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Editorial, Opinion Piece Respond To Closure Of Murdered Abortion Provider Tiller's Clinic
Two newspapers recently published an editorial and an opinion piece in reaction to the announcement that murdered Kansas abortion provider George Tiller"s Wichita clinic would be permanently closed. The clinic was one of a handful in the U.S. offering abortion procedures in the second and third trimesters. Summaries appear below.~ Kansas City Star: The closing of Tiller"s clinic is "a tragedy for American democracy," and the "irrational violence" of his death has "trumped public policy," a Star editorial states. "The basis of civilization is that we agree to submit to the rule of law in order for society to flourish," the editorial says, adding that Tiller"s murder is "antithetical to that principle. It is dismaying to see a killer achieve his objective." The editorial notes that Tiller provided abortion services in "tragic cases" involving women "at risk of infertility or death; fetuses with severe abnormalities; and victims of rape and incest." It continues that the "reduction or loss of that service will create hardships and may put women"s lives at risk." Hospitals and doctors who refer such cases to abortion providers "must reassess the circumstances under which they would perform late-term abortions," according to the editorial. In addition, the "medical profession must take a role in training and supporting doctors willing to provide abortions," and the government and local police "must do all they can to protect a legal medical practice," the editorial says. It concludes, "Democracy demands that we not allow murder to make de facto public policy" (Kansas City Star, 6/11).~ Eric Zorn, Chicago Tribune: The announcement that Tiller"s clinic will remain permanently closed "was simply more proof that violence and intimidation can get results where civil discourse and political process fail," Tribune columnist Zorn writes. "The question isn"t whether prominent foes of abortion rights are being honest with us when they decry Tiller"s violent death and express regret over the means used to achieve an end they"ve sought," Zorn writes, adding, "Some are, I"m sure." He continues that abortion-rights opponents "recognize that ... a movement calling itself "pro-life"can"t also be pro-murder" and "are politically savvy enough to know that the gains won by terrorist acts are grudging and difficult to sustain." He continues that to "make terrorism less effective, and thereby discourage it," abortion-rights advocates, the medical profession, politicians and law enforcement officials "need to reopen that clinic in Wichita and assure its safe operation ... to defy terrorism, if for no other reason." He concludes that "as long as abortion remains legal, this same coalition needs to strive to expand the number of facilities where it"s available" (Zorn, Chicago Tribune, 6/11).
Mental Health

Study Offers First Look At Effects Of Genetic Copy Number Variation On Volatile Anesthetics

A study published in the July issue of Anesthesiology offers perhaps the first estimation of how genomic copy number variation (CNV) can influence anesthetic sensitivity and the magnitude of this influence. CNV is a sometimes naturally occurring halving or doubling of a block of genes in an organism. This means that there is either a 50-percent increase or a 50-percent decrease - by genetic duplication or deletion - of the effects or traits generated by that specific block of genes. In the study, the fruitfly Drosophila was genetically engineered to mimic the kind of CNV that is found in humans. Howard A. Nash, M.D. and his research group from the Laboratory of Molecular Biology of the National Institute of Mental Health in Bethesda, managed to show that CNV does indeed have a significant impact on sensitivity to certain anesthetics. "Individual patients and experimental animals show a great amount of variation in sensitivity to volatile anesthetics," said Dr. Nash. "To our knowledge, this study is the first to demonstrate that changes in CNV contribute significantly to such variability, and our work should serve to stimulate and guide the examination of the way this type of genetic polymorphism impacts the clinical use of volatile anesthetics." Volatile anesthetics are general anesthetic drugs that are liquid at room temperature but which evaporate readily for inhalation. In a companion editorial to the study, Max B. Kelz, M.D., Ph.D., and Eliot Friedman, M.D., of the University of Pennsylvania School of Medicine, said that researchers are just now beginning to understand the important role that CNV plays in genetic variability in humans. CNV could be especially important for anesthesiologists. "One key question for anesthesiology is the clinical relevancy of genetic diversity in the day-to-day practice of anesthesia," said Dr. Kelz. "It is conceivable that CNV might contribute to the diversity in anesthetic responsiveness, including a study subject"s resistance to or hypersensitivity to anesthetics. Among the many interesting ways CNV could manifest are awareness under anesthesia or delayed emergence from anesthesia." Dr. Nash used deletions in 50 percent of the flies" total genetic makeup before exposing them to the volatile anesthetic halothane. Because the entire genome of the Drosophila has been completely mapped and sequenced, discovering which genes are having what precise effects can be done much more effectively than in humans, whose genome has not yet been fully mapped. For anesthesiologists, studies such as Dr. Nash"s are meant to be stepping stones for better understanding how gene variance can predict an individual"s reaction to anesthetics. These results suggest that CNV and its effect on anesthetics will be an important subject of study in future trials. "Changes in CNV thus take their place within the spectrum of genetic aberrations that significantly influence anesthesia in flies," said Dr. Nash. "And current efforts are exploring how CNV influences the effectiveness of various drugs in patient populations. Our experience with Drosophila suggests that it would be worthwhile to include volatile anesthetics in such studies." American Society of Anesthesiologists (ASA)


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