Misplaced Pages

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81-618: The principal purpose of the treatment was to improve Ashley's quality of life by limiting her growth in size, eliminating menstrual cramps and bleeding, and preventing discomfort from large breasts. The combination of the surgery and the estrogen therapy attracted much public comment and ethical analysis in early 2007, both supportive and condemning. Ashley's parents granted their first written interview to CNN Health in March 2008, and their second to The Guardian in March 2012. In addition, The Guardian published two interviews with mothers of

162-605: A diapered child. A variety of treatments have been used over the last several decades to deal with these issues. In July 2004, Ashley had a hysterectomy (to prevent menstruation ) and surgical removal of her nascent breast buds (to prevent development). She also underwent an appendectomy (because Ashley wouldn't be able to vocalize symptoms). The surgery was performed at Seattle 's Children's Hospital and Regional Medical Center . In addition, in December 2006 she completed estrogen therapy through dermal patches, which sped up

243-542: A CC/GC genotype led to a more significant likelihood of the disorder impacting the individual overall and increasing the likelihood of any of the three phenotypes. A second associated SNP was located 308 base pairs upstream from the start codon of the TNF-α gene, in which guanine was substituted for adenine . A GG genotype at the loci is associated with the disorder and has been proposed as a possible genetic marker to predict PD. There has also been an association with mutations in

324-729: A cancer drug in development by J&J. It is believed to be the first of its kind in the pharmaceuticals industry. Recent activity has included spearheading a movement to relax restrictions on blood donations by gay men and urging postponement of the Rio Summer Olympics because of the Zika virus threat. In early May 2020, the United States Conference of Mayors announced the Mayors Advisory Panel on Sports, Recreation & Health, with Caplan as

405-659: A co-chair, to "advise mayors and sports and recreation officials on safe policies and practices as cities reopen from the COVID-19 pandemic ", and in November 2020 he joined the NCAA COVID-19 Medical Advisory Group. MarketWatch featured Caplan in an article on the life of a bioethicist during the COVID-19 pandemic on August 4, 2020. Much of his time from 2020 to present has been focused on

486-636: A family history of dysmenorrhea. Dysmenorrhea is a highly polygenic and heritable condition. There is strong evidence of familial predisposition and genetic factors increasing susceptibility to dysmenorrhea. There have been multiple polymorphisms and genetic variants in both metabolic genes and genes responsible for immunity which have been associated with the disorder. Three distinct possible phenotypes have been identified for dysmenorrhea which include "multiple severe symptoms", "mild localized pain", and "severe localized pain". While there are likely differences in genotypes underlying each phenotype,

567-527: A girl and a boy who had completed the treatment. A 2014 TV program and article tell the similar story of a girl in New Zealand . A survey on growth attenuation among pediatric endocrinologists was published in July 2015. Ashley was born with a severe brain impairment of genetic cause, termed a "static encephalopathy " because it does not improve. Although she sleeps and awakens, and breathes on her own, she

648-443: A hallmark of or associated with specific disorders can produce dysmenorrhea as a symptom which accompanies the primary disorder. In contrast with secondary dysmenorrhea, primary dysmenorrhea (PD) has no underlying pathology. Genetic mutation and variations have therefore been thought to underlie this disorder and contribute to the pathogenesis of PD. There are multiple single-nucleotide polymorphisms (SNP) associated with PD. Two of

729-539: A junior research assistant and then as a post-doctoral fellow. He spent the next 10 years at the center, serving as the associate director from 1985 to 1987. During this time, Caplan published many papers on genetics (including the ethics of genetic testing and screening), evolution, sociobiology, and the teaching of ethics. He also became involved in the ethics of human and animal experimentation and new medical technologies, applying philosophy in public discourse and speaking on public policy issues. In 1987, Caplan moved to

810-400: A low body weight. A pelvic exam and ultrasound in individuals who are sexually active may be useful for diagnosis. Conditions that should be ruled out include ectopic pregnancy , pelvic inflammatory disease , interstitial cystitis and chronic pelvic pain . Dysmenorrhea occurs less often in those who exercise regularly and those who have children early in life. Treatment may include

