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

A study published in the June issue of Anesthesiology has shown that a drug metabolite of the opioid morphine may be a key factor in the paradoxical increased sensitivity to pain caused by chronic morphine use. For the first time, this metabolite (called morphine-6 glucuronide, or M6G) was shown to act independently of the pain receptors typically targeted during morphine administration. The study, which was led by Albert Dahan, M.D., Ph.D., and his colleagues from the Leiden University Medical Center, Leiden, Netherlands, and the City University of New York, included both mice and human subjects and could break new ground in understanding how to treat some of the side effects of opioids and improve their analgesic properties. "We now better understand that increased sensitivity to pain caused by opioid use is not necessarily related to morphine receptors and that it may be treated by blocking other pain receptor systems in the body," said Dr. Dahan. "Our results could help chronic and cancer pain patients obtain a more optimized pain therapy." Morphine is the drug most commonly used to treat severe acute pain. After prolonged use, though, analgesic benefits become limited and it may actually increase pain sensitivity and make pain worse. In a companion editorial to the study, Jē¶rn Lē¶tsch, M.D., of the University of Frankfort, explained that once morphine becomes metabolized by the body, it breaks down into two separate substances: M3G (morphine-3-glucuronide) and M6G (morphine-6-glucuronide), each playing a different role in morphine"s effects on the body. It is M6G that Dr. Dahan"s study, and previous studies before it, has linked to unwanted increased sensitivity to pain. One of the most critical and defining aspects of Dr. Dahan"s study, said Dr. Lē¶tsch, is that the mice used in the research were cross-bred to be deficient in the genetic pain receptors that opioids are known to influence. "The incidence of increased pain sensitivity when M6G was introduced into these mice models indicates that mechanisms apart from opioid receptors play a key role in this clinical phenomenon," said Dr. Lē¶tsch. The $10,000 question then is this: If the pain receptors that opioids are known to target are completely blocked, what is making the subjects" pain worse? The answer may lie in the body"s NMDA (n-methyl-D-aspartate) receptors, which are distinctly different from opioid receptors. Past studies have shown that anesthetics called NMDA antagonists can reverse opioid-induced sensitivity to pain. Here, again, Dr. Dahan"s results offer another new insight into morphine research. "In our study, the NMDA receptor antagonist MK-801 was shown to be effective in blocking or reversing increased pain sensitivity after injection of the morphine metabolite M6G," said Dr. Dahan. There currently is no definitive explanation as to how NMDA receptor antagonists such as MK-801 can reverse the hyper-sensitivity to pain that chronic opioid use can cause. But Dr. Dahan"s study brings researchers one step closer to solving puzzling questions about drugs that anesthesiologists and others use every day to treat pain. "M6G may not only make an important contribution to understanding how morphine works to control pain, but also to how it causes increased sensitivity to pain," he said. "This potential role for M6G as a factor in increased pain sensitivity in morphine use requires further study." American Society of Anesthesiologists


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