Tuesday, March 31, 2015

Parental Delay or Refusal of Vaccine Doses

"Parents who delayed and refused vaccine doses were more likely to have vaccine safety concerns and perceive fewer benefits associated with vaccines. Guidelines published by the American Academy of Pediatrics may assist providers in responding to parents who may delay or refuse vaccines."

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3113438/

Summary of last two presentations

We discussed Specie-ism. It was about whether or not animals were to be accepted at the same status as humans regard themselves. It was evenly split on whether animals had the same rights as humans. This topic was sparked by the discussion of whether or not it was "the right thing to do" to put animals to sleep when they are in pain and not for humans. The question more specifically, "why is assisted suicide immoral for humans but perfectly acceptable for animals?"

The last presentation was about genetic engineering. There were arguments for it, including that it does not mean that genetic engineering is playing God and that it was a moral obligation according to Savalescu. The arguments against were that it is delving into the unknown or unnecessary. Someone mentioned that if one must use the "it is wrong because it is playing God" argument that the point at which genetic engineering is playing God should be defined.
On immunity 135-163
FACT QUESTIONS

Everyone who is born holds dual citizenship,  in the kingdom of the ____________ and in the kingdom of the ___________. (P.135


______________ is essential to the health of any ecosystem  (p.161)

Discussion question

Do you believe that " immunity is a shared place- a  garden we tend together"? Or do you refer to immunity as a battlefield?

Consequences of Refusing Vaccines

"I fully support parents’ rights to choose not to vaccinate, but there are consequences to that decision.  I have had many conversations with parents in the middle of the night when their child has a fever and had to explain to them that because of their decision to not vaccinate, research indicates that their child is at a significantly increased risk for life-threatening diseases, and so will need invasive testing in the ER.  It will take hours, and it will hurt their child.  I tell them that the diseases we vaccinate against aren’t just nuisances; they kill and maim children every day, and they are almost completely preventable by vaccination."

http://www.voicesforvaccines.org/the-consequences-of-refusing-vaccines/

Bill Gates jumps further into vaccination debate with review of ‘On Immunity’
http://www.geekwire.com/2015/bill-gates-jumps-further-into-vaccination-debate-with-review-of-on-immunity/

Exam2 - QnA's...


Sandel Ch.5, Mastery & Gift

1. What does Sandel think the dissolution of "giftedness" would change about the "moral landscape"? (Name one of the three features it would transform.) 86
Humility, Responsibility, and Solidarity.

2. As more is subject to choice, less is attributed to what? 87
Chance

3. What's "playing naked"? -"flying blind"? 88-9
Playing without the use of enhancing drugs

4. What is the inadvertent result of insurance industry practice that creates a de facto social safety net? 90
Pooling the risk of all people, healthy and not.

5. Is "changing our nature to fit the world" necessary or desirable, according to Sandel? 97
No. It’s the deepest form of disempowerment.

6. Who called the new technologies of genetic intervention a "cosmic event"? 98-9
==
Sinsheimer.
Quiz March 17

1.      What constrains medical intervention in nature? 101
The goal of restoring normal human function

2. What embryonic stem-cell research compromise was supported by Bill Frist and Mitt Romney? 106
Using spare embryos left over from fertility clinics

3. In what way does Sandel agree with Sen. Brownback about stem cell research? 111
moral arguments for stem cell research and cloning stand or fall together.

4. What does not follow from the fact that the blastocyst is "human life"? 115
That it is a human being.

5. Under what conditions would pregnancy constitute a public health crisis? 125
If the embryo loss that accompanies natural procreation where the moral equivalent of infant death.

6. Does Sandel support a ban on human reproductive cloning? 127
Yes

Quiz March 19


1.      The stories of Achilles and the dragon imply what about immunity?
Immunity is a mith… no mortal can be invulnerable.

2. "A valuable asset placed in the care of someone to whom it does not ultimately belong" is Biss's definition of what? OR, it captures her understanding of what? 9-10
What it is to have a child.

3. Our vaccines are now sterile, so anti-vaccine activists' greatest fear is not of bacterial but ____ contamination. 14
chemical

4. What is Dracula about, besides vampires?16
vaccinators inflicting “wounds” on babies. Blood thirsty, spreading disease in old days… etc…

5. Who said love is known "by its fruits"? 17
Soren Kierkegaard

6. Contributions to the "banking of immunity" give rise to the principle of ____ immunity. 19
Herd Immunity

7. What's the most common way that infants contract hep B? 24
Mothers – bodily fluids

8. What raises the probability that undervaccinated children will contract a disease? 27
Large groups of unvaccinated children in nearby areas.