891-449: A major factor in primary dysmenorrhea. When the uterine muscles contract, they constrict the blood supply to the tissue of the endometrium, which, in turn, breaks down and dies. These uterine contractions continue as they squeeze the old, dead endometrial tissue through the cervix and out of the body through the vagina . These contractions, and the resulting temporary oxygen deprivation to nearby tissues, are thought to be responsible for

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972-561: A regular commentator on CNN , WOR Radio , WGBH (FM) 's "Boston Public Radio" and WMNF Tampa 's "Everyday Ethics" podcast. He is a frequent guest and commentator on various other media outlets, discussing public health issues like obesity , Ebola virus disease , Zika virus , vaccination , and COVID-19 . He has been co-director of the Joint Council of Europe/United Nations Study on Trafficking in Organs and Body Parts. He

1053-615: A teaching assistant and was the final graduate student of Nagel's career. During his time at Columbia, Caplan met psychoanalyst and Dean of Education Bernard Schoenberg. Schoenberg allowed him to participate as both an observer and a medical student in clinical rotations in the university's medical college, first experiencing "ethics in action". In 1977, Caplan met Daniel Callahan , a philosopher who co-founded The Hastings Center (now in Garrison, New York ) with psychiatrist Willard Gaylin . In 1977, Caplan joined The Hastings Center, first as

1134-543: A variety of issues common in children with severe neurological impairments. As these children grow larger, it takes more strength to move them and provide basic bodily care, raising the risk of pressure sores from immobility. Precocious puberty is common in children with various forms of severe brain damage. The early appearance of secondary sexual characteristics is often distressing to parents and caretakers. Many parents of severely disabled children explore possible ways to avoid having to deal with menstruation and fertility in

1215-739: Is presacral neurectomy . Dysmenorrhea is one of the most common gynecological problems, regardless of age or race. It is one of the most frequently identified causes of pelvic pain in those who menstruate. Dysmenorrhea is estimated to affect between 50% and 90% of female adolescents and women of reproductive age. Another report states that estimates can vary between 16% and 91% of surveyed individuals, with severe pain observed in 2% to 29% of menstruating individuals. Reports of dysmenorrhea are greatest among individuals in their late teens and 20s, with reports usually declining with age. The prevalence in adolescent females has been reported to be 67.2% by one study and 90% by another. It has been stated that there

1296-464: Is an innovative and sufficiently safe therapy that offers the possibility of an improved quality of life for nonambulatory children with profound cognitive disability and their families. Pediatricians and other care providers should include discussion of these options as part of anticipatory guidance around the age of 3 years so that, if elected, potential clinically meaningful benefits of growth-attenuation therapy can be realized. The two bioethicists from

1377-495: Is associated with increased pain sensitivity and heavy menstrual bleeding . For many, primary dysmenorrhea symptoms gradually subside after their mid-20s. Pregnancy has also been demonstrated to lessen the severity of dysmenorrhea, when menstruation resumes. However, dysmenorrhea can continue until menopause . 5–15% of women with dysmenorrhea experience symptoms severe enough to interfere with daily activities. There are two types of dysmenorrhea, primary and secondary, based on

1458-455: Is insufficient evidence to recommend the use of many herbal or dietary supplements for treating dysmenorrhea, including melatonin , vitamin E , fennel , dill , chamomile , cinnamon , damask rose , rhubarb , guava, and uzara. Further research is recommended to follow up on weak evidence of benefit for: fenugreek , ginger , valerian , zataria , zinc sulphate , fish oil , and vitamin B 1 . A 2016 review found that evidence of safety

1539-437: Is insufficient for most dietary supplements. There is some evidence for the use of fenugreek. One review found thiamine and vitamin E to be likely effective. It found the effects of fish oil and vitamin B 12 to be unknown. Reviews found tentative evidence that ginger powder may be effective for primary dysmenorrhea. Reviews have found promising evidence for Chinese herbal medicine for primary dysmenorrhea, but that

1620-493: Is no significant difference in prevalence or incidence between races, although one study of Hispanic adolescent females indicated an elevated prevalence and impact in this group. Another study indicated that dysmenorrhea was present in 36.4% of participants, and was significantly associated with lower age and lower parity . Childbearing is said to relieve dysmenorrhea, but this does not always occur. One study indicated that in nulliparous individuals with primary dysmenorrhea,

