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The West is failing to enforce anti-FGM laws: Perspectives

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The West is failing to enforce anti-FGM laws: Perspectives

Female Genital Mutilation (FGM), also known as Female Genital Circumcision (FGC) or “cutting” to those who practice it, is the intentional partial or total removal of a female’s genitalia. The World Health Organization (WHO) estimates that over 200 million women have undergone this practice in 30 countries, mostly in the Middle East, Asia, and Africa. In the past three weeks, two major world players made bold comments regarding FGM, attracting the attention of international media. On September 15th, a committee of British MPs in the House of Commons declared in their report Female Genital Mutilation: Abuse Unchecked, “it is beyond belief” that while about 137,000 girls were subjected to FGM in 2011 in just Wales, there has not been one successful prosecution. FGM was made illegal in the UK 30 years ago[1]. According to the scathing report, when this “horrific crime” and “violent child abuse” is inflicted, it causes “severe physical and psychological pain and leaves survivors with lifelong health consequences.”

On the opposite end of the spectrum, an Egyptian MP stated on September 7th that women must undergo female circumcision in order to limit their “sexual appetites” and help curb men’s “sexual weakness” due to the widespread impotence of Egyptian men[2]. Though the practice was made illegal in 2008, the MP’s remark is indicative of the widespread cultural imperative within Egyptian society that demands female circumcision in return for societal acceptance. According to a 2015 Egyptian’s Health survey, 87% of women reported being cut[3]. Though Egyptian FGC has existed since the Pharonic period, there has recently been a slight decline among younger women, possibly in response to the 2008 prohibition.

FGC is thousands of years old and is practiced across thousands of unique cultures and tribes. The techniques and symbolic meanings vary drastically, therefore the the physical and emotional implications on the lives of women do as well.  According to some proponents, female circumcision is used to promote the health, beauty, and protect the virginity of a woman. As reported by Dr. Moges, many supporters claim medical benefits, such that FGC, “enhances fertility, controls and prevents waywardness of girls... the clitoris is dangerous and hinders intercourse, creates impotency, and kills baby at delivery”[4]. Those who oppose female genital mutilation cite that this practice is a massive violation of human rights, resulting only in lifelong harm. Western feminists critique that FGM is an extreme form of control over a woman’s sexuality. WHO (an organization that values Western medicine) recently released a report stating that FGM causes, “severe bleeding, pain with urination, later cysts, as well as complications in childbirth and associated with death of the newborn”[5].

Bettina Shell-Duncan is anthropology professor who specializes in FGC and speaks on the need to clarify cultural misconceptions. First and foremost, emphasizing that this practice is largely done by and for females. Unbeknownst to those unfamiliar with nuances of the practice, a great number of women feel pride partaking in this cultural tradition and in joining the ranks of their mothers, sisters, and ancestors. Even if a father does not wish to subject his daughter to “cutting”, his personal opinion is largely irrelevant as cutting is a collective decision made by a community, deeply embedded in societal function. Shell-Duncan believes that fostering a contextual understanding of motive is the first step the West should take to eradicate FGM. She claims it is imperative to realize that parents subject their daughters to the practice because they want the best possible future for their children – like most parents do – and they believe cutting will ensure this.

Shell-Duncan notes that when many refugees come to Europe they, “very quickly realize that … the future for their girls might not be best secured by being circumcised any longer”[6]. This is reflected in a recommendation from the MP’s House of Common’s report. The report calls for a commitment from those who come into contact with children-  especially those trained in health, education, and social work – to identify and report FGM. They assert that, “prosecutions will not be possible if we wait for daughters to report their parents to the police, which is unlikely to happen”[7]. Studies have found that many community workers ignore FGM when they see it. It is vital that community workers are properly educated so that they will to foster a commitment to identification and reporting.

The report admits that new policies on education and even the practices of targeting  girls and their parents through the legal system has proven to be ultimately unsuccessful. Shell-Duncan goes further in identifying that eradication programs need to reach out to extended families and authority figures in these communities who have influence over the acceptance of the practice within their cultural enclave. Female circumcision is a sacred cultural tradition that allows a girl to enter into the realm of womanhood. The Egyptian MP comments speak to how deeply embedded this tradition remains in the social order. If the West wants to eliminate the practice, it will require a massive shift in the way a culture understands women, physicality, and rites of passage.