9. Who or what were microbiologist Graham Rook's "old friends"? 30
Ancient Pathogens, Worms, bacteria, and parasites from long ago.

10. "There is never enough evidence to prove that an event _____ happen? (can/can't) 36
Can’t

11. When do we see disease as unnatural? 42
When disease manifests as illness.

12. What is variolation? 52
Purposefully infecting a person with a mild case of smallpox to avoid serious illness.

Quiz March 24


1.      What disappointed Biss about the immuno-semiotics conference? 55
That the conference was more concerned about how the body and not the mind interprets symbols.

2. What game metaphor does Biss prefe, to describe our immune systems and viral pathogens? 60
Chess

3. What caused the fatal form of croup that has virtually disappeared in this country since the '30s? 65
Diphtheria

4. What caused the spread of puerpal sepsis ("childbed fever")? 69
Doctors who did not wash their hands between exams.

5. What did Andrew Wakefield do to get branded "irresponsible and dishonest" by the British General Medical Council? 69-70
Released article saying MMR vaccine might be linked to autism.

6. A popular theory of disease among "people like [Biss]" blames ____, rather than filth or germs. 73
Toxins

7. If ___ were sold at Piggly Wiggly, some stock would exceed federal food safety levels for DDT & PCBs. 74
Human milk

8. Who were the Polio Pioneers?
650000 children who got volunteered for the polio vaccine. OR, Where is polio now endemic? 84-5 Pakistan, Afghanistan, and Nigeria.

9. What does Biss consider the greatest impoverishment of capitalism? 97
When we begin to believe that everyone is owned (capitalism as innate laws of human motivation).

10. What does Arthur Caplan see as the biggest problem with the "restaurant model" of health care? 99
Doctors giving patients what they want, even if its not good for them.

BONUS: "Most problems will get better if left alone" is an argument for what, according to Biss? 104
For preventative medicine as much as it is a sign of defeat (not sure about this one)

BONUS: What's wrong with "Dr. Bob's world"? 108
It relies on future scientific knowledge to disguise a gamble.

Quiz March 26


1.      What does Paul Offit find laughable? 112
That people would go into research to make money by finding a cure for something.

2. How much revenue did the rotavirus vaccine
(665mil) and Lipitor (12bil) generate, respectively? 113

3. What did a Nashville woman sell for $50? 116
Lollipops infected with chicken pox.

4. What did Jacobsen v. Massachussetts (1905) uphold? 120
Compulsory vaccination laws

5. What 20th century political philosopher does Biss's sister mention, in criticizing "Dr.Bob's" counsel of silence? 123
John Rawls

6. What paradoxical emotional state does Biss say is induced by citizenship in this country? 134

Empowered powerlessness.

Monday, March 30, 2015

Antimicrobial Resistance

As I was reading through On Immunity, I saw a portion talking about resistant bacteria, and it made me curious as to the worldwide effects.  Here's an article from WHO.

http://www.who.int/mediacentre/factsheets/fs194/en/

Friday, March 27, 2015

Ken Burns tackles cancer



(Watch full episodes here... and think about whether you'd be interested in reading/discussing the book-available from amazon for about $11.)

Cancer: The Emperor of All Maladies, based on the Pulitzer Prize-winning book by Siddhartha Mukherjee, tells the complete story of cancer, from its first description in an ancient Egyptian scroll to the gleaming laboratories of modern research institutions. At six hours, the film interweaves a sweeping historical narrative; with intimate stories about contemporary patients; and an investigation into the latest scientific breakthroughs that may have brought us, at long last, to the brink of lasting cures.
Visit Cancer: The Emperor of All Maladies Website

Airs on PBS beginning Monday, March 30.