1701-460: Is not fertilized and there is no pregnancy, the built-up uterine tissue is not needed and thus shed. Prostaglandins and leukotrienes are released during menstruation, due to the build up of omega-6 fatty acids . Release of prostaglandins and other inflammatory mediators in the uterus cause the uterus to contract and can result in systemic symptoms such as nausea, vomiting, bloating and headaches or migraines. Prostaglandins are thought to be

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1782-921: Is on the board of trustees of the Institute for Ethics and Emerging Technologies . He also sat on the board of the National Center for Policy Research on Women & Families , the Franklin Institute , the Iron Disorders Foundation, and the National Disease Research Interchange . Caplan has been elected as a fellow of The Hastings Center (1990), the American Association for the Advancement of Science (1994),

1863-695: Is one of the 10 most influential people in America in biotechnology, according to the National Journal ; one of the 10 most influential people in the ethics of biotechnology, according to Nature Biotechnology ; one of the 50 most influential people in American health care, according to Modern Health Care magazine; and one of the 100 most influential people in biotechnology, according to Scientific American magazine. Caplan holds eight honorary degrees from colleges and medical schools. He received

1944-667: Is the most common menstrual disorder . Typically, it starts within a year of the first menstrual period . When there is no underlying cause, often the pain improves with age or following having a child. The main symptom of dysmenorrhea is pain concentrated in the lower abdomen or pelvis . It is also commonly felt in the right or left side of the abdomen. It may radiate to the thighs and lower back . Symptoms often co-occurring with menstrual pain include nausea and vomiting , diarrhea , headache , dizziness , disorientation , fainting and fatigue . Symptoms of dysmenorrhea often begin immediately after ovulation and can last until

2025-468: Is unable to raise her head, sit up, hold an object, walk, or talk, and must be tube-fed. Nonetheless, she is alert and responsive to her environment, particularly enjoying the music of Andrea Bocelli . Her parents have nicknamed Ashley "Pillow Angel", because she always remains where she is placed, which is usually on a pillow. In 2004 when Ashley was six and a half years old, she began to show signs of puberty and her parents and doctors began to anticipate

2106-435: Is usually in the pelvis or lower abdomen. Other symptoms may include back pain , diarrhea or nausea. Dysmenorrhea can occur without an underlying problem. Underlying issues that can cause dysmenorrhea include uterine fibroids , adenomyosis , and most commonly, endometriosis . It is more common among those with heavy periods , irregular periods, those whose periods started before twelve years of age and those who have

2187-676: The College of Physicians of Philadelphia (1994), the New York Academy of Medicine (1997), and an honorary fellow of the American College of Legal Medicine (2008). Caplan was named a person of the Year in 2001 by USA Today . In December 2008, Discover magazine named him one of the 10 most influential people in science, for ”translating philosophical debates into understandable ideas” and “democratizing bioethics.” He

2268-548: The MEFV gene and dysmenorrhea, which are considered to be causative. The phenotypes associated with these mutations in the MEFV genes have been better studied; individuals who are heterozygous for these mutations are more likely to be affected by PD which presents as a severe pain phenotype. Genes related to immunity have been identified as playing a significant role in PD as well. IL1A

2349-804: The University of Minnesota , where he became a professor in the Departments of Philosophy and Surgery and the first director of the Center for Biomedical Ethics. In 1989, he organized the Center for Bioethics Conference on Medical Ethics and the Holocaust, the first conference convened to discuss bioethics and the Holocaust . During his time at Minnesota he was active on issues relating to organ transplantation and genetics and worked with Rosalie A. Kane on dilemmas of "everyday ethics" involving treatment of

2430-570: The pelvic region or other areas of the body. Individuals with disorders may have genetic mutations related to their diagnoses which produce dysmenorrhea as a symptom of their primary diagnosis. It has been found that those with fibromyalgia who have the ESR1 gene variation Xbal and possess the Xbal AA genotype are more susceptible to experiencing mild to severe menstrual pain resulting from their primary pathology. Commonly, genetic mutations which are

