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What is a ‘textbook’ execution?

February 4, 2024
Editor, First Opinion

When Joel Zivot — an anesthesiologist and expert on the role of medicine in capital punishment — emailed me to say that he was interested in writing about the impending execution of an Alabama inmate by nitrogen, I admit I was a little skeptical. Not about Joel, but about whether the execution of Kenneth Smith was actually going to happen. I kept thinking some court would order at least a temporary delay. 

But then, on the evening of Thursday, Jan. 25, it happened. For the first time, a U.S. death row inmate was executed by nitrogen. 

On Monday, I published Joel's powerful piece on what we know and, more importantly, what we don't know about Smith's final minutes. It was an execution that Alabama officials called "textbook," but Joel writes, "As no one anywhere in the world had used this technique for execution, I wonder: Where might I find such a textbook?"

Joel goes on to discuss how, based on its self-proclaimed success, Alabama is now offering to help other states create nitrogen execution protocols — but has shared virtually no useful scientific information with the public. "Alabama may be finally moving away from its debased and torturous version of intravenous anesthesia only to replace it with a torturous version of inhaled gas delivered by a mask. The state can't seem to shake a need to impersonate the practice of anesthesiology," he writes.

The piece is a must-read.

Also in First Opinion this week: Shella Keilholz was part of the mass exodus from NeuroImage's editorial board last year. Now, she's explaining why she and her colleagues quit to start their own scientific journal. "Scientists like me are beginning to rebel against the unjustifiable waste of resources" of subscription fees and "article processing charges, she writes. 

Paula Stephens, who studies how the U.S. structures and funds biomedical research, writes about the promise and limitations of the newly announced Arena Bioworks. In an excerpt from her fantastic new book "Legacy: A Black Physician Reckons with Racism in Medicine," Uché Blackstock writes about the birth of emergency medicine and its enduring intersection with racism. David Kappos and Andrei Iancu, both former undersecretaries of commerce for intellectual property and directors of the United States Patent and Trademark Office, raise the alarm about IP waivers for Covid treatments and diagnostics. Robert Klitzman, director of the masters of bioethics program at Columbia University, says the pope is missing something key on commercial surrogacy. After a rough business and regulatory year, what comes next for digital therapeutics? "What country has the best health care?" is the wrong question. And despite what some in Congress think, Medicare does not need to be in lockstep with the FDA.

Recommendation of the week: "Beware the Woman" by Megan Abbott is, in many ways, a typical Abbottian novel: It's a thriller offering an incisive exploration of gender and family dynamics. But unlike most of her books, this one isn't focused on teenage girls — it's about a newlywed who finds herself in a remote small town where nothing feels quite right, just as her pregnancy becomes difficult. 

Adobe

Can Arena Bioworks upend the traditional scientific research model in the U.S.?

Arena Bioworks' plan to build a biomedical research institute outside of the university is promising — but there is much to be learned.

By Paula Stephan


Medicare has different standards than the FDA. That's how it should be

Lobbyists appear to have convinced many policymakers and the public to demand that Medicare should pay for all drugs that the FDA approves.

By Diana Zuckerman


Where do we go from here on digital therapeutics?

Deep structural challenges threaten the future of "software as a medical device" and other digital health technologies.

By G. Luke Hartstein and John Torous



Adobe

Why I left the editorial board of the prestigious scientific journal NeuroImage — and helped start something new

A journal editorial board's rebellion threw the brain imaging research community into a frenzy. The rest of the world should take notice.

By Shella Keilholz


The Biden administration should not support a WTO petition to strip IP protections from Covid-19 treatments

There is no evidence to support claims that IP waivers could expand access to shots, therapeutics, and diagnostics in the developing world.

By David Kappos and Andrei Iancu


What the pope is missing about commercial surrogacy

The pope is right that the potential for exploitation exists in commercial surrogacy. But that doesn't have to be the case.

By Robert Klitzman


Photo by Scott Olson/Getty Images

The emergency room is where the United States' social problems come home to roost

In this excerpt from her new book "Legacy," Uché Blackstock examines how health disparities play out in the ER.

By Uché Blackstock


I'm an anesthesiologist. Kenneth Smith's execution by nitrogen gas was far from 'textbook'

An anesthesiologist and expert on capital punishment writes that Kenneth Smith's execution by nitrogen gas tells us nothing.

By Joel B. Zivot


Which country has the best health care? That's the wrong question

We should spend less time debating which model is ideal and more time learning from the nearly 200 natural experiments around the world.

By Irene Papanicolas


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