Early in Monday’s first installment of PBS’s “Cancer: The Emperor of All Maladies,” a statistic about cancer’s toll in the United States is offered to convey the magnitude of the subject. “More will die from cancer over the next two years than died in combat in all the wars the United States has ever fought, combined,” the narration says.
It’s an apt comparison, because what follows, in three episodes of two hours each, is itself the story of a war that has been going on for centuries. This fight has had risk-takers, mistake-makers, heroes and casualties just like any armed conflict, but watch long enough and some specific wars might come to mind — Vietnam, for instance, or the war on terror. The battle has grown more complex as it has gone along, and clear victories have been hard to come by.
This absorbing series, directed by Barak Goodman, has as an executive producer, Ken Burns, who knows something about how to make a documentary about a war and how to make history come alive. It’s atimeline of humanity’s long effort to cure cancer, going back to the preindustrial age but concentrating on the last 75 years or so... (continues at nyt) 
==
Teenagers Face Early Death, on Their Terms- A national push and a new guide are giving critically ill young patients a voice in end-of-life discussions.

Company Thinks It Has Answer for Lower Health Costs: Customer Service- An innovative practice hopes its patient-centered methods will work on a national scale, allowing it to expand without losing effectiveness.

Learning to Say No to Dialysis-Some older adults with advanced kidney failure are resisting the usual answer by deciding the sacrifices required by the treatment aren’t worth it.


Trying to Fool Cancer-Which mutations are evil, and which are innocent?
Without doubt, therapies that target genetic abnormalities have made huge inroads in the survival of cancer patients, most notably in some chronic leukemias, melanomas and lung and breast cancers.
But they haven’t been curative. And we shouldn’t delude ourselves, or our patients, in thinking that standard chemotherapy is a thing of the past. Or that a few more months of life, which is what many targeted drugs have been able to deliver on average, is a panacea in cancer care.

Death, Redesigned - The California Sunday Magazine

Polio to treat cancer? Scott Pelley reports on Duke clinical trial - CBS News

Thursday, March 26, 2015

Study Guide, exam #2

EXTRA CREDIT: Reply in a couple of paragraphs to the relevant DQ of your choice, OR to this one: Imagine you are a pediatrician or general practitioner, and your client insists on refusing all vaccinations for her child. What's your response, and your policy? Will you work with her, attempt to educate her, or simply dismiss her?
==
Review for the exam by revisiting relevant texts.
(Thanks for assembling the study guide, Gregory!)

Quiz March 3
Sandel Ch.5, Mastery & Gift

1. What does Sandel think the dissolution of "giftedness" would change about the "moral landscape"? (Name one of the three features it would transform.) 86

2. As more is subject to choice, less is attributed to what? 87

3. What's "playing naked"? -"flying blind"? 88-9

4. What is the inadvertent result of insurance industry practice that creates a de facto social safety net? 90

5. Is "changing our nature to fit the world" necessary or desirable, according to Sandel? 97

6. Who called the new technologies of genetic intervention a "cosmic event"? 98-9
==


Quiz March 17
1. What constrains medical intervention in nature? 101

2. What embryonic stem-cell research compromise was supported by Bill Frist and Mitt Romney? 106

3. In what way does Sandel agree with Sen. Brownback about stem cell research? 111

4. What does not follow from the fact that the blastocyst is "human life"? 115

5. Under what conditions would pregnancy constitute a public health crisis? 125

6. Does Sandel support a ban on human reproductive cloning? 127


Quiz March 19


1. The stories of Achilles and the dragon imply what about immunity? 5

2. "A valuable asset placed in the care of someone to whom it does not ultimately belong" is Biss's definition of what? OR, it captures her understanding of what? 9-10

3. Our vaccines are now sterile, so anti-vaccine activists' greatest fear is not of bacterial but ____ contamination. 14

4. What is Dracula about, besides vampires?16

5. Who said love is known "by its fruits"? 17

6. Contributions to the "banking of immunity" give rise to the principle of ____ immunity. 19

7. What's the most common way that infants contract hep B? 24

8. What raises the probability that undervaccinated children will contract a disease? 27

9. Who or what were microbiologist Graham Rook's "old friends"? 30

10. "There is never enough evidence to prove that an event _____ happen? (can/can't) 36

11. When do we see disease as unnatural? 42

12. What is variolation? 52


Quiz March 24


1. What disappointed Biss about the immuno-semiotics conference? 55

2. What game metaphor does Biss prefer, to describe our immune systems and viral pathogens? 60

3. What caused the fatal form of croup that has virtually disappeared in this country since the '30s? 65

4. What caused the spread of puerpal sepsis ("childbed fever")? 69

5. What did Andrew Wakefield do to get branded "irresponsible and dishonest" by the British General Medical Council? 69-70

