The Immortal Life Of Henrietta Lacks

Introduction

Cancer has been one of the most devastating ailments in the recent times. Indeed, statistics have shown that cancer is the second largest killer after malaria. A 2008 study showed that about 12.7 million new cases of cancer were diagnosed in the entire world, with female breast, lung, stomach and colorectal cancers being the most commonly diagnosed forms of cancers as they accounted for over 40% of all cases. On the same note, it is estimated that the disease causes more than 7 million deaths every year, with the figures continuing to rise. Needless to say, the ailment has claimed the lives of numerous people, both famous and nondescript. It is worth noting that extensive research has continually been done since time immemorial with an aim of having a comprehensive knowledge of the intricacies pertaining to cancer, its causes, symptoms, and especially, how it can be cured. While enormous discoveries have been made in this regard, one of the most fundamental discoveries in the history of cancer remains the HeLa cells. These cells are named after a woman called Henrietta Lacks, and are the basis of the book “The Immortal Life of Henrietta Lacks”.

“The Immortal Life of Henrietta Lacks” is a skillfully crafted investigation pertaining to a social wrong done in the medical field, as well as the resultant medical and scientific miracles. It takes the readers through the exceptional journey from the Johns Hopkins Hospital’s colored wards of the 1950’s to the white laboratories that have freezers full of HeLa Csells. It chronicles the journey from the small town of Clover, Virginia, where Henrietta Lacks used to live, to East Baltimore, where her kids and their kids currently live and fight with the legacy that her cells left. Indeed, it makes for a riveting story that details the collision between race, medicine and ethics, as well as a daughter that has numerous questions pertaining to the mother that she knew little about. Essentially, the story is connected to the dark history pertaining to the use of African Americans in experiments, the start of bioethics, as well as the legal battles pertaining to whether individuals have control over the materials that make them.

On 29th of January 1951, Henrietta Lacks was taken to Hopkins, which was the only key hospital close to their homes that could treat black patients. Lacks was diagnosed with cervical cancer and specifically the “Epidermoid carcinoma of the cervix, Stage I”. Henrietta had developed the cervical cancer known as carcinoma, which develops from epithelial cells covering and protecting the cervix’s surface. At this time, doctors in the institution were participating in a nationwide debate pertaining to the making of cervical cancer and the best technique for treating it. It was generally believed that the noninvasive type of cervical carcinomas were not fatal, in which case they mainly concentrated on treating the invasive type. However, one of the top cervical cancer experts Dr. Richard TeLinde disagreed with the notion and opined that the noninvasive type was simply an early stage of the invasive type. TeLinde had the uncanny history of using patients for research without their knowledge or consent. He had determined that 62% of women who had invasive cancer had initially been diagnosed with the noninvasive types. He contacted George Gey, who was Hopkins’ head of research on tissue culture in an effort to compare living samples derived from normal cervical cancer, and living samples from the invasive and noninvasive carcinoma. Gey had been striving to grow the first immortal human cells. In this case, Gey gladly tried to grow living samples from a supply of cervical cancer tissue that TeLinde offered him. It is worth noting that TeLinde had been collecting the tissues from all women that had cervical cancer including Henrietta Lacks. Lacks was, apparently treated successfully dr. Lawrence Wharton, who was a surgeon at Hopkins. Dr Wharton, however, collected samples samples of her healthy and cancerous cervical tissues and gave them to Dr. Gey, who successfully developed a culture of Henrietta’s cancerous cells. As the author notes, “Henrietta’s cells weren’t merely surviving, they were growing with mythological intensity” (Scloot 13). Unfortunately, Lacks died the same year at the age of 31. Following her death, doctors started planning an immense operation that would generate trillions of HeLa cells every week.

It is worth noting that HeLa cells have been used in the treatment of numerous ailments. Indeed, HeLa Cells have been crucial in the development of polio vaccine, uncovering of the varied hidden aspects of cancer, viruses, as well as the effects of atom bombs. In addition, it led in crucial advances in fields such as gene mapping, cloning, and in-vitro fertilization, as well as the treatment of influenza, herpes, leukemia, AIDS, Parkinson’s disease and hemophilia among others. The difference between Lack’s cells and those of others is that her cells had the capacity to live, as well as replicate outside the body. This essentially explains why just about any lab that deals with cell culture would have billions of the HeLa cells. The cells only need to be provided with the nutrients necessary for survival, after which they would apparently live and replicate forever. Testament to this is the fact that they have done this for the last 60 years since the first culture was obtained.