2511-527: The spine may decrease symptoms, a 2006 systematic review found that overall no evidence suggests that spinal manipulation is effective for treatment of primary and secondary dysmenorrhea. Valerian , Humulus lupulus and Passiflora incarnata may be safe and effective in the treatment of dysmenorrhea. A 2011 review stated that high-frequency transcutaneous electrical nerve stimulation may reduce pain compared with sham TENS, but seems to be less effective than ibuprofen. One treatment of last resort

Ashley Treatment - Misplaced Pages Continue

2592-452: The 5,000 emails they received were in support of the treatment, many of these testimonies and support emails are posted on Ashley's blog. The parents indicated that there was especially strong support among parents and caregivers of children with similar conditions to Ashley's, those who have the direct experience. They cite several ethicists in support of the treatment, including George Dvorsky , Peter Singer , Norm Fost, and Doug Diekema. In

2673-423: The COVID-19 pandemic. He has spoken and written extensively on vaccine-related topics, including the ethics of placebo-controlled trials during the pandemic, what is owed to vaccine trial participants after a vaccine has been authorized, COVID-19 vaccination of transplant candidates, and more specialized topics such understanding attitudes toward the disease and vaccines among a Haredi-Orthodox Jewish community. He

2754-689: The Drs. William F. and Virginia Connolly Mitty Professor of Bioethics and the founding director of the Division of Bioethics. In May 2015, Caplan launched, with pharmaceutical company Johnson & Johnson , a pilot project for the equitable distribution of experimental drugs outside ongoing clinical trials. He created the Compassionate Use Advisory Committee (CompAC), a panel of bioethicists, physicians, and patient advocates, to respond to appeals from terminally ill patients for

2835-561: The LiveWorkPlay self-advocacy organization. In a rebuttal, Wellar attacked the notion that Ashley's limited mental abilities justified the decisions made on her behalf: "Infants have human rights even though they can't speak for themselves. Why should Ashley have received any less consideration?" On May 8, 2007, an investigative report done by Disability Rights Washington (formerly The Washington Protection and Advocacy System) in conjunction with The Utah Disability Law Center criticized

2916-1257: The McGovern Medal of the American Medical Writers Association in 1999, the John P. McGovern Award Lectureship from the Medical Library Association in 2007, and the Patricia Price Browne Prize in Biomedical Ethics in 2011. In 2014, he was given the public service award of the National Science Board/ National Science Foundation . In May 2016, he received the Rare Impact Award from the National Organization for Rare Disorders (NORD). The American Society for Bioethics & Humanities (ASBH) awarded Caplan its 2016 Lifetime Achievement Award, and in 2018

2997-570: The Sidney D. Caplan Professor of Bioethics was established at the University of Pennsylvania's Perelman School of Medicine, named for Caplan's father. Arthur Caplan became the first holder of the professorship. While at the University of Pennsylvania, he became the first bioethicist to be sued for his professional role, after his involvement in a gene therapy trial that resulted in the death of research subject Jesse Gelsinger . The family's suit

3078-598: The United Kingdom, the British Medical Association stated, "If a similar case occurred in the UK, we believe it would go to court and whatever decision was ruled would be in the best interests of the child." Dr. Peter Hindmarsh, Professor of Paediatric Endocrinology at Great Ormond Street Hospital was troubled by the treatment decision being taken by a hospital ethics committee . " 'I am not sure

3159-812: The United States, Arthur Caplan , of the University of Pennsylvania's Center for Bioethics , has criticized the Ashley Treatment in an MSNBC editorial, arguing that it is "a pharmacological solution for a social failure—the fact that American society does not do what it should to help severely disabled children and their families." Three renowned bioethicists spoke in support of the treatment and discussed different aspects of it in opinion statements presented by Scientific American. Disability rights advocates, including Not Dead Yet and Feminist Response in Disability Activism (FRIDA), called

3240-820: The United States; helping to create the system for distributing organs in the U.S.; and advising on the content of the National Organ Transplant Act of 1984 , rules governing living organ donation, and legislation and regulation in many other areas of health care including blood safety and compassionate use. Born in Boston in 1950 to Sidney D. and Natalie Caplan, Arthur Caplan grew up in Framingham, Massachusetts . He has described his family as " Workmen's Circle , Zionist, and secular." He credits his background of Judaism with stimulating his interest in methods of inquiry and argument. At age six, Caplan

