Perhaps Dr. Frankenstein Was Just Misunderstood

You are currently viewing Perhaps Dr. Frankenstein Was Just Misunderstood

Perhaps Dr. Frankenstein was just misunderstood

In the past, we have discussed many aspects of Catholic bioethics as they apply to living human beings, born and unborn.  Today, we find ourselves thinking about the human body, absent the eternal soul, that is, a corpse.

There is something fundamentally unsettling about a dead body.  It always seems small and empty, despite its physical size.  Dead bodies are simultaneously sad, a little scary and depressing.  This seems to be a basic and foundational plank of the human psyche.  The unease we feel around the dead is a primal emotion that transcends multiple cultures and historical era.  Whether in Orthodox Judaism, Islam, Native American cultures and even secular atheism, dead bodies are respected, but also separated from the living and interred, that is, disposed of, quickly.  Just touching a dead body, or touching someone who has touched a dead body, renders an Orthodox Jew unclean and in need of ritual cleansing.  Horror movies and ghosts aside, the dead are immediate and poignant reminders of our own mortality.  This is not to completely discount ghosts. The human spirit is so vibrant and vital that it is unfathomable to believe it is completely gone after death. Beliefs about heaven and hell, an afterlife and lost spirits walking the earth abound throughout recorded history.

Even secular society has laws and regulations regarding the handling of corpses and treatment of the dead. In most jurisdictions there are statutes that prohibit what is commonly termed, “abuse of a corpse” and prescribe penalties for things like disinterring bodies, selling body parts and other broadly termed “offensive” actions. Taking Texas law, for example, the following are felonies in that state:

  • disinterring, disturbing, damaging, or otherwise treating a human corpse in an offensive manner
  • concealing a corpse knowing it to be illegally disinterred
  • buying, selling, or trafficking a human corpse
  • transporting a corpse out of state
  • vandalizing a gravesite (1)

Laws in most states and many countries are similar. Wisconsin being an exception, when three men were caught disinterring a corpse for the purpose of sexual intercourse, there was not an existing statute regarding corpse abuse in effect, but they were charged with sexual assault, among other things. This prompted Wisconsin to update its laws.(2) (Quite frankly, given the state of sexual mores in this society, I am surprised there is not more representation of the necrophile community in the LGBTQABCDEFG+ alphabet soup and multicolored flag.  Perhaps there is; it is hard to keep track.)

Similarly, cannibalism is pretty taboo in most of the world. Despite being rather ubiquitous in the animal kingdom, human cannibalism is seen as barbaric and, for the most part, limited to certain cultural rituals, wartime trophy beliefs and situations of extreme famine.  (There are also cases of cannibalism as a sexual fetish, again, not sure if that is represented on a “pride” flag.)

The Catholic Church is clear on the treatment of dead bodies. The Catechism, No. 2300, says, “The bodies of the dead must be treated with respect and charity, in faith and hope of the Resurrection.” No. 2301 states, “Autopsies can be morally permitted for legal inquests or scientific research.”(3) Other religious traditions follow suit, and corpses are considered the sacred property of God, which has been loaned to the human spirit for its time on earth.(4)

Thus, the body, even when separated from the immortal soul is not just another piece of meat and human bodies are distinguished from the remains of other living organisms. (It seems that the only people who put no special value on human beings are the pro-abortion cheerleaders, but more on that later.)

The use of dead bodies for organ and tissue harvest, medical research and teaching is the subject we are contemplating this week. Given the special reverence for human bodies across cultures, it is reasonable to believe that there should be limits and regulations as to what can be done with dead bodies in the name of science. Before going there, however, we should define what is actually a dead body.

For most people throughout history, death meant the irreversible cessation of cardiac function, that is, a heartbeat. We still pretty much think of cardiac death as dead-dead, or “really dead”, or, as we say in Louisiana, “DRT” (for dead right thar!) This is an easier concept when it comes to medical research and teaching. In the United States, persons may will or donate their bodies after death to local medical schools and other scientific institutions for the purpose of the study of anatomy and pathology. For most older medical schools, this is the source of bodies for the teaching of gross anatomy by cadaveric dissection. Medical schools are very resistant to change and anatomy has been taught this way since the middle ages. To those of you who have not experienced this odd pedagogy, a typical anatomy lab session consists of about 5 medical students around a body. One student (usually the self-proclaimed surgeon wannabe) is middling at dissection of a particular anatomic structure, another student is guiding the first using a reference or picture book, a third is looking on, the fourth is texting on a cell phone and the fifth is looking out of the window. This goes on, several hours a week, usually throughout the first year of medical school. Classically, the reasoning behind this educational method is that it best teaches a student the intricacies of anatomy, while ingraining a respect of humanity and a rite of passage in admittance to the medical “guild.”  Not so much.

