DIALOGUES ON BEING HUMAN: Intersections of Art, Health and Dignity with artist Jesse Krimes in dialogue with Marc Howard of the Prison and Justice Initiative moderated by Alicia Ely Yamin, Director of the Health and Human Rights Initiative. Anita Alvin Nilert is the Art Dialogues Curator please direct any questions or comments to firstname.lastname@example.org.
Artist Jesse Krimes conveys the dehumanizing experience of incarceration through his compelling body of artwork clandestinely produced over 6 years on the inside while doing time for a non-violent drug offense. Saying that he only survived his odyssey through the criminal justice system by producing art every day, the work embodies themes of alienation, purification, redemption, social stratification and power. Awaiting sentencing in a 23 hour maximum security lock down for one year, he created 292 separate portraits, mostly of offenders, on slivers of prison-issued bars of soap. Then while serving a 70 month sentence, he created a 39-panel mural illustrating heaven, hell and purgatory using contraband prison sheets, hair gel, plastic spoons, and newspaper clippings, that he smuggled out in the mail. Mr. Krimes jail-made art work and compelling story embody issues of prison reform, sentencing and social justice.
In an international game of Whac-A-Mol, this week China announced that it would be adding four lethal heroin-like narcotics to a list of controlled substances to help combat the growing opioid epidemic in America. The primary target of the ban is Carfentanil, one of the latest and deadliest synthetic opioids to show up in the United States.
Carfentanil is so deadly that an amount smaller than a poppy seed can kill a person, and until recently, was best known as a tranquilizer for knocking out moose and elephants, or as a chemical weapon. Today you can find it on the streets in Ohio and Indiana.
For decades before being discovered by drug dealers, Carfentanil has been banned from the battlefield under the Chemical Weapons Convention. However, last year drug dealers discovered that large profits could be made by cutting fentanyls into illicit drugs, and US customs authorities seized in the first six months of 2016, 295 pounds of a substance they had rarely seen before.
And overdose rates have sky rocketed.
It is clear that U.S. opioid demand is driving the development and proliferation of a new class of deadly synthetic drugs. According to the DEA, most synthetic drugs like Carfentanil that end up in the United States arrive from China – synthetic opioids that are not widely abused in their country of origin. Produced by nimble chemists to stay one step ahead of Chinese law, drugs like Carfentanil proliferate as soon as a similar substance is banned. For example, after Beijing tightened its focus on other fentanyls late last year, the AP documented how Chinese vendors began to actively market alternative opioids.
Ultimately, the fundamental qualities of the global political structure are making it impossible to fully address this problem. Portable substances spill across national borders, and the need to effectively manage their production permeates every State – even those who have no problem with the substance – as the capacity to manage global issues like drug development and consumption has not kept pace with the evolution of its complexity and danger.
Throughout history, autonomy has been paramount to sovereignty. The current international global governance structure is predicated on the idea of a Westphalian State, and until recently, the slow dispersion rates of people, knowledge, and objects did not necessitate a need for change. However, as the world is flattening, the distance between nations and the idea of a purely independent state is becoming less and less of a possibility. Where a cannon was laborious and difficult to move, newly developed drugs can be mailed via domestic postal services.
How do we fight an opioid epidemic in America when the drugs come in so quickly and easily through our own postal service? Without a unified, global plan, independent nation states will continue to play Whac-a-mole. And people will continue to die. We no longer live in the age of the isolated state, and we must change our global health laws protocols to reflect this reality.
Although the actions in China this week are greatly appreciated and highly cooperative, we must not forget that they are not a solution, but merely a temporary fix to a much larger, global issue.
There is no doubt that viruses, emerging and re-emerging, have become an imminent global health threat. Starting in 2014, we saw the decimation of West African countries as a result of the Ebola epidemic. Soon after came the Zika outbreak that continues to pose a threat to countries in the Americas and around the world. Since December 2016, Brazil has been experiencing a rise in yellow fever cases, and deaths, among humans and monkeys alike. Colombia and Peru have already reported probable cases. As a response to rising human cases of the H7N9 bird flu, China just ordered the closure of all poultry markets in the eastern province of Zhejiang to stop the trade of live poultry.
Experts warn that the question is not whether but when a pandemic will hit. Unknown or little-known viruses currently looming in animal populations undetected pose a especially dangerous risk–we have little to no experience with them, we do not know whether or when they will spill over to humans, and we do not know where they will emerge next.