3321-429: The absence or presence of an underlying cause. Primary dysmenorrhea occurs without an associated underlying condition, while secondary dysmenorrhea has a specific underlying cause, typically a condition that affects the uterus or other reproductive organs. Painful menstrual cramps can result from an excess of prostaglandins released from the uterus. Prostaglandins cause the uterine muscles to tighten and relax causing

Ashley Treatment - Misplaced Pages Continue

3402-486: The aggravation of a perhaps serious underlying cause. Further work-up includes a specific medical history of symptoms and menstrual cycles and a pelvic examination . Based on results from these, additional exams and tests may be motivated, such as: Treatments that target the mechanism of pain include non-steroidal anti-inflammatory drugs (NSAIDs) and hormonal contraceptives. NSAIDs inhibit prostaglandin production. With long-term treatment, hormonal birth control reduces

3483-419: The amount of uterine fluid/tissue expelled from the uterus. Thus resulting in shorter, less painful menstruation. These drugs are typically more effective than treatments that do not target the source of the pain (e.g. acetaminophen). Regular physical activity may limit the severity of uterine cramps. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen are effective in relieving

3564-491: The best interests of their daughter, namely, to enable them to personally continue constant care for her at home; to maximize her inclusion in family activities; to avoid the cramps and discomfort associated with menstruation; and to avoid the discomfort from large breasts (which runs in Ashley's family) while lying down or strapped in the chest area while in her wheelchair. Furthermore, they cited additional side benefits: to reduce

3645-475: The course of several days as is typical. Signs and symptoms include spotting, bleeding, abdominal pain, and menstrual cramps. The resulting uterine tissue is called a decidual cast and must be passed through the cervix and vagina. It typically takes the shape of the uterus itself. Membranous dysmenorrhea is extremely rare and there are very few reported cases. The underlying cause is unknown, though some evidence suggests it may be associated with ectopic pregnancy or

3726-503: The differing phenotypes associated with dysmenorrhea. Two additionally well studied SNPs which are suspected to contribute to PD were found in ZM1Z1 (the mutant allele called rs76518691) and NGF (the mutant allele called rs7523831). Both ZMIZ1 and NGF are associated with autoimmune responses and diseases , as well as pain response. The implication of these genes impacting Dysmenorrhea is significant as it suggests mutations which affect

3807-405: The effect of acupuncture and magnets to be unknown. A 2007 systematic review found some scientific evidence that behavioral interventions may be effective, but that the results should be viewed with caution due to poor quality of the data. Spinal manipulation does not appear to be helpful. Although claims have been made for chiropractic care, under the theory that treating subluxations in

3888-750: The elderly. He also wrote about bioethics in relation to the Holocaust. In 1992, he joined the Medical Advisory Council of the United States Holocaust Memorial Museum . Caplan secured the first apology for the Tuskegee Syphilis Study , from Lewis Sullivan, M.D., then secretary of HHS, in 1991. He worked with William Seidelman, M.D., and others to secure in 2012 an apology from the German Medical Association for

3969-407: The end of menstruation. This is because dysmenorrhea is often associated with changes in hormonal levels in the body that occur with ovulation. In particular, prostaglandins induce abdominal contractions that can cause pain and gastrointestinal symptoms. The use of certain types of birth control pills can prevent the symptoms of dysmenorrhea because they stop ovulation from occurring. Dysmenorrhea

4050-411: The estrogen in birth control pills was more effective than NSAIDs. Norplant and Depo-provera are also effective, since these methods often induce amenorrhea . The intrauterine system (Mirena IUD) may be useful in reducing symptoms. A review indicated the effectiveness of transdermal nitroglycerin . Reviews indicated magnesium supplementation seemed to be effective. A review indicated

4131-507: The ethics committee was the right place to decide,' he said, adding that it was not clear who represented the child's interests when it went before the committee." In Canada , ethicist Arthur Schafer 's nationwide opinion piece defending the operation as justifiable considering Ashley's comfort engendered criticism from disability rights activists such as Dave Hingsburger of the York Central Hospital and Keenan Wellar from