Any physician who is honest, really honest, will tell you he/she didn’t learn anything during gross anatomy. Medical school requires mastery and memorization of a very large body of knowledge in a relatively short time, much of it minutia only tangentially related to the practice of medicine. A first-year student is drowning in work, freaked-out by the dead body, woozy from the formalin smell and just wants to be anywhere else. It is a massive time sink that is better spent elsewhere.  Additionally, this “rite of passage” diminishes empathy and compassion over time, as students are overwhelmed by the amount of study to be done, compounded by the “meat” in the anatomy lab consuming their efforts.(5) While memorial and thanksgiving ceremonies for the donors help, a little, to alleviate this emotional “hardening,” much of the time they as seen as more “time wasters” in an already packed schedule. In practicality, most of the anatomy that is learned comes from atlases and other guidebooks, studying bodies that have not been amateurishly chopped to pieces by medical students.  (Now, anatomists will tell you that gross dissection is important to teach students normal anatomical variation, but, for the reasons we have discussed, they are probably just trying to protect their phony-baloney jobs.) Newer medical schools, including our planned Saint Padre Pio Institute for the Relief of Suffering, are increasingly turning to virtual and assisted-reality technologies for the study of anatomy, including the use of medical imaging, like MRI and ultrasound. This actually has practical value to medical students, makes them better doctors and is a more efficient use of their time, in addition to delivering the subject matter more accurately and without the cost and burden of maintaining an anatomical mortuary and body donation program. Studies have yet to be done, but I suspect students relying on virtual anatomy will have increased empathy and compassion for their patients, rather than seeing them as “meat”.

Thus, medical research on bodies after cardiac death is pretty straightforward. It is permitted by the Catholic Church and most other faiths, save for Orthodox Judaism and Islam, assuming the body is treated with respect and returned (or offered for return) to the donor family when its use is finished. There has been occasion when donor families have been distressed to learn that the body of their loved one was not used for medical student dissection, but rather, blown up to study the effects of explosives on human tissue, or similarly traumatized for non-dissection study.(6) (Medical student dissection is pretty traumatic anyway, so land-mines are just a matter of degrees, I should think.)

The difficulty in this comes when we consider medical research on the “brain-dead”.  That is, persons who have been declared legally dead because of irreversible and complete loss of brain function, but whose bodies remain animated through the automatic function of the heart and supported by various medical technologies, like ventilators and medications. In many cases, these people, or their families, are donating their organs to be transplanted into other people in need, but sometimes there is also medical research to be done. This is when it starts to get creepy.

Patients who are brain-dead will also become cardiac-dead if their breathing is not supported by a mechanical ventilator. Usually, they also require significant amounts of potent medication to maintain their blood pressure and heart rhythm. The brain is not only an organ for thinking and consciousness, it is also important in the physiologic regulation of the body. Without a functioning brain, breathing is impossible and other body systems, such as the circulatory and cardiac systems, require artificial support to remain functioning. Hence, using the brain-dead as platforms for medical research is no small feat. Additionally, since whatever is being studied has no chance of helping that particular patient there are ethical considerations since the research is for informational purposes in other patients and conditions. The brain-dead experimental subject is a very elaborate physiologic laboratory. This came to light early in 2022, when researchers at the New York University School of Medicine announced that they had genetically modified a pig kidney to be less likely to be rejected by the body and had successfully attached this kidney to the thigh of a brain-dead test subject.(7) So this modified kidney was attached to the blood vessels of the leg and observed for 54 hours, as it made urine and showed no signs of rejection. Subsequently, NYU surgeons also transplanted genetically-modified pig kidneys into two other brain-dead patients with good results, at least for the kidneys.(8) On the one hand, this sort of research is important, as the demand for donor organs far outstrips supply and every year about 8,000 people die awaiting an organ transplant that would have saved their lives.(9) So, an animal source for transplant organs would provide for these patients. On the other hand, given our natural and emotional respect of the body itself, research on the body is off-putting. Again, this is pure research and will have no beneficial effect, whatsoever, on the dead experimental subject. In a conversation I had about this topic with a member of the National Catholic Bioethics Center, a highly-regarded think-tank on Catholic bioethics, he felt that, provided appropriate consent was obtained, and, if the study in question would offer benefit to others, it was ethically acceptable. I am not sure I am in 100% agreement, because there are a lot of slippery slopes around here (watch your step.)

