The Ethical and Legal Implications of Octuplets

We all know about the old woman who lived in a shoe, the one with all those kids and who didn't know what to do. Well, one thing she didn't do was have eight more kids. And this wasn't because nothing rhymes with octuplets.

Having eight children at once - or seven, six, five or four, for that matter - is not healthy for the children. Such human litters rarely occur naturally because, the sad truth is, the children rarely survive to adulthood to mate and to pass along a genetic predisposition to multiple births.

It's a simple medical fact that the more babies in the brood, the lower their average birth weight. And the lower their birth weight, the more they are susceptible to a lifetime of health and social challenges.

The question is why would a medical doctor deliberately implant six embryos in a woman when this would guarantee a known medical condition called "very low birth weight" (VLBW) or quite possibly "extreme low birth weight" (ELBW). Among Nadya Suleman's eight new children, six were VLBW (below 3.3 pounds) and two were ELBW (below 2.2 pounds).

Implanting disease

The California Medical Board and the American Society for Reproductive Medicine are curious, too. Earlier this month they announced separately that they were investigating the Suleman case, stopping short of naming Michael Kamrava, the fertility doctor thought to have aided Suleman.

While much has been said about the social ramifications of the Suleman octuplets - such as issues about being a single mother, or the impact on the welfare system - these medical organizations need to investigate the case as they would any malpractice suit: Did the doctor deliberately put eight children at risk for serious medical conditions?

The science is rather conclusive that VLBW and particularly ELBW pose serious health risks. Many of these babies don't survive their first year, succumbing to hypothermia, respiratory problems, electrolyte imbalances, anemia, hemorrhaging, poor absorption of nutrients or infections.

Many babies survive and indeed thrive, but the odds are stacked against them.

Tough road

A study published in JAMA in 2005 followed over 200 ELBW babies until age 8 and found 14 percent to have cerebral palsy; 21 percent to have asthma; 10 percent to have vision worse than 20/200; nearly 40 percent to have an IQ lower than 85, which approaches a mental deficiency; and nearly 50 percent with poor motor skills.

Similarly, a study in Pediatrics in 2000 found that more than 50 percent of VLBW babies and up to 70 percent ELBW babies need special assistance at school.

Bad news often follows these kids through life.

Many studies of VLBW reveal higher rates of attention deficit disorders, brain abnormalities, hearing loss and chronic diseases. A 2007 study in the New England Journal of Medicine found that VLBW adults are at greater risk of developing diabetes and high blood pressure due to worsening glucose intolerance from birth.

A 2004 study in Pediatrics showed VLBW adults had on average a 17 percent reduction in the size of their posterior corpus callosum, that part of the brain that connects the left and right hemispheres. A 2008 Swedish study revealed half of VLBW adults had below-average IQs, with nearly 12 percent classified with extremely low intelligence.

Improving the odds

ELBW and VLBW are on the rise as a result in part of infertility treatments and multiple births. Yet other, poorly understood factors are at play, such as a mother's race, age and general health.

The health costs are staggering. A 2007 study in Pediatrics estimates that nearly $6 billion is spent annually on low-birth-weight deliveries, with an average ELBW birth costing $65,600.

The good news is that more and more ELBW and VLBW individuals are leading healthier lives with few if any cognitive delays as the result of medication and other interventions. Suleman children, if they are lucky, will grow up healthy. They are in fact off to a good start, born heavier than expected.

If these innocent kids survive and thrive, then the doctor, too, is lucky. His professional peers, however, might not view him any less guilty of placing eight children at risk for a hard life.

• The Future of Babymaking
• All About Pregnancy: News and Information
• Octuplets Reveal Limits to Human Empathy

Christopher Wanjek is the author of the books "Bad Medicine" and "Food At Work." His column, Bad Medicine, appears each Tuesday on LiveScience.

• Original Story: The Ethical and Legal Implications of Octuplets

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Home Prices Post Biggest Drop in 21 Years

The S&P/Case-Shiller U.S. National Home Price Index plunged 18.2% during the final quarter of 2008, the biggest annual decline in the closely watched index's 21-year history.