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4212-535: The evidence was limited by its poor methodological quality. A 2016 Cochrane review of acupuncture for dysmenorrhea concluded that it is unknown if acupuncture or acupressure is effective. There were also concerns of bias in study design and in publication, insufficient reporting (few looked at adverse effects ), and that they were inconsistent. There are conflicting reports in the literature, including one review which found that acupressure, topical heat, and behavioral interventions are likely effective. It found

4293-535: The girls, out of which only 27% sought medical advice from a doctor. Arthur Caplan Arthur L. Caplan (born 1950) is an American ethicist and professor of bioethics at New York University Grossman School of Medicine . He is known for his contributions to the U.S. public policy, including: helping to found the National Marrow Donor Program ; creating the policy of required request in cadaver organ donation adopted throughout

4374-409: The hospital that performed this controversial procedure for violating Washington State law, which is disputed by the family's attorney. Menstrual cramps Dysmenorrhea , also known as period pain , painful periods or menstrual cramps , is pain during menstruation . Its usual onset occurs around the time that menstruation begins. Symptoms typically last less than three days. The pain

4455-400: The immune system (specifically the inflammatory response) and pain response may also be a cause of primary dysmenorrhea. The underlying mechanism of primary dysmenorrhea is the contractions of the muscles of the uterus which induce a local ischemia. During an individual's menstrual cycle, the endometrium thickens in preparation for potential pregnancy . After ovulation , if the ovum

4536-471: The menstrual cramps. This type of dysmenorrhea is called primary dysmenorrhea . Primary dysmenorrhea usually begins in the teens soon after the first period . Secondary dysmenorrhea is the type of dysmenorrhea caused by another condition such as endometriosis , uterine fibroids , uterine adenomyosis , and polycystic ovary syndrome . Rarely, birth defects , intrauterine devices , certain cancers, and pelvic infections cause secondary dysmenorrhea. If

4617-444: The most well studied include an SNP in the promoter of MIF and an SNP in the tumor necrosis factor (TNF-α) gene. When a cytosine 173 base pairs upstream of macrophage migration inhibitory factor (MIF) promoter was replaced by a guanine there was an associated increase in the likelihood of the individual experiencing PD. While a CC/GG genotype led to an increase in likelihood of the individual experiencing severe menstrual pain,

4698-511: The natural closure of her growth plates . Ashley's story first broke in October 2006, in the Archives of Pediatrics & Adolescent Medicine . In January 2007, her parents, who wish to remain anonymous, set up a blog to explain their reasoning for their decision and to share their story with families of other children who might benefit. The parents state that they sought such treatment for

4779-429: The pain occurs between menstrual periods, lasts longer than the first few days of the period, or is not adequately relieved by the use of nonsteroidal anti-inflammatory drugs (NSAIDs) or hormonal contraceptives , this could indicate another condition causing secondary dysmenorrhea. Membranous dysmenorrhea is a type of secondary dysmenorrhea in which the entire lining of the uterus is shed all at once rather than over

4860-504: The pain of primary dysmenorrhea. They can have side effects of nausea, dyspepsia , peptic ulcer , and diarrhea. Use of hormonal birth control may improve symptoms of primary dysmenorrhea. A 2009 systematic review (updated in 2023) found evidence that the low or medium doses of estrogen contained in the birth control pill reduces pain associated with dysmenorrhea. In addition, no differences between different birth control pill preparations were found. The review did not determine if

4941-459: The pain or cramps experienced during menstruation. Compared with non-dysmenorrheic individuals, those with primary dysmenorrhea have increased activity of the uterine muscle with increased contractility and increased frequency of contractions. The diagnosis of dysmenorrhea is usually made simply on a medical history of menstrual pain that interferes with daily activities. However, there is no universally accepted standard technique for quantifying

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5022-525: The previous article also published an article in January 2010 cataloging and countering the criticisms that targeted the Ashley Treatment, and concluded as follows: The purpose of this paper is to provide a brief review of the [Ashley Treatment] case and the issues it raised, then address 25 distinct substantive arguments that have been proposed as reasons that Ashley's treatment might be unethical. We conclude that while some important concerns have been raised,