We have just spent a lot of time discussing the intrinsic value and sacred nature of the human body, even absent its immortal soul. To this day, relics of Saints are venerated and the incorruptibility of the body is sometimes among the criteria for Sainthood. Best intentions to the contrary, would one advocate for the educational use of the body of Saint Padre Pio in the anatomy lab? Saints, while exalted in heaven, during their time on earth are not more human than you and me. Intellectually, we understand the argument for the use of dead bodies in scientific research. In practice, it still leaves us emotionally uncomfortable. Accepting pretty much unlimited use of dead bodies for research and study leads to other slopes.

The first of these is the “dead-enough” slope. While brain-dead patients are physiologically complicated, people in a persistent non-cognitive state are not necessarily (e.g., coma, “vegetative” (not a good term, but part of the vernacular.)) Patients in a minimally or non-conscious state usually require only nutrition and hydration through a feeding tube. They breathe on their own and their cardiac function is stable. So, this is now an easier experimental platform in a patient that has been dehumanized by the medical system. This means medical research can be conducted, long-term, on a living human without the need for extraordinary physiologic support. Is anyone uncomfortable yet? The secular establishment increasingly sees patients in persistent minimally cognitive states as “equivalent” to dead. Their inability to interact with the world around them leads the establishment to see them as not living a “meaningful” life and worthy of an accelerated death. After all, it is an accepted, albeit heinous, medical practice to hasten the death of these patients by simply withholding nutrition and hydration. That’s right, for living people who may be in a coma for whatever reason, family members, or sometimes physicians, can simply choose to stop the ordinary care of providing food and water. The Catholic Church has definitively stated that this is unacceptable and, essentially, murder, but secular society carries out a lot of things that the Church considers murder (here’s looking at you, reproductive health care and a woman’s right to choose.)

The nearly dead, or dead equivalent, are also looked at hungrily by the organ transplant industry. Yes, it is undeniable that the demand for donor organs far outstrips supply. Does that justify hastening the deaths of these people who have a “reduced quality of life”?  The euthanasia cheerleaders love to use emotional triggers of “ending suffering” and “she/he would not want to live like this.”  Of course, the “at least his/her organs can do good for others” train is never late. There is an increasing push to allow the harvesting of organs from patients in persistent non-cognitive, (but not yet dead,) states.

In the Olympics of all things unethical, China and Canada seem to be running neck and neck.  With a zeal that would make even the most aggressive veterinarian blush, Canada is strongly pushing their “Medical Assistance in Dying” (MAiD, cute, no?) program on the terminally ill, “suffering,” sick, elderly, disabled, mentally ill, and now, the impoverished and even children.  The result of this has made Canada the world leader in organ “donation” from persons who have been killed by euthanasia. Even without a planned massive expansion, right now, over 10,000 people a year are being killed by euthanasia in Canada.(10)  Quebecois seem to be especially enthusiastic about the concept (11) (no, I don’t get it either.  Stress of bilingualism?)

Roughly half of the world’s donated organs following euthanasia come from Canada. Belgium and the Netherlands, who also have an appetite for euthanasia are taking notes and trying as hard as possible to kill as many people as Canada, but they are relative pikers. Canada is the only country in the world where a nurse practitioner, rather than a physician, can authorize medical murder, I mean, MAiD.(10) You might think the Canadians are shy about their new industry; you would be wrong. In an interview with CTV, Arthur Schafer, director of the University of Manitoba’s Centre for Professional and Applied Ethics, said he was “proud” of Canada’s standing in rates of organ donations among assisted suicide deaths. “It’s a wonderful opportunity for someone facing death to make something significant out of the end of their life,” he said.(10) (One has to think that Joseph Goebbels, playing cards in hell with Margaret Sanger, is thinking, why didn’t I think of a catchy acronym?  I could have gotten a medal, instead of that cyanide.”)