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In America there have been no prosecutions under the federal anti-FGM law since 2012, and only one criminal prosecution of FGM related activity[8]. According to the Center for Disease Control and Prevention, at least 150,000 to 200,000 girls have undergone FGM in the United States and these numbers remain in an upward trend. A recent report released by FBI estimated that at least 500,000 women in America are at risk of undergoing the procedure[9]. Both the UK and America publicly condemn FGM as a serious legal offense, whereas Egypt and other similar countries recognize FGM as a legal offense, but fail to publically condemn it. The UK is the primary Western country beginning to recognize the realistic challenges in actually  prosecuting FGM. This may lead anti-FGM cultures to creatively implement more effective policies that mustbegin with the refusal to see FGM as reductively barbaric, rather as a diversely practiced and deeply embedded social act.

 

References:

[1] United Kingdom, Parliament, House of Commons. (2016). Female Genital Mutilation: Abuse Unchecked. London.

[2] Egyptian MP: Women must undergo FGM to control men's desires. (2016, September 7). Middle Eastern Monitor. Retrieved September 20, 2016, from https://www.middleeastmonitor.com/20160907-egyptian-mp-women-must-undergo-fgm-to-control-mens-desires/

[3] Egypt, Ministry of Health and Population. (2015). 2015 Egypt Health Issues Survey. Cairo.

[4] Moges, A. (2003, September 15). FGM: Myths and Justifications. Lecture presented at Eighth International Meropolis Conference in Austria, Vienna.

[5] New WHO guidelines to improve care for millions living with female genital mutilation. (2016, May 16). World Health Orginazation. Retrieved September 20, 2016, from http://www.who.int/mediacentre/news/releases/2016/female-genital-mutilation-guidelines/en/

[6] Khazan, O. (2015, April 8). Why Some Women Choose to Get Circumcised. The Atlantic. Retrieved September 20, 2016, from http://www.theatlantic.com/international/archive/2015/04/female-genital-mutilation-cutting-anthropologist/389640/

[7] United Kingdom, Parliment, House of Commons. (2016). Female Genital Mutilation: Abuse Unchecked. London.

[8] Female Genital Mutilation in the United States: Protecting Girls and Women from FGM and Vacation Cutting [Scholarly project]. (2013). In Sanctuary for Families. Retrieved September 20, 2016, from http://www.sanctuaryforfamilies.org/wp-content/uploads/sites/18/2015/07/FGM-Report-March-2013.pdf

[9] FBI Reaching Out About Female Genital Mutilation (13 May 2016).  In Federal Bureau of Investigation. Retrieved September 21, 2016, from https://www.fbi.gov/news/stories/fbi-reaching-out-about-female-genital-mutilation

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Concerns Persist Over Organ Harvesting in China

Concerns Persist Over Organ Harvesting in China

Concerns are again being raised over China’s execution of prisoners in order to use their organs for transplant. In today’s economy, organs can fetch a high price; in 2014 the organs of a single human body, including the heart, lungs, liver, kidney, pancreas, and intestines, were valued at $689,9001. Including medication, a hospital stay, and other fees associated with surgery, an organ recipient may pay nearly $1.2 million1. Today, the price is likely even higher.

 

With such high value placed on organs and an aging population increasingly in need of transplants, China has struggled to find voluntary organ donors. For years, global health officials were wary of China’s high execution rate and its reputed connection to organ donation. According to Amnesty International, China’s rate of capital punishment is one of the highest in the world, with over 1,500 prisoners being executed in 2015. 2 With such high execution rates and limited information on who is executed and on what charge, it is widely accepted that China was killing two birds with one stone: execution of political prisoners serves to eliminate anti-communist ideology and provides a source of much-needed organs.

 

Along withthe prisoners being held on death row for heinous crimes, those up for execution include political prisoners and prisoners of conscience3. It is believed that these include members of the persecuted Falun Gong religious group and suspected anti-Communists 3. Upon entering prison, reports confirm 3 that prisoners are subjected to medical tests, and the results stored in a database. Once the need arises, the prisoners are executed and the necessary organs extracted, or in some cases, the extraction is done on live patients to ensure a fresh transplant.3

 

In 2005, after years of global suspicion, China publicly confessed that the organs of executed prisoners were being harvested for transplants, and in 2011, China’s transplant chief Dr. Huang Jiefu estimated that 65% of all transplanted organs in China came from executed prisoners. 4 This renewed global concern over possible human rights violations. Finally in 2015, after facing increasing international pressure, Chinese officials announced that organs would no longer be harvested from executed inmates.