Separately, for the month of December alone the Case-Shiller 20-City Composite Index fell 18.5% compared with the previous December, also a record decline. The most severe declines were in Phoenix, Las Vegas, and San Francisco, which all dropped by more than 30% in December compared with December 2007.

But the financial crisis has helped to spread the pain across the nation. Other cities that were holding up relatively well until recently are now seeing a quickening pace of declines. The year-over-year price decline in the New York metro area, which is at the center of the financial meltdown, was 9.2% in December, compared with 8.6% in November and 7.7% in October. Home prices in Charlotte, a major banking hub, fell by 7.2% in December. In October, Charlotte prices fell at just 4.4% compared with a year earlier. And home prices were actually increasing on an annual basis as recently as March 2007.

More Decreases Ahead

Stuart Hoffman, chief economist for Pittsburgh's PNC Financial Services Group (NYSE:PNC - News), said home prices will probably fall for years to come (though the declines will get smaller and smaller). Most metro areas won't start to see price increases until 2011 or 2012, he said.

"I think people would be happy if both home prices and stock prices just stopped going down," Hoffman said.

The speed of the declines in several metro areas, including Denver, Los Angeles, Miami, San Diego, and Washington, improved slightly in December or at least remained stable. But in many cases, it's just because prices are already falling at such a rapid pace. A notable exception, however, is Denver, where prices dropped by just 4% in December compared with a year earlier.

In the Miami metro, for example, prices fell at an annual pace of 28.8% in December -- almost the same pace as in November.

Rock-Bottom in Miami?

Miami real estate agent Zoila Perez-Chanquet said investors willing to pay cash are bidding down prices for foreclosed homes, which make up much of the inventory. But sales are picking up now that prices are so low, and sellers can sometimes hold firm on already rock-bottom prices, she said.

One of her clients offered $65,000 in cash for a two-bedroom home listed at $79,900 in the Hialeah Gardens area of Miami-Dade County. The property sold this month for $90,000.

"Buyers need to understand that prices are low enough as it is," Perez-Chanquet said. "They need to offer either listing price or above because the sellers are taking the highest offer."

Iran tests its first nuclear power plant

BUSHEHR, Iran – Iranian and Russian technicians are conducting a test run of Iran's first nuclear power plant, officials said Wednesday, a major step toward launching full operations at the facility, which has long raised concerns in the U.S. and its allies over Iran's nuclear ambitions.

At the same time, Iran claimed another advance in its nuclear program: The number of centrifuges carrying out uranium enrichment had increased to 6,000, the country's nuclear chief said — up from 5,000 in November.

His announcement was the latest defiance of United Nations' demands that Tehran suspend its enrichment program because of fears it could be used to produce material for a warhead. Iran denies it seeks to build a nuclear bomb, saying its nuclear program aims only to generate electricity.

The power plant in the southern port city of Bushehr, built with Russian help, is meant to be the first in a number of reactors for an energy program. But the opening of the 1,000-megawatt light-water reactor has long been delayed by construction and supply glitches. The United States for a time tried to dissuade Russia from helping the project.

It's unclear when the reactor could be switched on.

The tests, which began 10 days ago, "could take between four and seven month," the nuclear chief, Vice President Gholam Reza Aghazadeh, told reporters at Bushehr. It was not known how long after the tests the reactor could start up.

The plant, which will run on enriched uranium imported from Russia, has worried the West because the spent fuel could be turned into plutonium, a potential material for nuclear warheads.

U.S. concerns over the reactor softened after Iran agreed to return spent fuel to Russia to ensure Tehran does not reprocess it into plutonium. Washington largely dropped its opposition to the project and argued instead that the Russia fuel deal shows that Iran does not need its own domestic uranium enrichment program. Russia's fuel deliveries to Iran began in 2007.

Enrichment is a concern because while low-enriched uranium is used as fuel for a reactor, higher-enriched uranium can be used to build a bomb. In the enrichment process, uranium gas is pumped through a series of centrifuges and spun at supersonic speeds to remove impurities.