While this may be seen as a scientific breakthrough, the issue has raised numerous ethical issues. This is especially considering that Henrietta Lacks was not informed about the use of her cells in replication or even have her consent sought. Indeed, information pertaining to this was released 2 decades later. Neither her, nor her family had given consent to the use of such cells or even the release of such information to the public. In fact, the family came to know about it when companies started approaching them asking them for samples of their cells (Lodish 34). This essentially introduces a new dimension to the discussion, especially with regard to patient consent.

While the issues raised and the actions of the doctors at that time can only be termed as despicable, it is worth noting that there has been a paradigm shift in the laws governing medical research since the 1950s to the current times. Scholars have noted that, in that era, it was common for doctors and surgeons to obtain cells from their patients and use them in research and experiments without informing and seeking the permission of the patients or even their families (Lodish 45). The incident took place a long time prior to the adoption of ethical guidelines and regulations pertaining to biomedical research that currently requires researchers to get a voluntary, informed consent from their subjects or patients prior to the use of any of their information or cells in carrying out biomedical experiments (Lodish 45).

This, however, does not negate the irony of the fact that Henrietta’s kids were living a life of poverty in Baltimore, whereas their mother’s cells made up the first biological materials ever sold and bought and which played an immense role in assisting the launching of a multi-billion-dollar industry. Indeed, Henrietta’s family has largely been living a life of poverty with a large number of them being unable to afford even health insurance (Miller et al 34). In fact, one of Henrietta’s sons was homeless and lived in Baltimore’s streets.

This book comes with fundamental lessons to both the scientists and even people outside the labs. For scientists, the most fundamental less revolves around the fact that behind every biological sample that they use in the labs is a human being. Indeed, a large part of science is highly dependent on the use of human biological tissue in one way or the other. Unfortunately, scientists often see these cells as just some inanimate tools or instruments that are always in their labs (Miller et al 34). However, the individuals from whom these samples were derived had their own feelings and thoughts pertaining to the things that should happen to their tissues. Unfortunately, their thoughts and feelings are not considered a crucial variable when making such decisions. On the same note, it would be inaccurate to hold the story of the HeLa cells and the things that Henrietta went through as an illustration of a racist white scientist that was doing malicious things to a black woman. Indeed, as much as Hopkins was the key hospital that could treat black people, it is worth noting that other races were also treated in the same hospitals. What happened to her could also have happened to other women of other races, with the only difference being that her cells worked while the others did not (Miller et al 36). In any case, the surgeons and doctors did not violate any laws pertaining to privacy and informed consent as none existed at the time. On the same note, tissue culture is not bad at all especially considering the enormous proportion of medicine today that is dependent on tissue culture. Indeed, the demand for the cells will only rise in the future rather than go down. Rather than taking this as a cue for outlining the things that should not happen, it would be imperative that this comes as a wakeup call to determine the best way that tissue culture can occur in a way that would not leave anyone out.

In conclusion, the book “The Immortal Life of Henrietta Lacks” traces the life of a poor black woman, whose cells were the first ones to be successfully used in tissue culture. Henrietta Lacks was diagnosed with cervical cancer in January 1951 and died in October the same year. However, some tissue of her healthy and cancerous cervix were taken without her knowledge or consent and used in experimentation. It is worth noting that at that time, there were no rules pertaining to patient confidentiality and informed consent, in which case the doctors cannot be said to have acted illegally. However, it is ironical that her children have been living in poverty whereas her cells were the foundation of a multi-billion industry. This, nevertheless, should not be used as an illustration of a white racist doctor who took advantage of a black woman. It is imperative that doctors acknowledge that the cells they use were derived from people who have their feelings and thoughts regarding what happens to their tissue.

Works cited

Skloot, Rebecca. The Immortal Life of Henrietta Lacks. New York: Crown Publishers, 2010. Print

Lodish, Harvey F. Molecular Cell Biology. New York: Freeman, 2012. Print.