Not to be outdone, China is well-known as a marketplace for organ harvesting from the terminally ill, and executed criminals, as well as others “suffering” from various political illnesses, such as Uyghur Muslims. It is estimated that some 15 million Uyghurs from Xinjiang Province have undergone medical screening for their suitability for organ harvesting.  Every year, some 25,000 Uyghurs “disappear” and are assumed to have been murdered for their organs.(12) The primary customers for these organs are wealthy Chinese, but there is also a shadow organ tourism industry of Japanese, South Koreans and Muslims from the Gulf States, (who prefer “halal” organs from other Muslims,) coming to China for their surgeries.  The waiting time for organs in China is weeks, rather than months and years as in the US, while hospitals offering organ transplantation have websites advertising their services in English, Russian and Arabic.(12) Ethnic cleansing while making a profit in a communist country!  (In that same card game, Joseph Stalin is looking at Mao and saying, “impressive,” while seeing Sanger’s bet and raising by a dollar.) Hard evidence of all this, however, has been lacking, until 2022.

In a twist of the academic slang, “publish or perish”, researchers from Israel reviewed over 2,800 scientific publications from China discussing organ transplantation. After running the papers through an automated algorithm, they settled on 310 papers for close review. These papers came from 56 hospitals in 33 cities across 15 provinces. After reviewing the papers, the research came across inadvertent evidence of organ harvesting from live patients in 71!(13) Recall that, among the criteria for brain death is a cessation of unassisted breathing. All brain-dead patients require a mechanical ventilator for breathing and this breathing is through an endotracheal tube. Well, in the 71 papers in question, descriptions of the procedure included discussion of placing an anesthesia mask on the patient before the induction of anesthesia and/or placing an endotracheal tube before the procedure. Without realizing it, the authors of the papers had just described administering anesthesia to living patients for the purpose of harvesting their organs!  (For those of you who are not revolted, stop reading, take a shower and go to confession.) (Colin Kaepernick’s antics aside, do you need any more reasons not to buy Nike products?) The Israeli paper, from the American Journal of Transplantation, by Matthew Robertson and Jacob Lavee, is available free online at:  It is worth your time to read it.

I pray that they are not, but perhaps Canada and China are previews of coming attractions.  Several years ago, I chaired a large department of anesthesiology in Philadelphia, PA. The Northeast corridor, from Washington, DC to Boston, is a densely populated area, and the demand for organs there is high; the local organ procurement agencies are also highly aggressive. On one occasion, we had a young man come to the operating room for organ harvest after being declared brain-dead less than 5 hours following admission to the emergency room after a motorcycle accident. That seems pretty quick, particularly given the effects of medications administered in the emergency room and the transitory pathological manifestations of traumatic injury. On another, and much more unsettling occasion, a young man who suffered from a debilitating neurodegenerative condition had decided to withdraw the ventilatory support keeping him alive. This unfortunate soul had a condition that rendered him conscious and alert, but unable to move and he required a ventilator for breathing through a tracheostomy, that is, a tube through a hole in his neck. Mechanical ventilation is extraordinary life support and it is considered acceptable to discontinue such support if someone would not want to be kept alive by such means. Usually, that decision is made either by advance directive (i.e., living will) of the patient, or by a family member, as these patients are usually unconscious. In this case, the young man was conscious but had decided he no longer wanted to live and wanted to discontinue the ventilator. So far so good, but he had also “decided” to donate his organs after death. I put decided in quotes, as it is unclear how much independent decision making really is going on here. After all, this man is in a very bad situation, has abundant reasons for clinical depression and may not be making medical decisions without influence. Akin to Canada’s MAiD, is there pressure to be “less of a burden?”   Has he received medically optimal care and can his quality of life be improved, or is this just an easy way out? All fair questions, particularly as the local organ procurement agency was involved to the point that the young man was taken to an operating room and prepped for surgery, the ventilator keeping him breathing was removed and, when his heart stopped, his organs were immediately harvested. I recall voicing my discomfort about this to one of the hospital administrators, but they were all giddy about the “heroic” actions of the young man. As this man did not need anesthesia, our department was not involved, but I remain uneasy to this day about the whole affair. It seems that much of the medical establishment, and our society in general, is quick to look for an easy, “dignified” death, and not so quick to fight for life. I shudder and keep that young man in my prayers.