Aghazadeh announced that 6,000 centrifuges were now operating at Iran's enrichment facility in the town of Natanz. He said Iran hopes to install over 50,000 centrifuges there over the next five years. "We are doing what we need to do in Natanz on the basis of a specific time schedule," he told a press conference.

Iran says it intends to use the enriched uranium fuel in its first domestically made nuclear power plant, in the town of Darkhovin, which it wants to start operating in 2016. Aghazadeh said any delay in enrichment will mean a delay in opening Darkhovin.

The tests at Bushehr are a computer run of the equipment to ensure there are no malfunctions in the future when enriched uranium fuel is introduced into the reactor. No electricity is produced during the testing.

In the first stage of the test, technicians for the past 10 days have been loading a "virtual fuel" into the reactor. The virtual fuel consists of lead, which imitates the density of enriched uranium, said Iranian nuclear spokesman Mohsen Shirazi.

Once the fuel is fully loaded, "we will check to see how the reactor will operate," said Russian nuclear agency chief Sergei Kiriyenko, who was inspecting the process. "This (test) is one of the major elements of an extensive project," he said.

Kiriyenko said Bushehr witnessed "remarkable progress in recent months" but that work remains to be done to "speed up the launching of the site." The Russian-Iranian team was "approaching the final stage" before the plant becomes operational, he said.

Aghazadeh, who was accompanying Kiriyenko, said the test was going well and engineers told him they expected no problems.

"Today was one of the most important days for the Iranian nation," Aghazadeh said. "We are approaching full exploitation of this plant."

In Israel, Foreign Ministry spokesman Yigal Palmor said, "Iranians are showing again that they are making progress in their nuclear race."

"This should be understood as very bad news for the whole of the international community," Palmor said, calling for "immediate and very determined steps in order to prevent Iran from becoming a nuclear power."

The Bushehr reactor was meant to start up in 2008, and some 700 Iranian engineers were trained in Russia over four years to operate the plant.

The Bushehr project dates backs to 1974, when Iran's U.S.-backed Shah Mohammed Reza Pahlavi signed an agreement to build the reactor with the German company Siemens. The company withdrew from the project after the 1979 Islamic revolution toppled the shah. In 1992, Iran signed an agreement with Russia to complete the project and work began on it in 1995.

Russia says there is no evidence that Iran is seeking nuclear weapons and has joined China in weakening Western-backed sanctions in the U.N. Security Council, arguing that punishing Tehran too harshly for its nuclear activities would be counterproductive.

The U.N. Security Council has passed three sets of sanctions against Iran over uranium enrichment and is considering further measures.

The 21st-century fireside chat: Did Obama connect?

At a harrowing national moment, Franklin D. Roosevelt commandeered the young airwaves for a "fireside chat" with the American people — a candid talk about big troubles and how to fix them. He was confident and strong, a father figure to a nation that was losing its way.

"My friends," said Roosevelt, freshly inaugurated, "I want to talk for a few minutes with the people of the United States about banking."

On Tuesday night, three quarters of a century later, Barack Obama stepped up to a less intimate but equally high-stakes version of the national fireplace to do the same thing: talk a good game, draw us a map back toward prosperity and "speak frankly and directly to the men and women who sent us here."

Many chief executives have spoken directly with the American people since FDR's era, and an address to Congress is hardly an intimate radio talk. No president, however, has faced a context so similar. Never have the words felt so aimed at soothing Americans who are scared, broke, rousted from their homes, uncertain about the future of their lives and nation.

"He speaks to people very well," said Fred Elliott, 44, owner of a Coldwell Banker realty office in Lehigh Acres, Fla.

Facing lawmakers and Americans by the millions, Obama traded doomsaying for optimism and invoked an American chestnut — the tenacity of hope. "We will rebuild, we will recover. And the United States of America will emerge stronger than before," he said.

But do we believe him? As in Roosevelt's time, comforter-in-chief is only one hat of many. On Tuesday, though, it seemed to fit.

"He exudes a kind of self-confidence that I don't think we've had for a long time. He kind of carries you along with it," said Terry Swihart of Wakarusa, Ind., who has been laid off twice in the past year — once from a job she held for 28 years. Her husband also lost his job.