As recent outbreaks have demonstrated, we are ill-prepared to protect ourselves–we continue to react rather than adopt a more proactive and preventative approach. That said, experts working in this area are challenging the world to think outside the box, and the Global Virome Project (GVP) is exactly that. Envisioned as a global partnership, the GVP would seek to identify 99% to 100% of viruses with potential of becoming epidemics through the use of revolutionary technologies. This ten-year project promises to facilitate the development of various countermeasures, including vaccines and diagnostics. Read More
Stem cell research is a volatile scientific topic in the US, with supporters who are usually divided along political lines. Conservatives tend to view stem cell research – and particularly embryonic stem cell research – with disfavor. Thus, the new administration poses a threat to the continued support of research and innovation in this field, despite the abundance of breakthroughs already made that are on the cusp of providing lifesaving cures and therapies for millions of people.
What is “stem cell research”?
First, let us go over that exactly is the topic at issue here. Stem cells are defined by the National Institute of Health as unspecialized cells capable of renewing themselves through cell division, sometimes after long periods of inactivity.
The beneficial potential for stem cells is that under certain physiologic or experimental conditions, they can be induced to become tissue- or organ-specific cells with special functions. The research underway in this field is to determine how scientists can trigger these unspecialized cells and instruct them to become specialized and form into new tissue or organs, such as healthy pancreas cells for someone with Type 1 Diabetes, or new neurons for someone whose nerve cells were damaged by Parkinson’s Disease.
Stem cells can be sourced from embryonic tissue, which usually comes from unused and donated embryos from in-vitro fertilization treatment. Some tissues and organs of the body also produce undifferentiated cells, called adult or somatic stem cells.
Since embryonic stem cells were discovered in 1998, political and ideological beliefs have significantly influenced the support and progress of research in the US. In 2001, President George W. Bush banned federal funding for embryonic stem cell research, citing that the use of these embryos, which would otherwise be discarded or would deteriorate in long-term storage, diminishes the value of human life. Scientists have identified other possible sources of stem cells, such as somatic cells. However, the completely unsullied nature of newly formed and undefined embryonic cells holds untold promise to scientists in this field who think they may be a more versatile means of generating healthy human tissue. President Obama lifted the embryonic research ban in 2009, but by then 8 years of critical research time was lost. Some states, like California, enacted legislation and provided funding to continue funding stem cell research during the Bush ban years. California implemented a $3 billion dollar state program – The California Institute for Regenerative Medicine (CIRM) – in 2004 to mitigate the effects of the federal ban. This program has already committed 75% of the $3 billion, and is estimated to deplete the fund by 2020. California is now faced with figuring out how to sustain its research initiative in the wake of another possible federal funding limitation or other encumbrances that could be imposed by the Trump Administration.
An Uncertain Outlook
Congressman Tom Price, the President’s nominee to run the Department of Health and Human services, previously sponsored a bill that defined the beginning of human life as starting at conception. He has made statements that were sharply critical of embryonic stem cell research, stating that Obama’s lifting of the embryonic ban would “force taxpayers to subsidize research that will destroy human embryos.” It stands to reason that if confirmed, he will not be an advocate for continued or increased funding for embryonic research, thus once again slowing progress in this promising area.
The Possibilities are Endless
Scientists see immeasurable potential for stem cell therapy if the research is allowed to continued unfettered and with robust support. Illnesses from Diabetes, to Cancer, to Parkinson’s and Alzheimer’s could be cured within our generation. Incredible advances in vision restoration and burn treatment have been realized with stem cell therapy. This video showing skin restoration on a burn victim is an incredible example of the life-changing treatments possible through stem cell therapy.
It is hard to imagine a world free of the ravages of cancer, Alzheimer’s, or ALS. But, scientists doing pioneering research tell us that this future is not merely a flight of imagination, but an attainable reality. Our government has a responsibility to support the continued preservation of the health and welfare of the American people. This responsibility does not vacillate based on which party is in power. It should not ebb and flow based on partisan loyalties or ideologies. It should be rooted in sound, objective judgment and facts. The promise of stem cells is a fact. The benefits it has already yielded are facts. The need to continue to support this research is a fact. The detriment to the public health if it is not pursued, and the blame that will fall squarely on the shoulders of those who impede this scientific progress, are facts that should never be allowed to become realities.
