I don't read Alyrium's posts in that manner. He does have less faith than the average person that parents know what's best for their kids, but that's based on both his personal experiences and a greater level of awareness of just how ignorant the average person/parent is on medical and scientific matters. Most parents do not know what is best for a disabled child. Thanks goodness most of them realize they are out of their depth and seek help and advice but the ones that don't can cause significant harm.Cesario wrote:Parents do not automatically know what is best, I agree completely. But by declaring what is and is not important, Alyrium is putting himself in the position of being the arbiter of what is and is not of value. In that sense, he is no better than the parents he doesn't think are worthy to make the decision.
Part of the problem there is that we all have our own baggage and bias. It is not at all unusual for the average doctor or nurse to have an unspoken bias as well as the parents of a child. Add in that many medical decisions are somewhat muddy ethically as medicine is not an exact science and no one can predict the future, much less all possible alternative outcomes.Cesario wrote:The right answer is to let the patient make the decision. Because this situation makes the only right answer impossible, we're left contemplating and weighing the various less right ways of making a decision that needs to be made.
For the purposes of this thread, the two most important points are:Cesario wrote:I agree, that is tragic.
But this brings up the other side of that "you've only got a limited window of brain development" coin. If the child doesn't hear before that window closes, they won't be able to process sound since those brain structures will be repurposed and pruned away just like those language centers. We want to make sure they have the chance to learn language. I see no reason we should not also want to make sure they have the chance to process sound by the same reasoning. The risks may be radically different, but the fundamental principle of what we're trying to do is precisely the same.
1) While both language and sound processing are important, for future quality of life it is more important to be able to process language. Loss of sound perception is less of an impairment than loss of language ability. Conversely, it is more important to preserve language potential than hearing.
2) We do not need to subject a child to stem cell treatment to preserve either of those two things, but most especially not to preserve language capability. There are alternatives for preserving both capabilities (CI's, Sign, etc.)
So far as I know the major factor in doing this with infants is the language window.Cesario wrote:Are you aware why the experiment is specifically targeting infants? I was under the impression that there were factors the researchers were looking at that were unique to children this young that would make research on adults inapplicable to this population or vice-versa. Was I mistaken about this?Broomstick wrote:Keep in mind, too, that a kid with a CI implanted and a developed language center in the brain should, in theory, be able to utilize stem cells later to regrow a damaged organic structure. Using a CI should keep the window open to use a fully developed stem cell technology later down the line, or to consent to experimentation as an adult.
Minor factors are that infants have a less developed immune system and are thus less likely to reject a transplant, and that the more time goes by the more umbilical cord blood degrades in quality. However, if you're using the infants own cord blood the immune system shouldn't be a factor at all
New vaccines are not tested on children, much less infants. Some vaccines have lower age limits, due either to side effects or because beneath a certain age a child's immune system will not reliably benefit from a vaccine.Cesario wrote:There is a difference in degree, but not in kind. I specifically brought up vaccinations because they're a proven technology that is generally considered to be worth the risks. But it's also one where there is a real cost-benefit analysis that needs to be done even now.
There is an established protocol to bring new vaccines into use, starting with testing in consenting adults and only gradually lowering the age limit. Such protocols for established technology, yet going to infants for stem cell treatment when it's not first established in adults, is one of the big issues here. It's not safe or reliable in adults, why are we using it in infants? The pro side of the argument will bring up the language window. The anti side brings up the unknown risks and alternatives that currently exist for mitigating the effects of deafness.
And here you are mischaracterizing Alyrium's true position. Do not mistake his playing devil's advocate for his personal position.Cesario wrote:I brought it up because I want to make sure that cost-benefit ratio is being weighed here, and not just discarded in the face of a treatment for a problem Alyrium doesn't think needs to be treated at all, ever.
Do keep in mind that Sign, CI's, conventional hearing aids, various forms of speech and language therapy can all be considered treatment for deafness. It is not so much a debate about whether to treat but how to treat.
I still think your conflating Alyrium playing devil's advocate with his personal position. That, and even among people with normal hearing the sense of hearing is valued differently. You are correct that human opinion is subjective. We can't know how a child with impaired hearing will value whatever hearing ability he retains down the line. Some will treasure every scrap of sound they can perceive. Others will eventually throw out the technological appliances.Cesario wrote:No. There is nothing objective about you presenting your personal values as a moral absolute. You don't value the sense of sound, but your lack of value for it is not a universal thing. A lot of people, even in just this thread, have noted that the sense of sound is something that they value, so all you've got is your own opinion, which is no more objective than theirs is.
While the device itself won't impair acquisition of Sign the attitudes of others certainly can.Cesario wrote:So the device won't interfear at all with the aquisition of sign language. That's what I thought. Which means you've been presenting a false-choice. That's what I thought.