Despite her approval, Swihart added this caveat: "I hope it's not just rhetoric."

That is always the fear, particularly for a president whose eloquence was targeted in the campaign as evidence of his disingenuousness. The words Obama chose — empathizing with Americans while also addressing Congress — were the language of hope but also of tough love.

"He seemed a little more upbeat, instead of just crisis, crisis, crisis," said Melissa Must, who runs a coffee shop in downtown Cincinnati. She stayed up to watch Obama's speech even though she rises before 5 a.m. to get to work.

"You have to take responsibility for yourself," Must said. And Americans, the president insisted, were ready. He addressed a nation that he insisted does not shy away from challenges — it's in our spirit — and demanded action not only from government but from the people.

What's more, he acknowledged that progress will not be immediate — bad news for an instant-gratification culture but something that Jaime Silahua, watching the speech in the San Francisco suburb of Antioch, understood well.

"He inherited a country with grave problems," Silahua said. "The change is going to take some time. He'll start it, and probably the next president will finish it."

Silahua is on the front lines of the tanking economy. Antioch has been hit hard by foreclosures, and housing values have dropped by 50 percent in many neighborhoods. Silahua's house, which he bought for $281,000 seven years ago, is now valued, he believes, at about $89,000. He is fighting a bank eviction.

So Obama's plan is, for him, a bit more abstract: "His initiatives are good — they just probably won't help me at this point."

That is often the problem when grand national themes collide with the building blocks of people's lives and bank accounts. Obama invoked the vaunted American optimism and said that yes, another American century was possible. But it can be a hard sell for folks who lie awake at 2 a.m. with the stomach-churning realization that the creditors will be calling at dawn.

"People are really worried about a long-term shift — is the American Dream over?" said Evan Cornog, a Columbia University historian who studies how presidents craft their own narratives.

Such fears are personified in Americans like Robert Lombardi, 64, who last month closed his pet store in Pennsylvania's Pocono Mountains, where foreclosures are at record levels and no one is buying pets. "A little soothing," Lombardi said of Obama's speech. But ...

"I love this country, and I hate to see it going where it's going," he said. "It's going down the toilet. But it's a long fight. These are just words, and now we're going to see what the actions are."

When FDR started his fireside chats in the depths of the Depression, hope was a scarce commodity — even more scarce than it is today. The new president, eight years before the U.S. entered World War II, reassured Americans with a voice that was "authoritative but not autocratic, persuasive but not coercive," FDR biographer Jonathan Alter wrote.

That was, of course, long before Vietnam and Watergate and the deep distrust in government that they begat. Jody Baugh, an unemployed Indiana welder, offers the modern equivalent of the warm reception that many Americans gave FDR's chats. Baugh was hungry for hope and, he said, Obama delivered.

"He didn't come across as a used-car salesman," Baugh said. "He came across as someone who legitimately cared about people like me." From Baugh, Obama received high marks on investing in the middle class and holding bankers accountable for their incompetence.

"This is the first time I ever watched the whole speech of any president," Baugh said. "I didn't get up at all. It gave me more confidence. I thought, `At least I've got somebody who is more on my side than before.'"

And though one-third of the nation's history separates them, Obama and Roosevelt shared one thing above all else as they addressed Americans about the economy at the beginning of their presidencies. Each demanded action — not only from government but from we, the people.

Said Roosevelt in 1933: "It is your problem no less than it is mine."

Said Obama in 2009: "The time to take charge of our future is here."

That distinctly American message — that it's up to us, if we can live up to our destiny — sat well with Bill Bibbes, a 68-year-old retiree in Jackson, Miss. Bibbes lost much of his savings to the Enron collapse, then watched lenders foreclose on his son-in-law's house and saw his wife's 401K dwindle as Wall Street tanked.

He thought Obama was being too ambitious with the economic recovery plan until he watched the president address the nation.

"My hope for the country is that we can come together," Bibbes said. "That's what we need more than anything. Everybody has to participate."

