note, also, that I made no mention of any sort of religious or, for that matter, spiritual concepts. They may be critical to certain arguments or inform certain perspectives on the moral status of unborn Homo sapiens, but no religious beliefs of any sort whatever are necessary to believe that the question of that moral status is real and capable of being argued legitimately both for and against. I think, therefore, your own comments include more than a few implicitly "loaded" terms.

In any case, I wasn't arguing above for anything so ambitious as a broad consensus on how these terms should be used, though that would be nice. I was merely arguing that the specific participants in any discussion of these topics take the trouble to try to come to some sort of explicit understanding of how they are using the terms themselves.

|6.21.06 @ 8:11AM|#

Geez.

It's interesting that people are extrapolating (misrepresenting) my point of view to include simple treatment/prevention.

Okay folks, let's try this again:

How far should one go to avoid the POSSIBILITY of death from a specific quantity?

Maybe I'm being "silly", but removing a functioning, healthy stomach seems like a very, very extreme measure. And I would feel just a little hesitant to do it just because some egghead tells me to.

The egghead is not taking any risks. He guarantees that I won't die of stomach cancer. That's perfectly logical. How can I die of stomach cancer IF I HAVE NO STOMACH!? Doesn't that seem slighly fallacious?

And let's consider quality of life. Not eating a "whole pizza" is a cute, but totally dishonest zinger. I'm thinking it goes much further than that. A stomach is a vital organ. If you don't have one, it's going to greatly affect your life, unless you're going to spend the rest of your days lying in a bed.

And folks, let's stop pretending that stomach removal is the only option, okay? According to Meyer:

"Patients with a genetic risk for familial gastric cancer who reject preventive total gastrectomy must be followed-up intensively by endoscopy every 6-12 months."

Yes, I'm sure having frequent endoscopic examinations would totally suck balls. But let's consider the fact that medical techology improves exponentionally. I can see these types of procedures becoming less and less invasive. Hell, it can get to the point that they can do a simple scan.

And maybe someday they will cure cancer.

So that's what I have. If anyone cares enough to have a beef, fine, but let's try to be honest, okay?

|6.21.06 @ 9:39AM|#

D.A.R.,

I can't tell if you don't understand the point I was trying to make or if you merely disagree. If the former, perhaps this will help. If the latter, I apologize. I'm not trying to badger you into submission.

I agree with you that there is a major problem with terminology. However, you appear to have either overlooked or dismissed and not commented on a different way of resolving the definitional issue. I think this different way is superior to the one you proposed. Since you said:

"At the very least, it is necessary to come to some consensus on what the terms "human," "human being," "person" or "people", etc. are intended to mean (or, for the Wittginsteinian's among us, how they are to be used) before the moral status of human embryos can profitably be addressed."

I thought it was worth pointing out the different methodology where this statement is not true in a significant sense.

Words often mean different things in different contexts, even when a single person is using the word. Normally this isn't a big issue because people are good enough at identifying the context, that these ambiguities can be resolved by the audience in the way that the speaker or author meant. Even when that's not the case, a misunderstood word typically doesn't dramatically change the meaning of an entire work or thesis, unless the word is central to the thesis. "Human" in the context of in-vitro related issues is such a word.

You think it's necessary to come to some consensus what the term "human" means. I disagree. I believe it's possible to either use a different word or add other words that supply context and avoid the issue of what "human" without context means. I used the term "loaded" to refer to some of the problem words, instead of "ambiguous" because lots of words are ambiguous, but they don't cause problems because their ambiguity doesn't lend itself to the sort of word games that people (often accidentally) play when using "human" as part of their central thesis.

I am not saying that discussions concerning abortion, in-vitro, etc. shouldn't use the word "human" anywhere in them, only that people should be willing to put enough context around human to get rid of the problematic use of the word. You see the same problem (I think), but your solution would be to come to a consensus for what "human" means. I think that's much harder than using a separate word or adding additional words for context.

So, I'm not suggesting saying "homo sapiens embryo" instead of "human embryo". I'm instead suggesting that if someone argues that a "human embryo" is human that someone else points out that "human" in the context of "human embryo" is like "human" in the context of "human sperm cell"; they're both correct uses of the word "human", but that particular use of human doesn't have the same meaning as all uses of human, including the one that is associated with "a human". This can all be done without ever having to define what "a human" is or what "human" means.

|6.21.06 @ 11:20AM|#

Mr. Nice Guy,

I think that you're overlooking some of the context - these people aren't having their stomachs removed simply because some "egghead" told them to.

It's true that the first ones to have surgery decided to accept the limitations and risks of stomach removal after watching an agonizing death by cancer and then being told they had the gene and a 70 percent chance of getting that same cancer. So yes, fear of a particularly bad death, and mathematics.

But after that, when the biopsies started to show that the removed stomachs were NOT healthy - that they were precancerous - the remaining family members had more to go on than some "egghead's advice." They got to see firsthand the disadvantages (and difficulty recovering) caused by the stomach surgery, but they also had the information that this theoretical 70% chance of cancer was affecting multiple people in their family. Even after seeing what the recovery from that surgery is like (and I've got to say that seeing my mother in the recovery room after gastric bypass was FAR more frightening than seeing my father in the recovery room after a dual valve replacement and dual bypass surgery), they still felt that going through that experience was better than going through the experience of dying from that stomach cancer.

So yeah, they will have some restrictions and disadvantages (such as a vulnerability to parasites that a person with a normal stomach wouldn't have too much trouble handling), and sooner or later they'll die of something else. But they won't die of that cancer - and if they think that's worth going through having their stomachs removed, why should they be derided for making that choice?

Personally, I think it's great that technology and medicine has at least arrived at a point where at least some people are free to make some choices that let them control some of the medical aspects of their life and death. The last thing I would want is for someone to have the power to say "I think that's a horrible, stupid choice, so I'm not going to allow you to make it."

|6.21.06 @ 8:14PM|#

anon2:

True, those embryos, if left alone would die.

But then, babies, if left alone would die.

So, let's say, if left alone, with their natural supply of care and nutrients or a reasonable facsimilie of such supply, would eventually become productive adults.

And the question is whether "rights" are something that your grant or recognize, or something that exists independent of your will. In short, do we have rights because others do not take them away, or do we have rights by being human?