 

With well over half of organ transplants coming from executed prisoners, nobody expected an easy transition from a corrupt system to a permanent, ethical means of organ transplantation. Donors are scarce in China, in part due to a very limited organ volunteer system and cultural belief that it is inappropriate to disfigure a deceased body. However, when a Canadian patient in need of a kidney made a trip to China this year and received an organ in three short days4, eyebrows were instantly raised. Clearly, China has a long road ahead if it ever hopes to shed its reputation for unethical organ harvesting.

 

 

References:

 

1  Hanson, Steven. “2014 U.S. organ and tissue transplant cost estimates and discussion.” Milliman, 30 Dec. 2014, http://www.milliman.com/uploadedFiles/insight/Research/

      health-rr/1938HDP_20141230.pdf

2

Perry, Juliet. “Amnesty report: Executions at their highest level in 25 years.” CNN, 6  April, 2016, http://www.cnn.com/2016/04/05/world/amnesty-2015-death-penalty-report/index.html

3

Robertson, Matthew. “China’s Former Security Chief Implicated In Organ Harvesting.” Epoch Times, 16 Mar. 2015, http://www.theepochtimes.com/n3/  1287014-chinas-state-sponsored-organ-crimes-find-scapegoat/

 

4 Merchant, Norman. “Does China Still Harvest Organs of Executed? Doctors Divided.” Stars and Stripes, 27 Aug. 2016, http://www.stripes.com/news/

    does-china-still-harves-organs-of-executed-doctors-divided-1.425833

Sex Confirmation Testing in International Sports

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Sex Confirmation Testing in International Sports

With the Rio Olympics ending, it seems an apt time to review some of the news that emerged surrounding the controversial and long-lived practice of verifying the sex of female athletes. The International Association of Athletics Federations (IAAF) and the International Olympic Committee (IOC) exist to ensure fair competition on the international stage, they police the actions of athletes and teams as well as determining eligibility for competition.  The IAAF states it is, “proud of its position at the forefront of the global fight against doping in sport, and is resolutely committed to athletics, and to the preservation of a zero-tolerance policy with respect to doping.” (IAAF Commitment to Healthy and Drug-Free Athletics, 2016). But where is the mention of other standards for fairness, other ways the playing field is leveled? These same governing organizations have been forcing athletes who intend to compete as females to undergo “gender confirmation testing” since the 1940’s, when a medical “femininity certificates” was required to compete as a woman; going as far as “mandatory genital checks” which began in 1966 (Padawer, 2016). Eventually these tests were deemed inappropriate and unjust. No male athletes attempting to compete as women were discovered through this practice.  The international governing bodies for sport moved towards chromosome testing, with the intent to remove unfair advantages. This practice has the IAAF viewing genetic discrepancies, not having only two X allosomes, in the same way they treat the advantages doping athletes may posses. This policy changed again in 2011 and the IAAF moved from “gender testing” to testosterone level testing (Padawer, 2016). By looking at hyperandrogenism (high testosterone levels) the agency was implying that this was a source of athletic  advantages. They set boundaries on the acceptable levels of testosterone in order to still compete as a woman. Some problems with this have been outlined, “The official Olympic testosterone cutoff for female athletes is 10 nanomoles per liter, but some go beyond it, into the “male” range, and some men fall into the “female” range, thanks to normal hormonal fluctuations that differ from individual to individual.” (Editors, 2016). Surgical and hormone suppressive therapies were set out as ways of reducing testosterone levels and lifting the ban on competing with their natural levels of testosterone. For the 2016 Rio Olympics, the practice of banning athletes based on naturally high testosterone was not employed. However, if significant evidence is found that higher than normal testosterone levels constitute an unfair advantage hyperandrogenism testing may resume on the national stage (Editors, 2016).

With this history outlined, there is a context to consider the games in Brazil. One athlete, in particular should be underlined in relationship to sex verification testing and biological fairness, Caster Semenya. Semenya is a South African runner who took gold this year in the 800m. She has been subject to many sex confirmational tests, the results of which were improperly handled by athletics governing bodies and made it to the press. The general secretary of the IAAF (Pierre Weiss) said publically about Semenya, “She is a woman, but maybe not 100 percent.” (Padawer) Despite all of the barriers to competing and private records leading to headlines she made it to the top of the podium in Rio. Hopefully, other athletes who faced difficulties with “gender verification testing” will see similar success. The news around gender testing is changing it seems that now more than ever the agencies that determine eligibility are under scrutiny rather than just the women striving to compete.