___

Ted Anthony covers politics and culture for The Associated Press. AP National Writers Sharon Cohen and Todd Lewan and AP writers Dan Sewell, Michael Rubinkam, Evelyn Nieves and Shelia Byrd contributed to this report.

Dating 101: How to Tell When You're Ready to Commit

There is something exhilarating about taking the big leap from dating to becoming a permanent "item" and making that final commitment. But before you run off into the sunset with your mate, make sure that the time you choose to commit is the right time -- and with the right person.

As a divorce attorney, I have found over the years that most couples who wind up splitting do so because there are discrepancies or control issues over what I term the "Big Six." These six categories include: wealth/property and money; children; health, physical and mental; growth, professional and personal; intimacy and loss of love; and fear, both physical and emotional. I ask my clients to take a close look at each of these categories to determine if there are major conflicts, not only with his or her chosen mate but also conflicts within themselves.
Have you found the right person? Is it the right time? Here are eight key questions to ask your mate -- and yourself. The answers will be very telling.

1. How do you believe we should spend our money and on what? If your mate says, "On fun stuff and we'll get to the bills later," you better reconsider going the commitment route until your mate grows up a bit. Most marriages and long-term relationships break up due to stresses and squabbles over money. Splits happen when a couple's values in spending and saving simply do not match. Don't overlook this question. It is critical in determining whether you or your mate are a match and whether you are both ready for a mature relationship -- one that requires fiscal responsibility.

2. What are your thoughts about starting a family? If your mate says, "This is not something I can even think about right now," do not ignore that remark. It could be that your mate will put this decision off longer than you wish or one day stand up and announce, "I've decided against having children." You also need to be honest with yourself. Do you want children? Let your mate know this up front. You may also want to ask your mate about his/her point of view on how the children should be raised. If there are huge discrepancies in this department, there are bound to be serious problems down the road.

3. If I get sick, how will you take care of me? If your mate laughs off such a question with, "How do I know? I'll figure it out then," you should take that offhanded remark as a serious indicator that your mate might not be grown up enough to handle your critical needs. There is a way to test this one: How does your mate treat you when you get sick with the flu? Also, if you know deep down that you would not have the patience or fortitude to care for an ailing mate, be fair and let him/her know of your concerns. Who needs someone in his/her life who is only there for the good times?

4. Do you envision us growing old together? If your mate quips, "How the heck do I know, that is a long way off" or "I guess so," neither answer should satisfy you. To suggest that you or your mate is uncertain of your eventual fate together -- or cannot envision those "golden" years as a couple -- should be a neon sign with bright red lights that flash, "This may only be temporary." Commitments should be thought of as permanent, not temporary.

5. Do you ever think about your ex? If the answer from your mate is "Well, I do sometimes," then you want to ask the next question: "In what context?" If your mate shares stories about the fun they used to have together, this could mean your mate is not over his or her last love. And what about you? Do you still think about your ex? When? How? I highly recommend backing off the commitment stage until you and your mate can safely say that thoughts about your exes are fleeting or random.

6. Has your mate ever told you they scared a former mate in any way? If your mate's answer is something like "Well, yeah, I scared my ex every time I became jealous or mad," step back and think twice. Though your mate may think he/she is ready for a commitment, it may not be the right time for one. If you have had similar issues, the same may apply to you. Are you worried your mate might cheat on you or keep secrets from you or inflict emotional or physical harm on you? If the answer is yes, tackle this now, not after you have made a commitment. Maybe you or your mate could benefit from therapy, anger management, rehab, or other appropriate behavior modification assistance.

7. Is your mate good at problem solving? Does your mate meet challenges head on and collaborate on solutions to problems, or sweep issues under the rug? What about you? Are you mature enough to approach your mate to say, "We have a problem. Let's find a solution to it." How you handle problems together may well determine how long your relationship will last.

8. How does my mate deal with a "screwup?" Does my mate place blame? Does my mate take responsibility for his/her actions? How do I handle my mistakes? Do we both acknowledge our errors and resolve to deal with them? If chronic, negative behavior persists in this area, take a second look to decide if you two are a good match and if you are ready to commit. It is not unusual, for instance, to have each partner blame the other, which rarely accomplishes anything. Placing blame, or finding fault, can only worsen once you are committed.