Germany joins the growing cannabis experiment
On January 19th, Germany joined the growing list of countries who have legalized marijuana for medical purposes. The bill, which was passed unanimously by the German Parliament after being first approved by the country’s cabinet in May 2016, will come into effect March 2017. The law allows doctors to prescribe cannabis to patients with multiple sclerosis and other severe illnesses as well as to those patients for whom the substance could alleviate certain symptoms, such as nausea or chronic pain, or who may see a positive effect on their disease progression.
Up until now, only certain people with serious medical conditions could be granted permission to use the drug for self therapy, and the bar was set fairly high. Only around 1,000 people in the whole country currently have been given permission to use the drug. Personal possession of the drug remains illegal in Germany, though small quantities in possession are not usually prosecuted.
Germany will provide patients with cannabis through a state-regulated program, allowing cannabis products to be grown under state supervision. Private producers could eventually also apply, but the requirements for approval would be very strict. The idea for a state-regulated program is that it will help in ensuring the plants quality. Until they are able to launch this program and grow enough plants, the products needed for patients will be imported.
Additionally, the Federal Health Minister, Hermann Gröhe, announced that “costs of using cannabis for medicinal purposes will be met by the health insurance companies of the critically ill, if no other form of treatment is effective.” Another win for public health is that along with the legalization, Germany is also planning to launch research to study the positive effects of such therapy, the appropriate dosage of the drug, and also its side effects. For this purpose, anonymous data on patients will be transferred to the Federal Institute for Drugs and Medical Devices (BfArM).
Growing information on existing evidence
A week before Germany legalized cannabis for medical cannabis, a new report from the National Academies of Sciences, Engineering, and Medicine was presented on the risks and benefits of cannabis use. “The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research” is one of the most comprehensive studies of recent research on the health effects of recreational and therapeutic cannabis use, offering a rigorous review of relevant scientific research published since 1999. This report summarizes the current state of evidence regarding what is known about the health impacts of cannabis and cannabis-derived products, including effects related to therapeutic uses of cannabis and potential health risks related to certain cancers, diseases, mental health disorders, and injuries. More than 100 conclusions about the health effects of marijuana, including claims of both helpful and harmful effects, were evaluated by the National Academies of Sciences, Engineering and Medicine. The report is the product of 16 experts in their fields, including neurologists, oncologists, epidemiologists and child psychiatrists.
The report concludes that there is not enough research to reach conclusive judgments on whether marijuana can effectively treat most of the symptoms and diseases it is advertised as helping. However, the same is also true of many of the risks said to be associated with using cannabis.
There was only enough evidence to conclusively support treatment for three therapeutic uses, the study found: to reduce nausea and vomiting from chemotherapy, to treat chronic pain and to reduce spasms from multiple sclerosis.
The following is a list of some of the therapeutic uses analyzed with the existing scientific and medical evidence (the definitions used in the report can be accessed here):
There is conclusive or substantial evidence that cannabis or cannabinoids are effective:
There is moderate evidence that cannabis or cannabinoids are effective for:
There is limited evidence that cannabis or cannabinoids are effective for:
There is limited evidence of a statistical association between cannabinoids and:
There is limited evidence that cannabis or cannabinoids are ineffective for:
All signs point to the need for more research
While the paper is broad and wide-ranging, it is unlikely to end debate on any number of treatments. One researcher studying the therapeutic impacts of the cannabis compound cannabidiol on children with epilepsy said researchers’ conclusions were broadly “conservative”, and on epilepsy “wrong”.
“For science to do what it does, I think when they do a scientific review they should incorporate all the evidence that is out there for that disorder, and I don’t think they did that for epilepsy,” said Orrin Devinsky, director of New York University Langone Medical Center’s comprehensive epilepsy center. Still, he called the report “very valuable”.
However, even though there may be some controversy surrounding the report, one thing is clear: there is a need for more and better research. Among the review’s most fervent calls were for more investigation with many researchers stating that conclusive evidence about the positive and negative medical effects is hard to come by.
The report also took the unusual step of calling for private funding sources to advance marijuana research. Researchers found it “difficult to gain access to the quantity, quality, and type of cannabis product necessary”, the report said. “A diverse network of funders is needed to support cannabis and cannabinoid research.” Currently, because cannabis in the US is a Schedule I drug, research is prohibited. Only the University of Mississippi is allowed to grow research-grade marijuana, making the supply extremely limited. If we want to obtain the research to obtain conclusive evidence, it will be necessary to have bigger and more studies.
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The views reflected in this blog are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.