5103-740: The risk of bedsores; to prevent breast cancer and fibrocystic growth (both of which have occurred in her family); to prevent pregnancy ; and to prevent appendicitis , which occurs in 5% of the population and which would be difficult to diagnose in Ashley as she would be unable to communicate the symptoms. They also believe that without secondary sexual characteristics , Ashley will be less vulnerable to sexual abuse by future caregivers when her parents will no longer be able to care for her. In an article published in June 2009 on Growth Attenuation, two pediatric endocrinologists and two bioethicists concluded as follows: Our analysis suggests that growth attenuation

5184-632: The role of German physicians in Nazi prison experiments during the Holocaust. In May 1994, Caplan went to the University of Pennsylvania in Philadelphia . He founded the Center for Bioethics and the Department of Medical Ethics and had professorial appointments in a variety of departments including Medicine and Philosophy. In the mid-1990s, he and colleagues conducted the first empirical studies on organ donor eligibility and donation rates. In 2009,

5265-484: The severity of menstrual pain decreased significantly after age 40. A survey in Norway showed that 14 percent of females between the ages of 20 to 35 experience symptoms so severe that they stay home from school or work. Among adolescent girls, dysmenorrhea is the leading cause of recurrent short-term school absence. A study from India conducted by Dr RimJhim Kumari found that painful menstruation affected 66.7% of

5346-484: The severity of menstrual pains. There are various quantification models, called menstrual symptometrics, that can be used to estimate the severity of menstrual pains as well as correlate them with pain in other parts of the body, menstrual bleeding and degree of interference with daily activities. Once a diagnosis of dysmenorrhea is made, further workup is required to search for any secondary underlying cause of it, in order to be able to treat it specifically and to avoid

5427-786: The specific correlating genotypes have not yet been identified. These phenotypes are prevalent at different levels in different population demographics, suggesting different allelic frequencies across populations (in terms of race, ethnicity, and nationality). Polymorphisms in the ESR1 gene have been commonly associated with severe dysmenorrhea. Variant genotypes in the metabolic genes such as CYP2D6 and GSTM1 have been similarly been correlated with an increased risk of severe menstrual pain, but not with moderate or occasional phenotypes. The occurrence and frequency of secondary dysmenorrhea (SD) has been associated with different alleles and genotypes of those with underlying pathologies , which can affect

5508-539: The treatment "invasive medical experimentation", "mutilation", "desexualization", and a violation of Ashley's human rights . FRIDA called on the American Medical Association to condemn the Ashley Treatment. The Disability Rights Education and Defense Fund (DREDF) declared, "we hold as non-negotiable the principle that personal and physical autonomy of all people with disabilities be regarded as sacrosanct". Ashley's parents reported that 95% of

5589-548: The use of a heating pad. Medications that may help include NSAIDs such as ibuprofen , hormonal birth control and the IUD with progestogen . Taking vitamin B1 or magnesium may help. Evidence for yoga , acupuncture and massage is insufficient. Surgery may be useful if certain underlying problems are present. Estimates of the percentage of female adolescents and women of reproductive age affected are between 50% and 90%. It

5670-528: The use of hormonal contraception. When laparoscopy is used for diagnosis, the most common cause of dysmenorrhea is endometriosis, in approximately 70% of adolescents. Other causes of secondary dysmenorrhea include leiomyoma , adenomyosis , ovarian cysts , pelvic congestion , and cavitated and accessory uterine mass. Genetic factors, stress and depression are risk factors for dysmenorrhea. Risk factors for primary dysmenorrhea include: early age at menarche , long or heavy menstrual periods, smoking, and

5751-453: The usefulness of using calcium channel blockers . Heat is effective compared to NSAIDs and is a preferred option by many patients, as it is easy to access and has no known side effects. Tamoxifen has been used effectively to reduce uterine contractility and pain in dysmenorrhea patients. There is some evidence that exercises performed 3 times a week for about 45 to 60 minutes, without particular intensity, reduces menstrual pain. There

