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Patent first, ask questions later: morality and biotechnology in patent law.

This Article explores the U.S. "patent first, ask questions later" approach to determining what subject matter should receive patent protection. Under this approach, the U.S. Patent and Trademark Office (USPTO or the Agency) issues patents on "anything under the sun made by man," and to the extent a patent's subject matter is sufficiently controversial, Congress acts retrospectively in assessing whether patents should issue on such interventions. This practice has important ramifications for morally controversial biotechnology patents specifically, and for American society generally. For many years a judicially created "moral utility" doctrine served as a type of gatekeeper of patent subject matter eligibility. The doctrine allowed both the USTPO and courts to deny patents on morally controversial subject matter under the fiction that such inventions were not "useful." The gate, however, is currently untended. A combination of the demise of the moral utility doctrine, along with expansive judicial interpretations of the scope of patent-eligible subject matter, has resulted in virtually no basis on which the USTPO or courts can deny patent protection to morally controversial, but otherwise patentable, subject matter. This is so despite position statements by the Agency to the contrary. Biotechnology is an area in which many morally controversial inventions are generated. Congress has been in react-mode following the issuance of a stream of morally controversial biotech patents, including patents on transgenic animals, surgical methods, and methods of cloning humans. With no statutory limits on patent eligibility, and with myriad concerns complicating congressional action following a patent's issuance, it is not Congress, the representative of the people, determining patent eligibility. Instead, it is patent applicants, scientific inventors, who are deciding matters of high public policy through the contents of the applications they file with the USTPO. This Article explores how the United States has come to be in this position, exposes latent problems with the "patent first" approach, and considers the benefits and disadvantages of the "ask questions first, patents later" approaches employed by some other countries. The Article concludes that granting patents on morally controversial biotech subject matter and then asking whether such inventions should be patentable is bad policy for the United States and its patent system, and posits workable, proactive ways for Congress to successfully guard the patent-eligibility gate.

Animals↗

Human reproductive cloning, embryo stem cells and germline gene intervention: an Israeli perspective.

The perspectives of applying the cloning technology to human reproduction have generated much controversy. Israel was one of the first countries to adopt (in 1998) a Law that prohibits reproductive cloning. This is a moratorium for 5 years during which neither cloning of an entire human being nor genetic changes affecting human reproductive cells will be allowed. An aim of the Law is to allow the examination of the moral, legal, and social aspects of these technologies and their implications for human dignity. With the intention of not being an obstacle to the advancement of medical genetics, the Law provides for a yearly report to the Israel Health Minister on the state of scientific knowledge in these technologies. This article reflects the 2002-3 report, relating to scientific issues and bioethical opinions in Israel and in the world on human reproductive cloning, embryonic stem cell research and germline gene manipulation. In the Jewish tradition, the primary importance of saving lives and helping suffering patients can take precedence over the fears generated by modern genetic and reproductive research. Provided that new technologies are applied for medical indications and respecting human rights and human dignity, it is legitimate to explore their beneficial potential.

Bioethics↗

Robotics and artificial intelligence: Jewish ethical perspectives.

In 16th Century Prague, Rabbi Loew created a Golem, a humanoid made of clay, to protect his community. When the Golem became too dangerous to his surroundings, he was dismantled. This Jewish theme illustrates some of the guiding principles in its approach to the moral dilemmas inherent in future technologies, such as artificial intelligence and robotics. Man is viewed as having received the power to improve upon creation and develop technologies to achieve them, with the proviso that appropriate safeguards are taken. Ethically, not-harming is viewed as taking precedence over promoting good. Jewish ethical thinking approaches these novel technological possibilities with a cautious optimism that mankind will derive their benefits without coming to harm.

Biomedical Technology↗

Artifacts and collaborative work in healthcare: methodological, theoretical, and technological implications of the tangible.

Although modeled as knowledge work with emphasis on data flow and decision making, healthcare is delivered in the context of a highly structured physical environment, with much effort and emphasis placed on physical and spatial arrangement and re-arrangement of workers, patients, and materials. The tangible aspects of highly collaborative healthcare work have profound implications for research and development of information and communication technology (ICT) despite the tendency to model work as flow of abstract data items. This article reviews field studies in healthcare and other domains on the role of artifacts in collaborative work and draws implications in three areas: methodological, theoretical, and technological. In regard to methodologies, assessment of new ICT and development of user requirements should take into account how artifacts are used and exploited to facilitate collaborative work. In regard to theories, the framework of distributed cognition provides a starting point for modeling the contribution and exploitation of physical artifacts in supporting collaborative work. In regard to technology, design and deployment of new technology should support the functions provided by physical artifacts replaced or disrupted by new technology, and profitable ways for new technology to support collaborative work by embedding ICT into existing infrastructure of physical artifacts.