Again, based on my experience in the health care industry: CI's are no longer considered experimental. Indeed, for some disorders they are now the treatment of choice. As a result of this, US health insurance companies will often pay for them and the required follow-up and maintenance as necessary medical expenses. But they only pay for one, not two. We invariably, at any given time, had one or two sets of parents clamoring for a second CI for their kid. They would invariably present statistics that a second CI improved sound perception and speech recognition, which it true, it does improve - by about 3-5%. This is not something you're going to notice in ordinary conversation. While there might be rare situations where the risks are justified (and just to be clear, the risks of CI implantation include not just "it won't work" and risk of meningitis, but also the possibility of damaging or destroying the body's balance sense or permanent facial paralysis) those cases are the exception. For example, a child who in addition to impaired hearing also has impaired vision might benefit greatly from two CI's and there were cases where such children were provided with double CI's. This does not apply to deaf children with normal vision. If (and such cases occurred) a child with a CI is only recognizing speech 50-60% percent of the time they don't need a second CI, they need to be routed into deaf education. Try telling the parents that, though. Yeah, they were hoping the CI would make their kid normal. It didn't. Deal with it properly assholes. They were wailing that we were depriving their child of something that would help him. The medical world was saying the potential benefit was small, too small to justify the risks still present in CI implantation. That, and by leaving one ear untouched another window remains open - the possibility of better technology down the line being used by the patient. Implanting a CI is destructive to the inner ear and cuts off future options. Implant two of them and you're locking the patient into today's technology forever, if something better comes along they probably won't be able to use it. But you can't reason with some people. They start court cases over this. Meanwhile, their kid isn't getting what he needs, education in a format that is most useful to him. Instead of being able to utilize Sign as the primary language with sound/speech as an adjunct the kid might be denied Sign and forced to utilize a communication channel that only works half the time. It's sad. It's tragic. It's going on even as we speak.
This does not apply, of course, to the lucky recipients who achieve an 80-90% speech recognition rate, those for whom a CI is an unequivocal good.
I'd also add to the despicable list parents who can not accept their kid doesn't hear well, or at all, and will subject the child to pain and suffering with no gain, who will volunteer their kids for medical experimentation with a new and risky technology for a less than life-threatening reasons, and who will deny their child a proper education in a format that works for the kid in preference to trying to force someone to be normal who never will be.Cesario wrote:The people I'm calling despicable are the ones who are arguing that children should not recieve medical treatment in order to force them into a culture. The people I'm calling despicable are the ones who are arguing that children should not recieve medical treatment because they personally don't value the capability that the treatment seeks to preserve or restore. The people I'm calling despicable are the ones who would cowardly deny that there is even a choice to be made in order to try to force other people into treating their personal prejudices as objective fact.Alyrium Denryle wrote:so calling a group of people with cultural experience seeing the wages of idiot parents, objecting to policy level use of CIs or child experimentation despicable is out of place and wrong-headed.
No, actually deafness is not guaranteed to reduce quality of life. Deafness does not impair major life functions, like ability to take care of oneself, or one's mobility. The disadvantages are mostly social.Cesario wrote:Deafness is guaranteed reduced quality of life, just like amputation of the left arm and blindness.Alyrium Denryle wrote: Experimentation in the way described in the OP really is a manifestly bad idea, and should only be permitted in cases where the condition being treated is life threatening or disabling to the point of guaranteed reduced quality of life. Deafness does not qualify.
Again, you are mischaracterizing Alyrium's position. Alyrium is not opposed to CI's, even though there are quantifiable risks to their use, as just one example.Cesario wrote:You think that deafness never needs to be treated anyway, so any medical exploration around that area will never be worth it in your mind, because any risks that come with the treatment will be weighed against nothing because you don't value the goal of the procedure.
You don't know how medical research is done.Cesario wrote:And now you're outright lying. If the best case scenario is "no effect", then there is no point in performing the experiment at all. No one would fund it. No researcher would be interested in performing the study. No regulatory body would approve the experiment.Alyrium Denryle wrote:Because I know how this shit works, and keep up with the literature. Stem cell trials have a tendency to go... poorly. It is very very hard to get stem cells into the right place and get them to do what you want them to do when you just inject them into a cavity like the inside of a damaged cochlea. It would be one thing if they were growing these things in vitro other otherwise ex situ and implanting them. They are not. They are hoping to throw them in situ without the necessary developmental signals, and that is a recipe for, at best, no effect, and at worse malignant tumors and systemic immune rejection. The majority of the confidence interval is in the range of "Fucked"Where are you getting your "likely" and "unlikely" when the descriptions reffer to "unknown"?
It is quite common in pharmaceutical research, for example, to dose healthy volunteers to detect adverse effects - in which case "no effect" is, in fact, the best-case scenario and a desirable outcome. Likewise for vaccine research where, if the vaccine doesn't "take", the "no effect at all" alternative is seen as desirable as opposed to worse outcomes. Well, Ok, "no effect" is the second best alternative to "cures the problem", but the point is "no effect" is far from the worst possible result in medical research. It's actually a pretty common one.