Miller, Tina., Birch, Maxine., Mauthner, Melanie and Jessop, Julie. Ethics in Qualitative Research. New York: SAGE, Sep 13, 2012. Print

Summary

            This paper discusses why Henrietta’s family need to be compensated from all the profits made from her cells. The paper has shown that HeLa cells are a significant milestone I medical research; as a result, the donor and her family members need to benefit from the profits accrued from the discovery using her cells. The noteworthy contributions made by HeLa cells warrant compensation. The need for compensation is justified by the fact there were various ethical and privacy violations underpinning the whole process. It is apparent that HeLa cells later developed to a multibillion dollar industry, implying that Henrietta Lacks and her family were entitled to profits made from the sale of her cells, and a violation of the ethical standards of practice involving the use of her cells without her informed consent. Suggested avenues for compensation include: ensuring that Henrietta Lacks receives a suitable headstone, establishing a scholarship fund for higher education for Henrietta’s descendants, ensuring that that commercial biotech firms establish a yearly Henrietta Lacks scholarship to facilitate the study of biology. In aIDition, Johns Hopkins should also offer medical care for the descendants of Henrietta at their hospital. The paper also suggests that a fraction of all profits should be directed to the family, and this financial model should be applied to all donors involved in lucrative biological studies.

 

 

Introduction

            Scientists and researchers concede that medical research depends significantly on human cells developed in the laboratory, in order to evaluate the functionalities of such cells, and test numerous theories concerning the causes and treatments of diseases (Fry, Veatach and Taylor 100). The cell lines needed for such experiments must be immortal, which implies that they should show signs of indefinite growth, split into a number of batches for use by numerous scientists, and frozen for long durations of time (Haggerty 10). In 1951, medicine received a significant boost derived from the discovery of the first immortal cell, which was discovered using a sample tissue acquired from a woman suffering from cervical cancer (Skloot 9). The immortal cells were later renamed HeLa cells, which have since become an essential tool in medical research. In the book The Immortal Life of Henrietta Lacks, Rebecca Skloot explores the source of the immortal HeLa cells and offers a comprehensive synopsis of impact of the HeLa cells on the field of medical research. Skloot uses an authoritative tone to advocate for a myriad of ethical considerations when undertaking bioresearch, which is somewhat justified considering the fact that the cells were obtained from Henrietta Lacks without her prior consent (Skloot 23). Although the HeLa cells have been bought and sold by numerous scientists, Henrietta’s family have not benefited from the profits made on those cell lines, the family cannot even afford to pay for their health insurance (Skloot 9). In the light of this view, this paper discusses how Henrietta and her family needed to be compensated from all the money made from her cells; the compensation for the family members draws on the fact that the immortal cells were derived from their mother’s cell.

Skloot (10) argues that the discovery of HeLa cells offered numerous opportunities for landmarks in medical research such as the use of immortal cells in vitro fertilization, mapping of genes, and cloning. This is attributed to the capability of HeLa cells to replicate indefinitely. In aIDition, the number of chromosomes found in HeLa cells is different from the typical cells found human beings (Starr, Evers and Starr 64). For example, the immortal cells have been utilized to facilitate the progress of scientific research discoveries. After making public the discovery of HeLa cell line by Dr. Gey, the immortal cells were utilized in the breeding of the poliovirus, a significant landmark in the development of polio vaccines (Haggerty 8). After the unearthing of the immortal HeLa cell line, they have been used in propagation and study of a number of viruses in an attempt to develop vaccines. Irrespective of the ethical issues underpinning the discovery of the HeLa cell line, they have made noteworthy contributions in medical research because of their capability to split up indefinitely while maintaining their genetic stability (Brooks 92). Reports by the National Library of Medicine estimate that about 61,900 studies have used HeLa cells, which have been instrumental widening the knowledge of diseases using the concept of molecular biology (Skloot 65). These contributions of the HeLa cells in medical research justify the need to compensate Henrietta’s family.

The discovery of the immortal HeLa cells imposed considerable impacts on medicine, especially concerning cell and molecular biology research (Starr, Evers and Starr 65). In aIDition, the unearthing of HeLa cells have been instrumental in highlighting the ethical issues when conducting a biological research involving samples obtained from human beings. HeLa cells were used initially in the propagation of vaccine for polio; however, its inception was a milestone in medicine because it facilitated numerous medical and scientific research studies that have been beneficial to humanity (Brooks 90). For instance, HeLa cells were used in the development of human-animal hybrid cells in 1965. Further, HeLa cells played an instrumental role in the discovery of human chromosomes in 1953. Skloot (50) affirms that the discovery of the immortal HeLa cells led to a number of advancements in cell culture techniques, which were essential in the conception of one of the earliest test tube infants in 1978. These contributions on medical research have been imperative in the elimination of human suffering, which justifies the need to compensate Henrietta’s family. Scientists have made huge profits from these contributions owing to the fact that human beings are usually willing to pay huge amounts to eliminate human suffering caused by diseases (Haggerty 10).