5832-755: The weight of these concerns is not sufficient to consider the interventions used in Ashley's case to be contrary to her best interests, nor are they sufficient to preclude similar use of these interventions in the future for carefully selected patients who might also benefit from them. After a year, Ashley's parents considered her treatment a success: She will never experience menstrual discomfort and cramps, she will always be flat chested and avoid breast related discomfort and other issues, and with her growth plates closed, she has reached her adult height of 53 inches (135 cm, or 4 ft 5 in) and weight of 63 pounds (29 kg), an estimated reduction of her potential height and weight of 20% and 40%, respectively. In

5913-878: Was a member of the Presidential Advisory Committee on Gulf War Illnesses and the special advisory panel to the National Institute of Mental Health on human experimentation on vulnerable subjects. He is an adviser to DARPA on synthetic biology and has addressed the Presidential Commission for the Study of Bioethical Issues. He has also served on the ethics committee of the American Society of Gene Therapy . Caplan has consulted with many corporations, not-for-profit organizations, and consumer organizations. He

5994-613: Was born in 1984. Caplan's second wife, Meg O’Shea Caplan, is the medical center director of the Bronx VA Medical Center. Caplan did his graduate work at Columbia University , receiving an M.A. in 1973, an M.Phil. in 1975, and a Ph.D. in the history and philosophy of science in 1979. His dissertation, Philosophical Issues Concerning the Synthetic Theory of Evolution , was co-supervised by Ernest Nagel and Sidney Morgenbesser . Caplan worked with Nagel as

6075-434: Was criticized as advocating for a war crime. Subsequent to Caplan's call for a total boycott of Russia, credible international organizations charged Russia and its leadership with war crimes. Caplan is the author and editor of more than 35 books and more than 860 papers in peer-reviewed journals of medicine , science , philosophy , bioethics , and health policy. He is a regular contributor to WebMD 's Medscape and

6156-505: Was diagnosed with polio . He was successfully treated at Children's Hospital in Boston and went on to play sports at Framingham North High School . Caplan has stated that this life-threatening illness was a formative experience that influenced his later commitment to philosophy and bioethics . Caplan did his undergraduate work at Brandeis University , where he majored in philosophy. There he met his future wife Jane. Their son, Zachary,

6237-535: Was found to be the gene most associated with primary dysmenorrhea in terms of its phenotypic impact. This gene encodes a protein essential for the regulation of immunity and inflammation.15 While the mechanism of how it influences PD has yet to be discovered, it is assumed that possible mutations in IL1A or genes which interact with it impact the regulation of inflammation during menstruation. These mutations may therefore affect pain responses during menstruation which lead to

6318-547: Was one of the more vocal proponents of controversial challenge studies for SARS-CoV2 vaccines. Caplan has been criticized by some classical philosophers for his "hands-on philosophy", and by some colleagues for his enthusiastic engagement with the media. In response, he said: "To me, the whole point of doing ethics is to change people, to change behavior. Why else do it?" In 2022, Caplan advocated that pharmaceutical companies should stop doing business in Russia, an action that

6399-688: Was settled with the University for an undisclosed amount of money, in exchange for, among other things, dropping Caplan from the suit. The federal government's suit on the same facts was settled for $ 500,000. In 2009, Caplan helped develop the first flu vaccine mandate at the Children's Hospital of Philadelphia and, later, New York state's policy to require health care workers to "vaccinate or mask". Also in 2009, he called for tightening restrictions on fertility clinics and IVF and has written extensively in favor of embryonic stem cell research. In 2012, Caplan came to New York University's School of Medicine as

6480-803: Was the chair of the Advisory Committee to the United Nations on Human Cloning , and served on the special advisory committee to the International Olympic Committee on genetics and gene therapy. Caplan has served on a number of national committees, including as chair of the National Cancer Institute Biobanking Ethics Working Group and chair of the Advisory Committee to the Department of Health and Human Services on Blood Safety and Availability. He

6561-454: Was the co-director of a United Nations/Council of Europe Study on organ trafficking. He has called for a new international convention on criminal organ trafficking. He has spoken out on international issues such as organ harvesting from Falun Gong practitioners in China . He instituted a boycott by leading medical journals of papers about transplantation coming from China. Internationally, he

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