Being able to live a meaningful and full life without X is not the same as not valuing X. This is a major stumbling block in discussing disability issues. A paraplegic can live a meaningful, full, and exciting life, travel the world, and so on while rejecting treatments that might potentially restore an ability to walk. It's not that the person doesn't value working legs, but rather they've adapted sufficiently to the situation that they are not willing to run the risks of experimental therapy in order to restore an ability where the lack of that ability is more an annoyance than anything else.Cesario wrote:And since you think that there is absolutely no meaningful benefit to being able to hear, you would not accept the treatment as an acceptable thing to provide even if it had all the risks of getting a papercut from reading a baby book to your child.Alyrium Denryle wrote: I happen to think deafness is only a disability by technicality and social context. It does not by itself harm the deaf person's ability to enjoy life. Quality of life and the hedonic value of future choices are what matter. If the treatment for deafness or any condition has a serious potential to be worse than what is being treated, then it should not be foisted on someone who cannot make the choice themselves.
As a much more mundane example: I wear eyeglasses. Without them, I am functionally blind, unable to read, to recognize faces, to safely cross a street. Over the years, many well-meaning people have encouraged me (even harangued me) to get eye surgery to correct this. They go on and one about how annoying glasses are (as if I haven't noticed, over the last 40 years or so), and how unattractive they are, how expensive they are over a lifetime (as if I haven't noticed that, either), the visual distortions of high refraction lenses (which is true, but the human brain compensates for that - YOU might find looking through my glasses distorted but my brain has learned to correct those distortions, I no longer see them) and why WOULDN'T I want that problem fixed?
Well, the truth is that refractive eye surgery is not without risk, and the side effects are largely permanent. If I get a botched pair of glasses I can get them replaced, but botched eye surgery is forever. More than that, though, my problem IS fixed as far as I'm concerned. The current solution works for me, it's extremely low risk, and I see no reason to change. That doesn't make me opposed to refractive eye surgery for others, just for me. And for people at high risk of complications. Again, those most enthused about the technology are largely those who will not be subjected to it.
It's not that I don't value 20/20 vision without needing corrective aids - I do. I annoy my friends and coworkers with 20/20 vision who don't wear safety glasses when using power tools because I value unimpaired vision enough to want to protect it in other people. I have a friend who just can not understand how I tolerate glasses at all (lucky man has better than 20/20 vision). Well, for me the benefits of them are so overwhelming that the downsides barely register in my awareness. My glasses do not hinder me, they liberate me. That doesn't mean I'm going to run out and embrace a technology that promises me normal vision without the use of a prosthesis. Why? Because wearing glasses doesn't impact the quality of MY life. Needing them has never stopped me from doing anything I've ever wanted to do. Having severe myopia and astigmatism does not impair me. It might be gravely disabling to someone who has aspirations of being, say, a fighter pilot but since I've never really felt personally piloting an F-16 to be one of my life goals it's not an issue for me.
And THAT is what is meant when a Deaf person says being deaf isn't disabling - it's not that they are unaware of the difference. They can perceive a difference between themselves and hearing people. What they mean is they don't view it as a problem for them. For the most part it doesn't stop them from doing the things they want to do, and when it does, it's often other peoples' attitudes that are the problem and not the lack of a reasonable solution to a problem that does arise. So a Deaf person isn't going to become a concert violinist - if that isn't an ambition of theirs anyway what does it matter? Sure, being deaf cuts off certain options, but there are so many other options still open that to many it's not that big a deal.
Yes, and that difference of opinion is why a hearing with hearing can view being deaf as being horrible and a Deaf person can view it as being of no importance.Cesario wrote:You don't seem to grasp that intelligent, moral people can disagree about what the best chance for a happy life is. In spite of you mindlessly parroting that line to me above.Alyrium Denryle wrote: If I lose my leg as an adult and decide I want to risk my long term health in experimental leg regeneration experiments, that is my prerogative. If it happens as a child, my parents have no right to risk my long term health when a prosthetic would give me the best chance at a happy life. If that takes a government or hospital ethics panel stepping in and telling them to fuck off, so be it.
There are some circumstances where adult people with a condition almost universally say "this sucks, a cure even with risks would be welcome." Deafness, however, is not such a condition. The experience of deaf people varies enormously, with many saying it's more an annoyance to them than anything else and others not bothering with the adaptive technology that is out there. This applies even to people who became deaf after a lifetime of hearing - not all of them feel an urgent need to run surgical risks to correct the lack. The experience of deaf people is no less valid than the experience of the hearing. Because, based upon the experience and input of deaf people, it is evident that being deaf does not always impact quality of life in a negative manner it is reasonable to conclude that running high risks in order to cure it (or more accurately, mitigate it) is not justifiable.