Artifacts↗

Clinical use of medical devices in the 'Bermuda Triangle'.

The pace of medical technological development shows no sign of abating. Analyzing the effect of major federal health agencies on the availability of such technology is critical. This paper describes functions of three government health agencies: the Centers for Medicare and Medicaid Services (CMS), the Food and Drug Administration (FDA), and the National Institutes of Health (NIH). Certain medical technologies fall into gaps between these agencies, which pose challenges in today's era of demand for evidence-based medicine. We suggest new policy and pragmatic strategies that can close the gaps and move decision making relevant to technology forward more rapidly than is now the case.

Biomedical Technology↗

Pyrosequencing AB.

Pyrosequencing AB develops, manufactures and sells research products that enable life sciences researchers to add utility to the massive amount of genomic information available, with the goal of improving human health. As more genomic information becomes available, research efforts are shifting toward implementing practical applications of this genetic information. Pyrosequencing has developed comprehensive genotyping solutions that provide researchers with rapid and accurate technology for assessing individual genetic variation. Genotypic information is anticipated to play an important role in the emerging field of applied genomics and as a result, significant opportunities may be derived from analyzing genetic variation in individuals and across populations. These data will be key to understanding how genetic differences may be used to determine an individual's predisposition to disease, detect and monitor disease progression, and select the most appropriate therapy and dose and to avoid adverse events. This is pharmacogenomics, an area in which Pyrosequencing technology is being applied and will no doubt continue to enable researchers to ultimately improve human health.

Biomedical Technology↗

The impact of future technology on cancer care.

Globally cancer will increase greatly over the next 20 years because of ageing populations. Minimally invasive surgery will reduce the need for routine organ resection. The application of sophisticated computer systems to radiotherapy planning will allow the precise shaping of beam delivery conforming exactly to the shape of the tumour. The most promising advances will come from the rapidly increasing understanding of the molecular genetics of cancer. This will have considerable impact on prevention, screening, diagnosis and treatment and lead to a golden age of drug discovery. Individual cancer risk assessment will provide messages tailored for individual prevention and have far-reaching public health consequences. Increased consumerism in medicine will produce increasingly informed and assertive patients seeking out novel therapies, bypassing traditional referral pathways through global information networks. This will bring new ethical and moral dilemmas. The cancer future will be created by the interaction of four complex factors: technological success, society's willingness to pay, future healthcare delivery systems and the financial mechanisms that underpin them.

Biomedical Technology↗

Some ways that technology and terminology distort the euthanasia issue.

Technology and terminology often detract from a reasoned appraisal of the euthanasia option, especially in those discussions that argue for euthanasia's incorporation into a beneficence-based medical model. "Beneficent euthanasia," assuming there is such a thing, poses special challenges to the traditional provider-patient relationship. These challenges argue for well-defined limits of beneficence and a more equitable distribution of responsiblity between participants. We should not allow technology and terminology to generate an unrealistic portrayal of patient death and its ramifications. Participants need to acknowledge their roles in the decision to kill and the obligations that those roles entail. Perhaps we can reach ethical consensus concerning euthanasia by first reasserting our span of control over the technology that can extend the near-death period and by openly discusssing euthanasia's implications.

Altruism↗

On Heidegger, medicine, and the modernity of modern medical technology.

This paper examines medicine's use of technology in a manner from a standpoint inspired by Heidegger's thinking on technology. In the first part of the paper, I shall suggest an interpretation of Heidegger's thinking on the topic, and attempt to show why he associates modern technology with danger. However, I shall also claim that there is little evidence that medicine's appropriation of modern technology is dangerous in Heidegger's sense, although there is no prima facie reason why it mightn't be. The explanation for this, I claim, is ethical. There is an initial attraction to the thought that Heidegger's thought echoes Kantian moral thinking, but I shall dismiss this. Instead, I shall suggest that the considerations that make modern technology dangerous for Heidegger are simply not in the character - the ethos - of medicine properly understood. This is because there is a distinction to be drawn between chronological and historical modernity, and that even up-to-date medicine, empowered by technology, retains in its ethos crucial aspects of a historically pre-modern understanding of technology. A large part of the latter half of the paper will be concerned with explaining the difference.

Biomedical Technology↗

Managed care, medical technology, and the well-being of society.