If organ harvesting is a slippery slope for people in minimally conscious states, then medical research is the bunny slope of ethics for these people.  They are not being killed by this research and are functioning as “human test beds” for one or another experimental therapy. Once again, “heroic” and “value to society” become tossed around, as secular bioethicists (sort of an oxymoron, but I digress) debate research on these unfortunate people.  Heather Draper, from the Centre for Biomedical Ethics at the University of Birmingham, in the UK, wrote in a 2006 paper in the Journal of Medical Ethics, “Helping others by taking part in clinical research is undoubtedly a good way to live out what may be years in a PVS or other less‐compromised states. It may even help those for whom such a life is a virtual certainty to find meaning for the future they are destined to live.”(14) In this paper, Dr. Draper is advocating that persons, either with or in anticipation of a diagnosis of a condition that will lead to a “persistent vegetative state” (“PVS”, a dehumanizing term, and telling that she uses this) provide consent for future medical research. Following this to its logical conclusion, there is no reason why, in the future, relatives of people in minimally conscious states would not be approached by researchers for permission to allow their loved ones to be used for research.  Indeed, in her paper, Dr. Draper discusses the advantages of the research relieving the family of the financial and physical “burden” of caring for their relative.(14) I guess ethical arguments about vulnerable populations and unfair incentives are on vacation for the purposes of her paper. Not only could the minimally conscious become “test-beds” for biomedical research, they could also become factories for various biological products (skin grafts, antibodies for therapies and hormones, to name a very few) for the rapacious biopharmaceutical industry. At the moment, some of this is illegal in the US, that is, selling body parts, but, when there’s a will there’s a way, as they say in China (maybe.)

In yet another slope here on bioethics mountain, there has been discussion about using brain-dead women as gestational surrogates in the rapidly-expanding surrogate industry. Professor Anna Smajdor from the University of Oslo, Norway, (Scandinavians, the same folks who brought you genocide against the unborn disabled and gender-reassignment surgery,) writes in a paper recently published in the Journal of Theoretical Medicine and Bioethics, “Whole body gestational donation (WBGD), or surrogacy, should be an option for those who do not want to go through pregnancy or risk their bodies. As pregnancy and labor can bring severe health issues, even in opulent environments with prevalent healthcare, shifting the risks to those who won’t be affected by them should be an option. Whole body gestational donation offers an alternative means of gestation for prospective parents who wish to have children but cannot, or prefer not to, gestate. It seems plausible that some people would be prepared to consider donating their whole bodies for gestational purposes just as some people donate parts of their bodies for organ donation.”(15)  (WBGD, not as cute as MAiD.  They need to work on that.)

Dr. Smajdor’s paper has been met with varying amounts of horrified reactions from the popular and scientific community, decrying the possibility of humans being used as “incubators” for the wealthy. Frankly, we think that Dr. Smajdor is just being honest. We have discussed the surrogacy industry in California, at length, in the past.(16) This is just taking it to another, logical level. Now, what Dr. Smajdor misses is the fact that keeping brain-dead patients functioning is not very easy. In the past, where pregnant women have suffered an injury or illness that renders them brain-dead, their bodies have been kept functioning, sometimes for several days to weeks, in order to bring their child to a point where she can be safely delivered. These cases are not common and there is not a lot of scientific literature around the subject, but in the 20 or so cases reported over the last few decades, the average time on mechanical support was 7.5 weeks, with infants delivered at 22 to 29 weeks gestational age.(17) So, it can be done, but it is pretty difficult and not a particularly attractive target for a growth industry.

Women in persistent non-cognitive states, however, are a different story. The medical and lay literature is replete with cases of women in comas becoming pregnant and giving birth after a normal gestational period, usually as a consequence of sexual assault by one of their “caregivers.”(18) As we have discussed, maintaining physiologic function in the comatose is far simpler than in the brain-dead. This is the opportunity of the growth industry, at least at the moment.  Frankly, given the state of our society’s mores, we are surprised this is not an industry already in China or Canada. (Perhaps it is, I don’t follow Chinese advertising that closely.) In our ski-slope analogy, maybe this is one of those double-diamond slopes, skiable to the experienced and not impossible. If someone can attach a kidney to the leg of a brain-dead patient just to show that it can be done, is using women in persistent non-cognitive states for gestational surrogacy that much of a leap?