9 dead in Turkish plane crash in Amsterdam

AMSTERDAM – A Turkish Airlines plane with 135 people aboard slammed into a muddy field while attempting to land at Amsterdam's main airport Wednesday. Nine people were killed and more than 50 were injured, many in serious condition, officials said.

The Boeing 737-800 fractured into three pieces on impact. The fuselage split in two, close to the cockpit, and the tail broke off. One engine lay almost intact near the wreck in the muddy field and the other was some 200 yards (meters) from the plane and heavily damaged, an Associated Press photographer at the scene said.

Flight TK1951 left Istanbul's Ataturk Airport at 8:22 a.m. (0622 GMT) bound for Amsterdam, then crashed next to a runway at Schiphol Airport.

Turkish Transport Minister Binali Yildirim said it was "a miracle" there were not more casualties.

"The fact that the plane landed on a soft surface and that there was no fire helped keep the number of fatalities low," he said.

Survivor Huseyin Sumer told private Turkish NTV television he crawled to safety out of a crack in the fuselage.

"We were about to land, we could not understand what was happening, some passengers screamed in panic but it happened so fast," Sumer said. He said the crash was over in 5 to 10 seconds.

The fact that the plane crash landed in a muddy, plowed field may have contributed to making the accident less deadly by absorbing much of the force of the hard impact, experts said. It may also have helped avert a fire resulting from ruptured fuel tanks and lines on the underside of the fuselage, which appeared to have suffered very heavy impact damage.

Hours after the crash, emergency crews still swarmed around the plane's cockpit.

At first, the airline said everyone survived. But at a news conference later, Michel Bezuijen, acting mayor of Haarlemmermeer, reported the fatalities.

"At this moment there are nine victims to mourn and more than 50 injured," he said. At least 25 of the injured were in serious condition and crew members were among the injured.

He said there was no immediate word on the cause of the crash.

The Turkish ambassador to the Netherlands, Selahattin Alpar, told the Anatolia news agency there were 72 Turks and 32 Dutch people on board. There was no information on the nationality of other passengers.

Candan Karlitekin, the head of the airline's board of directors, told reporters that visibility was good at the time of landing.

"Visibility was clear and around 5,000 yards (4,500 meters). Some 550 yards (500 meters) before landing; the plane landed on a field instead of the runway," he said.

"We have checked the plane's documents and there is no problem concerning maintenance," he added.

Turkish Airlines CEO Temel Kotil said the captain, Hasan Tahsin, was very experienced and a former air force pilot. Turkish officials said the plane was built in 2002 and last underwent a thorough maintenance on Dec. 22.

Gideon Evers, spokesman of the International Federation of Airline Pilots Associations, said the cause of the crash remained unclear. There was no indication that the crash had anything to do with fuel levels, Evers said, adding that regulations require all commercial flights to carry ample reserves.

"Certainly it appears to be an unusual circumstance, but as always the sensible course of action is to wait for the results of the investigation," he said.

According to mandatory limits, a passenger airliner must carry sufficient fuel to get to its destination, remain in holding patterns for 45 minutes, possibly divert to an alternate airport, hold for another 45 minutes, and then carry out a normal approach.

The initial impact with the ground appeared to have sheared off the hot engines, which could have ignited leaking fuel, and the loose soil would have absorbed it — further decreasing the risk of fire.

The Dutch government pledged a swift investigation.

"Our thoughts go out to the people who were in the plane and of course also to those who are now waiting in uncertainty to hear about the fate of their loved ones," a government statement said.

Wim Kok, a spokesman for the Dutch Anti-Terror Coordinator's office, said terrorism did not appear to be a factor.

"There are no indications whatsoever (of a terror attack)," Kok said.

____

Associated Press Writers Toby Sterling in Amsterdam, Mike Corder in The Hague, Slobodan Lekic in Brussels and Suzan Fraser in Ankara, Turkey, contributed to this report.

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