Brooks (94) points out that ethical considerations are a significant concern when it comes to bioresearch, especially biological studies involving human beings or tissue samples obtained from human beings. Brooks further maintains that the tissue samples used to develop the immortal HeLa cells were obtained from Henrietta Lacks without her approval. Further, neither Lacks nor the family benefited from this discovery and the profits made by the scientists following the discovery. Most medical experiments use biological tissues obtained from human beings; however, scientists do not perceive human cells as being animate (Holloway 79). As a result, the test subjects during scientific research are not considered when undertaking medical research. It is apparent that HeLa cells were the first human animate materials to be traded, which has then led to the establishment of a multi-billion dollar industry, yet Henrietta’s family has not benefited from the scientific discovery (Haggerty 9). Medical research should place emphasis on the underlying ethical issues when handling animate samples acquired from human beings. The goals of medical research can be for the good of humankind, but the issues involving ethical research and consent should not be disregarded, as in the case of using Henrietta Lacks cells to develop the immoral cell lines that were helpful in fostering scientific discoveries for saving humanity (Starr, Evers and Starr 64). Skloot (56) holds the view that Henrietta’s family was not aware of the debate surrounding the commercialization of human tissues despite the wide media coverage. Henrietta’s family believed that John Hopkins stole the cells from their mother, and owed them millions of dollars. Skloot (48) demonstrates the importance of medical research in eliminating human suffering, especially with regard to the discovery, production and later use of the immortal HeLa cells (Haggerty 9). Irrespective of the good intents associated with the discovery of HeLa cells, there are numerous ethical issues evident from the research. This does not rule out that bioresearch is bad; rather, it is imperative for scientists and researchers to take into account the ethical issues underpinning the use of animate human samples (Starr, Evers and Starr 66). In 1950s, the aspect of informed consent was not developed as in the present day. Cases of people used in research without their knowledge were rampant. Further, scientists had little knowledge regarding the fundamental functioning of cells. Irrespective of this viewpoint, it is apparent that HeLa cells later developed to a multibillion dollar industry, implying that Henrietta Lacks and her family were entitled to profits made from the sale of her cells, and a violation of the ethical standards of practice involving the use of her cells without her informed consent (Holloway 79).

The debate surrounding the production and use of HeLa cells extends beyond their usage without Henrietta’s consent. There is much more to HeLa cells; for instance, the family was not informed of the existence of the HeLa cells until the 1970s, when scientific researchers intended to undertake a research on Lacks children in order to learn more concerning the cells (Brooks 95). Henrietta’s children were used in the study without their consent and without having most fundamental queries regarding cells answered; for instance, “What is a cell?”, and “What does it mean that Henrietta’s cells are alive?” There are other numerous things that Henrietta’s family later found upsetting; for instance, Henrietta Lacks medical records were released and published by a reported without the approval of the family, which was extremely traumatizing for Henrietta’s children (Holloway 77). Henrietta’s children were extremely angry after discovering that individuals were buying and selling their mother’s cells, which was instrumental in launching a multibillion dollar industry, yet the family did not benefit from any obtained from the commercialization of these cells. At present, Henrietta’s family cannot afford to pay for health insurance (Skloot 9).

Skloot (66) maintains that Henrietta’s family has reached a point whereby they are attempting to separate what occurred with their mother’s cells from what occurred to them. It is evident that Henrietta’s cells have been valuable for scientific research and medicine, and Henrietta’s family perceives this as a miracle. However, things could have been different if the family could have been informed, asked and their queries answered when they asked (Holloway 79). Things could be different if Henrietta’s medical records had not been released. Henrietta Lacks family is currently unhappy about the manner in which they were treated. The family does not perceive the discovery of the immortal cells as dark or negative; rather, they are unhappy with the manner in which things transpired. Henrietta Lacks family members are still upset regarding the issue of money compensations; this is because other have benefited significantly from their mother’s cells, yet Henrietta’s family has not benefited, which is still the case today. Henrietta Lacks family has hopes that Hopkins and other companies that have benefited from the commercialization of HeLa cells should do something in order to honor Henrietta Lacks and acknowledge what the family experienced (Holloway 77).