 

References:

 

"IAAF Commitment to Healthy and Drug-Free Athletics." IAAF. International Association of Athletics Federation, n.d. Web. 05 Sept. 2016. <https://www.iaaf.org/about-iaaf/medical-anti-doping>.

Editors. "Naturally Occurring High Testosterone Shouldn't Keep Female Athletes out of Competition." Scientific American. Scientific American, 1 Aug. 2016. Web. 5 Sept. 2016. <http://www.scientificamerican.com/article/naturally-occurring-high-testosterone-shouldn-t-keep-female-athletes-out-of-competition/>.

Padawer, Ruth. "The Humiliating Practice of Sex-Testing Female Athletes." The New York Times. The New York Times, 02 July 2016. Web. 05 Sept. 2016. <http://www.nytimes.com/2016/07/03/magazine/the-humiliating-practice-of-sex-testing-female-athletes.html>.

 

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Belgian Olympian Faces Final Challenge

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Belgian Olympian Faces Final Challenge

        Olympians amaze and astound people across the globe with their unmatched athleticism, agility, and stamina. Olympians perform such jaw-dropping feats that oftentimes people question whether they are human.  However, they are every bit as human as you and me. Olympian Marieke Vervoot exemplifies this idea, for she currently faces the same challenge that thousands of individuals across the world face: ending one’s own life via euthanasia. Vervoot won gold in the 100-meter wheelchair sprint in 2012 and has recently competed in her final Paralympic Games in Rio de Janeiro. Citing that competing is her main passion in life, she has now requested to be euthanized. Many view her desire as inhumane and barbaric. While those people certainly have a valid argument, one must consider many different aspects of the individual’s life and evaluate the patient’s claim before dismissing it as unethical.

 

    Belgium has the most liberal euthanasia laws in the world. The practice was legalized for adults in 2003, a year in which 235 people were euthanized. In 2013, there were 1,816 cases of euthanasia and currently about 1 in 20 Belgian deaths are assisted suicides (Carle). In 2014, Belgium became the first country in the world to legalize euthanasia of children (with parents’ consent). In order to be eligible for euthanasia, a patient must exhibit chronic, debilitating, and incurable physical or mental pain. Most patients seeking euthanasia are diagnosed with terminal cancer, but people with psychological disorders and autism have also been euthanized. Belgium’s cultural acceptance of euthanasia and the policies created as a result of this mindset have allowed people like Vervoot to pursue a more dignified and peaceful way to end their lives.

 

           Marieke suffers from a degenerative disease that has impaired her vision and causes her great pain everyday. Her lone salvation is competing, saying, “sport is my only reason for living” (Cook). That is one thing her condition has not taken away from her: the ability to compete at a very high level. After these Olympics, Vervoot says that she will have nothing to live for, which is the primary reason she seeks to end her life. Dr. Wim Distelmans, a Belgian doctor on the vanguard of euthanasia, argues that the Vervoot’s prospect of being euthanized has actually extended her life. He explains, “The certainty that there is an emergency brake to stop the intolerable pain gives one peace. This mindset can extend one’s life”. Distelmans argues that euthanasia can bring clarity to someone whose life has been characterized by uncertainty and fear. By knowing that she is able to die on her own terms, Vervoot will be able to focus on all the positive aspects of her life rather than obsess over all of her interminable pain. As a result, she might find something so worthwhile, like competing, that will give her the motivation to live even longer.

 

           Dr. Ezekiel Emanuel led a study about patients’ feelings towards euthanasia and whether they would seriously consider it for themselves. His study found that those seriously considering euthanasia had the following common characteristics: depressive symptoms, substantial caregiving needs, and pain. Why is it ethical for a judge to force these people to feel such anguish every day for the rest of their lives? This question becomes especially pertinent when the patient has a neurodegenerative disorder, such as amyotrophic lateral sclerosis (ALS). Is it not better for people to die on their own terms, rather than dependent on a machine to keep them living for an extra year or two? For some patients, euthanasia provides a more dignified and humane way to die.

 

           There are millions of smart and talented individuals across the globe whose end-of-life experiences are plagued with machines breathing, eating, and speaking for them. After evaluating the costs of dying and the benefits of living, doctors, judges, and legislators must realize that sometimes it is ethical to die as a functioning human being rather than live with perpetual pain.

