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In this week's issue of The New England Journal of Medicine, Henry Aaron -- not the baseball legend, the senior fellow at the Brookings Institute, takes a look at waste in the medical system. He says, among other things, that it will take a long time to root out, which is why it's important to start now.

The Journal also has posted an article examining reproductive-freedom issues as outlined by the two major presidential candidates. Once confined primarily to abortion-related issues, this area now covers greater, and grayer, issues such as embryonic stem-cell research.

And this article examines our country's problems -- and problems they are -- with reproductive health.

This week's New England Journal of Medicine offers three publicly available full-text articles that raise thorny questions about the profession's relationship to government.

One addresses the considerations that must be balanced when a medical professional offers advice to a campaign or government. The advisers occupy:

... a role awash in ambiguity, opportunity, and risk. The adviser is the president's ally — in the lingo of organizational economics, an "agent" serving the interests of a "principal." Yet as a bearer of specialized knowledge, the adviser is also responsible to a larger profession, to its values and commitments, and ultimately to the ideal of expertise itself.

The adviser, in short, must both "speak truth to power" and aid in the exercise of power, both offering unbiased intelligence and acting as a very biased assistant. It is fashionable to pretend these two roles are the same, but they are not. An expert adviser has special knowledge, training, and skills — all of which are needed more than ever in the White House. The question is whether these talents can really be used, or be useful, in the bare-knuckles world of American politics — and, more important, whether the values they embody can be upheld when science, advocacy, and democracy collide.

Even higher stakes, affecting individual patients, are involved, when a physician serves in, or with, the military. Such doctors must deal with questions such as whether to help in the interrogation of prisoners (some of whom have died in U.S. custody); whether to force-feed prisoners who refuse to eat; what standards to use in certifying soldiers to be deployed, or re-deployed, for combat; and whether to use psychotropic drugs as a way to get psychologically damaged soldiers back into combat.

A third article examines in more detail the conflict between the military and the profession over the issue of physicians over interrogation. In some cases, the article says, what doctors are asked to do directly violates professional standards.

The timing of these articles, particularly the latter two, ties in with today's anniversary of the 2001 terrorist attacks as the profession and the military continue today to deal with consequences of those attacks. I welcome discussion on the issues and questions they raise.

One reason Wake Forest University is starting a master's program in bioethics is that biotech advances are outstripping the framework the medical profession has for examining the ethical issues such advances raise. Here's one example: direct-to-consumer genetic testing that gives people interpretations of their own DNA, which has gained regulatory approval in California.

What exactly a layman is supposed to do with this information isn't entirely clear. But as knowledge about the human genome grows, we're likely to see more such services -- and need to be prepared to wrestle with the ramifications.

The nonprofit group LifeSharers says that the first crack at transplants for those who need them should go to people who are organ donors themselves.

What do you think?