Various people have come up to advocate for the compensation of Henrietta Lacks family in order to recognize the contribution of her cells in medical research. It seems strange that Henrietta’s cells have made considerable contributions in medicine, yet her family cannot afford to access medical doctors. Skloot (9) maintains that this does not make any sense. This state of affairs can be used to advocate for financial compensation for Henrietta Lacks family. Some suggestions to ensure that biomedical community recognizes the HeLa cell lines include: ensuring that Henrietta Lacks receives a suitable headstone and establish of a scholarship fund for higher education for Henrietta’s descendants. In aIDition, Brooks (93) recommends that commercial biotech firms establish a yearly Henrietta Lacks scholarship to facilitate the study of biology. Johns Hopkins should also offer medical care for the descendants of Henrietta at their hospital. Fry, Veatach and Taylor (102) argue that a fraction of all profits should be directed to the family, and this financial model should be applied to all donors involved in lucrative biological studies. Fry, Veatach and Taylor (103) further oppose the ruling that once the tissues have been detached from the body, donors do no longer own them. Similar sentiments were echoed by Haggerty (8), who believes that willing donating tissue samples does not warrant a compensation, wherein the donor does not need financial compensation. However, this was not the case with the discovery of HeLa cells. There was no prior understanding of what transpired, and there were cases of privacy violations. Further, although the informed consent was issued, it was not valid. The process was devoid of effective communication involving the patient, family members and the medical team; as a result, there is the need to compensate Henrietta’s family members by John Hopkins hospital for the dishonesty and unpleasant manner in which the tissue samples were acquired, and especially the biotech companies that benefited financially from the discovery. Starr, Evers and Starr (65) take a similar stand by claiming that Henrietta Lacks and her family have an absolute right to compensation for the commercialized use of the tissues and rectification of the deception behind the whole process. Perhaps, the financial compensation for the Henrietta Lacks family should be derived from the biotech firms that profited from the discovery and the John Hopkins hospital. The family should trace all the firms that used HeLa cells in their medical research and file a suit claiming for compensation. Further, such firms should compensate the Henrietta family out of kindness and decency in their heart, which can be implemented in the form of social responsibility.

Assessing the need to compensate Henrietta Lacks family can be evaluated using the aspect of social justice in examining the ethics of science (Holloway 77). The two aims of social justice include improving the well being of humanity and eradicating the densely woven patterns that undermine the core components of well being, which include personal security, respecting other people as moral agents, affection and attachment, health, self determination and reasoning capacities to think in relation to the world. Applying the social justice theory in the context of Henrietta Lacks, Holloway (79) introduces counterfactuals, which are usually referred to as the “what if statements”. For instance, what if the Lacks Family were compensated? What if Henrietta was a wealthy white person having access to health insurance? Would this story raise concerns of social justice? Holloway (80) uses the social justice theory to argue for compensation of Henrietta’s family because of the social injustices that the family faced, even after their mother’s cells were used in spearheading one of the most essential breakthroughs in medical research.

To sum up, it is apparent that the paper has provided justifications as to why Henrietta Lacks and her family needed compensation following the use of immortal cells discovered from her tissue samples. Some of the fronts used in arguing for the need to compensate Henrietta Lacks and her family include the noteworthy contribution of the HeLa cells in medical research, and deception and privacy violations involving the discovery, production and commercialization of the HeLa cells. In aIDition, the aspect of social injustices has been used in advocating for compensation of Henrietta and her respective family members. Monetary compensation should stem from the biotech companies that made huge profits out of HeLa cells and John Hopkins hospital, which deceived the family regarding the discovery of HeLa cells.

Annotated Bibliography

Brooks, Micheal. 13 things that don’t make sense: The most intriguing scientific mysteries of           our time. New York, NY: Profile Books, 2010. Print.