 

References:

Carle, Robert. “Give me Liberty and Give me Death: Belgium’s Brave new Euthanasia Regime”. The

    Witherspoon Institute: Public Discourse. Accessed 22 August 2016.

    <http://www.thepublicdiscourse.com/2015/09/15355/>.

 

Cook, Michael. “Gold medalist paralympian from Belgium seeks

           euthanasia”. Bioedge: bioethics news from around the world.

           Accessed 19 August 2016. <http://www.bioedge.org/bioethics/gold-medallist-

           paralympian-from-belgian-seeks-euthanasia/11956>.

 

“Current Law Regarding Euthanasia in Belgium”. Patients Rights Council. Accessed 22 August 2016.

    <http://www.patientsrightscouncil.org/site/belgium/>.

 

Emanuel, EJ, et. al. “Attitudes and Desires Related to Euthanasia and Physician-Assisted

           Suicide among Terminally Ill patients and their Caregivers”.  JAMA.  Accessed 19

           August 2016.

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End HIV by 2020? Tell Us ‘How’

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End HIV by 2020? Tell Us ‘How’

As someone who has dedicated her young life to learning how best to combat the HIV/AIDS epidemic, I am struck by articles wherein there is little thought given to the ‘how’ or ‘why’ we can fight HIV/AIDS. Instead, there is more focus on ‘what’ is needed or lacking in our armament. It seems to me that we are quick to judge ‘what’ is not working in the HIV intervention realm: treatments are failing, equipment lacks luster, drug stocks are insufficient. Yet there is little talk of ‘how’ to mitigate these challenges and ‘why’ such tribulations arise in the first place. It is about time that someone started talking about the ‘how’ and ‘why’ – maybe then we can rally behind the 90-90-90 Targets that I believe so deeply in.

 

Last week, BBC News published: “HIV effort let down by test shortages, says WHO,” wherein the writer discussed “gaps in provision” vis-à-vis rolling out HIV medications for global treatment. The article referenced the UNAIDS 90-90-90 Targets: by 2020, 90% of all people living with HIV should know their HIV status, 90% of those diagnosed should receive antiretroviral therapy, 90% of (these) treated patients should be virally suppressed. Viral suppression is a measure of inactivating the HI virus such that the probability of reinfection is mitigated. Within the article, one Vincent Habiyambere (Senior Procurement and Supply Management Office, World Health Organization) is quoted for claiming that “low and middle-income countries, including African countries where the HIV burden is high, are not geared up” for the fight against HIV/AIDS. Habiyambere implied that such countries lacked necessities to fight HIV such as staff training and properly installed equipment. Furthermore, laboratories and machines needed for testing and treatment were poorly maintained.

 

The article called for “strong leadership, resources, planning and management” as tools to implement and provide HIV services. Yet, there was little mention of ‘how’ to provide these tools in countries where most victims of HIV/AIDS are living below the poverty line.

 

Contrastingly, in her article “Are Young South Africans ignoring the Aids message?” (BBC News on 18th July 2016), Karen Allen described the plight of South Africans: “when the rest of the world was rolling out a drug called Nevirapine to reduce the chances of mothers transmitting the virus, South African leadership famously advised patients to use lemon and garlic, instead, to protect themselves.” Allen neglected to mention that the Nevirapine drug was sold for close to $100 per pill, especially since it was founded in 1996 and shortly approved by the FDA in the USA – a country far removed from South Africa in both distance and wealth at the time.

 

The drug embodied a luxury that most South African mothers could not afford. Hence the leadership turned to a more reasonable ‘home-remedy’ in garlic. While I openly admit this was likely less effective, I am reminded that this was at least presented a viable mode of action. Interestingly, we see that Allen honed in on the ‘what’ (lack of Nevirapine advocated in South Africa) while easily ignoring the ‘how’ and ‘why’ that I attempt to explore by means of the cost price of the drug.

 

Allen goes on to talk about a new plight in South Africa – the “sugar daddy syndrome.” She maintains that there are a number of young people who are newly infected with HIV due to intergenerational sex: sex across age groups. Needless to say the dim picture that Allen paints includes gender violence and inequality. While these are harsh realities in South Africa today, I believe that there is more achieved in highlighting the strides made against these social challenges instead of adding to the noise, which echoes their existence.