Finally, there is widespread “embryonic stem cell” research going on throughout the world.  “Embryonic stem cell” is a euphemism for very young living human beings. We have already discussed the horrific situation of the millions of unborn children, trapped as frozen embryos in IVF clinics around the world, awaiting their fates.(19) One of these fates is “donation” for scientific research. These children, created through an act of evil and selfishness, are then sent for experimentation upon, since they are not “human enough” to receive the protection, respect and dignity given to the more “worthy” human lives.  IVF is an evil industry, perpetrated by evil scientists and the humans created therein are sometimes used for evil purposes. I think they call that a trifecta.

Everything that can be conceived of will eventually be accomplished. The question is, should it?  In the future, could a great, great, great-grandson of Baron Von Frankenstein piece together a woman and re-animate dead tissue for the purpose of gestational surrogacy, biomedical research or pharmaceutical production? Would the “young Frankenstein” (great movie, by the way) be hailed as a “hero” for simultaneously providing “reproductive health care services,” while easing the problem of disposal of accumulating body parts? Perhaps he would receive a Lasker award, as was given to Étienne-Émile Baulieu for the invention of mifepristone, also known as RU486, the “abortion pill”?

The Catholic Church, usually a bulwark of clarity and consistency, has been a little less so on these issues. Over time, it has modified its position on the use and disposition of dead bodies.  For example, prior to 1963, cremation was forbidden. Owing to population and economic pressure, that was modified to permit cremation, but the ashes are still required to be interred in a cemetery of columbarium, rather than scattered at sea or placed on the fireplace mantle.(20) Similarly, the Church’s views of biomedical research are sort of broad and ill-defined, emphasizing a trade-off of respect for the body and person, versus benefit to others.  As Pius XII stated in his usual, academic way, “The public must be educated. It must be explained with intelligence and respect that to consent explicitly or tacitly to serious damage to the integrity of the corpse in the interest of those who are suffering, is no violation of the reverence due to the dead.”(21) Under those conditions, could medical students dissect the incorruptible remains of Saint Cecilia, or Saint Nicholas of Tolentino, or any of the incorruptible Saints, in an effort to research the aging and decomposition process?  If not, why not?

We think it is always best to go back to our fundamental principles when considering these issues. All human lives are unique and worthy, created in the image and likeness of God, sacred and cherished, from the moment of conception to natural death. The body is God’s special gift and should be treated with the dignity and respect due to this corporeal vessel of the immoral soul on earth. To wit:

  1. Biomedical research and teaching on the cardiac-dead body, that is, a corpse, should be done only when there are no other alternatives to its use and only for purposes important to the benefit and well-being of others. For example, virtual dissection is preferable to the use of corpses for medical student education.
  2. Biomedical research on brain-dead persons should be prohibited, except in cases of overwhelming and significant benefit to science and the well-being of others.
  3. Biomedical research on those in persistent non-cognitive states, but not dead, should be illegal, except for investigations that may directly benefit the patient on whom the research is performed. Organ harvesting from these patients should be illegal.
  4. Biomedical research on embryos, similarly, should be illegal, except when said research may benefit that specific embryo. Gestating embryos, for any purpose except the growth and eventual birth of the specific embryo, including organ and tissue harvesting, should be illegal.
  5. Gestational surrogacy, in any patient, living or otherwise, should be illegal, as should be IVF and embryo storage. This does not preclude embryo adoption and gestation to free the children trapped in the frozen evil of IVF and only until those children are liberated from their hell on earth.

The ends do not justify the means.

Dr George Mychaskiw (4000 × 5000 px)

George Mychaskiw II, DO, FAAP, FACOP, FASA
Founding President
Saint Padre Pio Institute for the Relief of Suffering
School of Osteopathic Medicine


  17. Esmaeilzadeh, Majid; Christine Dictus; Elham Kayvanpour; Hamedani; Michael Eichbaum; Stefan Hofer; Guido Engelmann; Hamidreza Fonouni; Mohammad Golriz; Jan Schmidt; Andreas Unterberg; Arianeb Mehrabi; Rezvan Ahmadi (2010). “One life ends, another begins: Management of a brain-dead pregnant mother-A systematic review-“BMC Medicine8(74): 74. doi:1186/1741-7015-8-74PMC 3002294PMID 21087498.