The growth of managed care could have widespread effects on the structure and functioning of the health care delivery system, potentially influencing all patients, even those not enrolled in managed care plans. One important mechanism by which managed care could have such broad effects is by influencing technology development and adoption. This article examines available literature on the effects of managed care activity on technology adoption and the implications of any effects on patient care, outcomes, and health care costs. Existing literature supports the view that managed care has contributed to slowing the adoption of new technologies, particularly the high-cost, high-profile technologies that have been the focus of the most attention. The literature outlining the effects of managed-care-induced changes in technology adoption on patient care and outcomes is not large, but what literature there is tends not to find negative effects on patient care and outcomes. Specific evidence about costs also is somewhat sparse, but it suggests that managed care has contributed to some reduction in health care spending, although the extent to which savings will persist over time is unclear. Although evidence thus far does not suggest important detrimental effects of managed care on care or outcomes and even indicates some benefit through savings, it should be noted that existing literature has only explored a small number of the many technologies and services that might have been influenced, and there remain issues for the future that deserve vigilance.

Biomedical Technology↗

[Phenomenology of viscerality: the impact of medical imaging technologies on corporeality].

This article deals with the phenomenological dimension of the inner body in light of the success of new medical imaging technologies outside the biomedical field itself. The new technologies contribute not only to the disembodiment of subjectivity, but also to the virtualization and objectification of corporeality. They neglect the constitutive subjective dimension of the living body. The article investigates this fundamental dimension of corporeality, ungraspable through medical imaging.

Anthropology, Cultural↗

Development of a teletechnology protocol for in-home rehabilitation.

Our ability to provide in-home rehabilitation is limited by distance and available personnel. We may be able to meet some rehabilitation needs with videoconferencing technology. This article describes the feasibility of teletechnology for delivering multifactorial, in-home rehabilitation interventions to community-dwelling adults recently prescribed a mobility aid. We used standard telephone lines to provide two-way video and audio interaction. The interventions included prescription of and/or training in functionally based exercises, home-hazard assessment, assistive technology, environmental modifications, and adaptive strategies. Patients were evaluated in three transfer and three mobility tasks, and appropriate treatment was provided over the course of four visits. To date, 13 of the 14 subjects enrolled in the rehabilitation study have completed all four visits (56 visits total). Equipment-related problems were most common early in the study, particularly on the initial visit to a subject's house. We identified (mean +/- standard deviation [SD]) 13.1 +/- 7.9 mobility/self-care problems per subject and made 12.5 +/- 8.3 recommendations per subject to address those problems. At 6-week follow-up, 60.1 percent of our recommendations had been implemented. The greatest number of problems was identified for tub transfers (mean +/- SD = 3.4 +/- 1.4), the greatest number of recommendations was made for toilet transfers (mean +/- SD = 3.1 +/- 3.4), and the most frequently implemented recommendations were for transition between locations. Overall, our results show promise that both the telerehabilitation technology and intervention procedures are feasible.

Biomedical Technology↗

The health impact of resolving racial disparities: an analysis of US mortality data.

The US health system spends far more on the "technology" of care (e.g., drugs, devices) than on achieving equity in its delivery. For 1991 to 2000, we contrasted the number of lives saved by medical advances with the number of deaths attributable to excess mortality among African Americans. Medical advances averted 176,633 deaths, but equalizing the mortality rates of Whites and African Americans would have averted 886,202 deaths. Achieving equity may do more for health than perfecting the technology of care.

Black or African American↗

Surgery in the information age.

Currently, surgical procedures involve direct data flows of sensation and mechanical output. As information technology progresses, surgery will change to a system of electronic data flows, with technical, ethical, and training implications.

Biomedical Technology↗

Cloning pigs: advances and applications.

Although mouse embryonic stem cells have been used widely for over a decade as an important tool for introducing precise genetic modification into the genome, demonstrating the great value of this technology in a range of biomedical applications, similar technology does not exist for domestic animals. However, the development of somatic cell nuclear transfer has bypassed the need for embryonic stem cells from livestock. The production of offspring from differentiated cell nuclei provides information and opportunities in a number of areas including cellular differentiation, early development and ageing. However, the primary significance of cloning is probably in the opportunities that this technology brings to genetic manipulation. Potential applications of gene targeting in livestock species are described with particular emphasis on the generation of pigs that can be used for xenotransplantation, and the production of improved models for human physiology and disease. The development of techniques for somatic cell nuclear transfer in pigs and the challenges associated with this technology are also reviewed.

Animals↗

High-tech tools transform the operating room.

This installment of our quarterly Clinical Management series examines how the hospital operating room is becoming a safer place for patients. Thanks to such technological breakthroughs as 3-D images, virtual patients and robots, surgeons can operate with more accuracy and efficiency.

Biomedical Technology↗