 

In the conclusion of her piece, Allen alludes to what I believe is the root of the epidemic that is crippling our nations - HIV stigma: “400 people die in South Africa every single day of HIV-related illnesses, either because they don’t seek help early on or default on their treatment.” The country is not alone given that more than “2 million adolescents” live with HIV globally (UNICEF 2016).

 

I am a graduate student who researches HIV/AIDS in South African urban townships. I believe HIV stigma embodies the ‘why’ surrounding HIV treatments specifically in terms of: why is treatment adherence so low, how do communities interact with HIV interventions. My work focuses on peer support and knowledge sharing for men at risk for and living with HIV/AIDS. I advocate that community members can provide the most knowledge when it comes to navigating streets rampant with treacherous HIV-stigma. As a result of this, I aim to facilitate and encourage platforms for knowledge sharing through peer interaction in ‘brave spaces’ that circumvent HIV stigma.

 

It seems to me that there are many discussions surrounding the ‘what’ when it comes to the world’s fights against HIV/AIDS. But if we are to win in this battle by 2020, we must begin brainstorming the ‘how’ and ‘why’ – before it is too late.

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References:

Allen, Karen. Are Young South Africans Ignoring AIDS message. BBC News. http://www.bbc.com/news/world-africa-36795484. July 2016.

HIV Effort Let Down By Test Shortages, says WHO. BBC News. http://www.bbc.com/news/health-37168771. August 2016.

Lynch, Dominic. Higher Education’s ‘Safe Space’ is Now a Ridiculous ‘Brave Space’. Real Clear Education. http://www.realcleareducation.com/articles/2015/05/08/higher_educations_safe_space_is_now_a_ridiculous_brave_space_1195.html. May 2015.

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Loss of a Hero in Fertility

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Loss of a Hero in Fertility

Mr. Frank Palopoli, the chemist who developed a drug to treat infertility and subfertility due to anovulatory tendencies died this past Saturday.  He was 94. The drug he helped into existence, Clomiphene citrate, which came to be marketed as Clomid, helps to induce ovulation. Due to it’s safe and effective ability to address infertility through the stimulation of natural hormone production it has been placed on the World Health Organization’s List of Essential Medicines, and remains the only ovulation inducer included. Though the drug was first developed in Palopoli’s lab in 1950 it was took 17 years to come to market, and remains in use today.

It has been shown that the use of clomiphene citrate, in women who experience anovulatory infertility, can increase the chances of pregnancy such that their fertility during treatment can be considered normal. This has allowed many people that previously would have been unable to conceive to do so either naturally or through in vitro fertilization or intrauterine insemination. Up to 80% of anovulatory infertility cases treated with this drug have been shown to be successfully addressed.

More recent research has examined clomiphene citrate as a possible treatment for hypogonadism, the loss of function in the gonads and subsequent decrease in testosterone levels, in men. This alternative use for the drug Mr. Palopoli played an integral role in developing, shows promise and may further extend the impact of his contributions to the collection of drugs used today.

The use of clomiphene citrate and other drugs that induce ovulation has the potential to over stimulate the release of eggs and cause an increase in the rate of multiple pregnancies. Because multiple pregnancies carry a greater risk for both the expectant mother and her children the use of Clomid has also been linked to the abortion debate and the ethics of pregnancy monitoring. The use of this and other fertility therapies remain an important topic in medical ethics.

The group of organic chemists he headed worked under the William S. Merrell Company and contributed to the development of several other agents including triparanol and tamoxifen (researched as possibilities for the treatment of high cholesterol and breast cancer respectively). Clomiphene citrate has now been used by millions of people worldwide.

References: 

Kousta, E. "Modern Use of Clomiphene Citrate in Induction of Ovulation." Human Reproduction Update 3.4 (1997): 359-65. Web.

Roberts, Sam. "Frank Palopoli, Who Aided Fertility With Clomid Drug, Dies at 94." The New York Times. The New York Times, 11 Aug. 2016. Web. 11 Aug. 2016.

Shabsigh, Ahmad, Young Kang, Ridwan Shabsign, Mark Gonzalez, Gary Liberson, Harry Fisch, and Erik Goluboff. "Clomiphene Citrate Effects on Testosterone/Estrogen Ratio in Male Hypogonadism." The Journal of Sexual Medicine 2.5 (2005): 716-21. Web.

"WHO Model Lists of Essential Medicines." World Health Organization. World Health Organization, 1 Apr. 2015. Web. 11 Aug. 2016.

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