Brooks advocates for the compensation of Henrietta Lacks family on accounts of the experiences of the family, yet biotech corporations made enormous profits from their mother’s cells. Brooks recommends that profit-making biotech firms set up a yearly Henrietta Lacks scholarship to assist in the study of biology. Johns Hopkins should also offer medical care for the descendants of Henrietta at their hospital

Fry, Sara, Robert Veatach and Carol Taylor. Case studies in nursing ethics. Sudbury, MA: Jones   & Bartlett Publishers, 2011. Print.

The authors advocate for a compensation of Henrietta Lacks family using a fraction of all profits generated from the trade of HeLa cells, and this financial model should be applied to all donors involved in lucrative biological studies. The authors further oppose the ruling that once the tissues have been detached from the body, donors do no longer own them. This was an important resource in charting the methods for compensating Henrietta’s family.

Haggerty, Carolyn. “The immortal life of henrietta lacks.” Internet Journal of Catholic Bioethics    6.1 (2011). Print.

According to Haggerty, donating tissue samples does not merit a monetary compensation, wherein the tissue donor does not need financial compensation. However, this was not the case with the discovery of HeLa cells. Prior understanding of what took place was lacking and there were cases of privacy violations, as evident in the release and publishing of Henrietta’s medical records. In aIDition, although the informed consent was issued, it was not valid. The process was devoid of effective communication involving the patient, family members and the medical team; as a result, the author states that there is the need to compensate Henrietta’s family members by John Hopkins hospital for the dishonesty and unpleasant manner in which the tissue samples were acquired, and especially the biotech companies that benefited financially from the discovery. This was an important resource in justifying the need to compensate Henrietta’s family.

Holloway, Karla. Private bodies, public texts: race, gender, and a cultural bioethics.           Durham, NC: Duke University Press, 2011. Print.

The author used social justice theory to argue for monetary compensation of Henrietta’s family because of the social injustices that the family experienced, even after their mother’s cells were used in leading one of the most indispensable advancements in medical research. The author argues that the case of Henrietta was analogous to the social injustice, which warrants monetary compensation for numerous ethical and rights violations.

Skloot, Rebecca. The immortal life of henrietta lacks. New York: Crown Publishers, 2010. Print.

Skloot illustrated the value medical research in eliminating human suffering, particularly regarding the discovery of the immortal HeLa cells. Irrespective of the good intention of medical research, Skloot argues that there are a number of ethical issues arising from such experiments, especially when they use tissues obtained from human beings. Therefore, Skloot advocates for the compensation of Henrietta’s family on accounts of ethical and privacy violations during the process. Biotech firms, particularly those that profited from selling HeLa cells, should adopt ways of compensating Henrietta’s family out of the kindness and honesty in their hearts. This is the primary source for the topic and was essential providing a synopsis of the case and debate surrounding HeLa cells.

Starr, Cecile, Christine Evers and Lisa Starr. Biology: Today and Tomorrow With Physiology.       New York, NY: Cengage Learning, 2009.

The authors argue that Henrietta Lacks and her family have a supreme right to be compensated for the commercialized utilization of the tissues from their mother’s cells, and rectification of the deception underpinning whole process. Conceivably, the monetary compensation for the Henrietta Lacks family should be undertaken by the biotech firms that made massive profits from the discovery and the John Hopkins hospital. The authors consent that the family should trace all the corporations that utilized HeLa cells in their medical research and file a suit demanding for monetary compensation. In aIDition, such corporations should reimburse the Henrietta family out of the kindness and decency in their heart, which can be implemented in the form of social responsibility.

Works Cited

Brooks, Micheal. 13 things that don’t make sense: The most intriguing scientific mysteries of our    time. New York, NY: Profile Books, 2010. Print.

Fry, Sara, Robert Veatach and Carol Taylor. Case studies in nursing ethics. Sudbury, MA: Jones   & Bartlett Publishers, 2011. Print.

Haggerty, Carolyn. “The immortal life of Henrietta Lacks.” Internet Journal of Catholic     Bioethics 6.1 (2011). Print.

Holloway, Karla. Private bodies, public texts: Race, gender, and a cultural bioethics.          Durham, NC: Duke University Press, 2011. Print.

Skloot, Rebecca. The immortal life of Henrietta Lacks. New York: Crown Publishers, 2010.

Starr, Cecile, Christine Evers and Lisa Starr. Biology: today and tomorrow with physiology. New  York, NY: Cengage Learning, 2009.