6. A popular theory of disease among "people like [Biss]" blames ____, rather than filth or germs. 73

7. If ___ were sold at Piggly Wiggly, some stock would exceed federal food safety levels for DDT & PCBs. 74

8. Who were the Polio Pioneers? OR, Where is polio now endemic? 84-5

9. What does Biss consider the greatest impoverishment of capitalism? 97

10. What does Arthur Caplan see as the biggest problem with the "restaurant model" of health care? 99

BONUS: "Most problems will get better if left alone" is an argument for what, according to Biss? 104

BONUS: What's wrong with "Dr. Bob's world"? 108


Quiz March 26


1. What does Paul Offit find laughable? 112

2. How much revenue did the rotavirus vaccine and Lipitor generate, respectively? 113

3. What did a Nashville woman sell for $50? 116

4. What did Jacobsen v. Massachussetts (1905) uphold? 120

5. What 20th century political philosopher does Biss's sister mention, in criticizing "Dr.Bob's" counsel of silence? 123

6. What paradoxical emotional state does Biss say is induced by citizenship in this country? 134

==
PLUS,

Questions on the concluding chapters of Biss's On Immunity, to be discussed prior to Tuesday's exam:

1. What "cultural obsession of the moment" do some mothers consider a viable substitute for vaccination? OR, what problematic implication of their obsession do some fail to consider? 137

2. Whose errant article "Deadly Immunity" was retracted, but only in its corrected version? 142

3. Who said "a scientist is never certain"? OR, Who advocated "negative capability"? 145

4. What was the bioethicist who said "it's not a matter of if, but when" referring to? 149

5. Immunologist Polly Matzinger's  _____ Model says the immune system is more responsive to entities that do damage than with those that are merely foreign. 160

6. Who said "we must cultivate our garden," which for Biss implies recognizing immunity as "a garden we tend together"?  162



New York, New York - Atul!

http://www.newyorker.com/contributors/atul-gawande

More on Atul!

http://us.macmillan.com/beingmortal/atulgawande

Food for thought!

http://news.nationalgeographic.com/news/2015/02/150206-measles-vaccine-disney-outbreak-polio-health-science-infocus/

leaving the anti-vaccer's world!

http://www.voicesforvaccines.org/leaving-the-anti-vaccine-movement/

Bad anti-vaccination arguments.

http://www.huffingtonpost.com/2015/02/05/anti-vaccine-arguments-analyzed-explained_n_6607026.html

On "Playing God"....

I'll preface this by stating that this is not meant to imply anything regarding my personal religious beliefs, spirituality, etc.

I will ask a question which operates under this assumption: Those who believe in a higher power (whom I'll very originally refer to as "God") presumably believe that said God also created nature and its laws.

My question is this: If God created nature and its laws, is it even possible for us to play God? Aren't we obligated to operate under the natural laws of the universe?

My personal belief is that, in reality, science and technology are actually just representations of our knowledge of how the natural world works. Therefore, I would argue that we cannot really play God, since all things we are able to accomplish and create must inherently operate under the laws of nature, and in fact may just be a "forceful manipulation" of those laws that were already in place.

Discuss!
On Immunity p. 110-134

Fact questions

1. _____________, one of the slogans common to vaccine activism, could easily be a critique of just about any aspect of our modern lives. (p.110)

2. Who is Dr. Paul Offit? (p.111)

3. What does the term conscientious objector mean? (p. 118)

4. Who wrote that "we have a duty to ourselves to examine our conscience? ?(p.121)

5. What is body politics? (p. 125)

6. In immunology, the term regulation refers to what? (p. 131)


Discussion Questions

1. Do you believe that conscientious objection is a good reason for parents to not vaccinate their children?

2. Are parents that choose to not vaccinate their children living in an" illusion of independence"?

'Conscientious objectors' forgo vaccines for their kids

http://www.myfoxorlando.com/story/27979201/conscientious-objectors-forgo-vaccines-for-their-kids

Is this "playing God"?

If so, I'm for it.

Why Doctors Are Trying A Skin Cancer Drug To Treat A Brain Tumor 

Listen to the story here.
MaryAnn Anselmo feared for the worst when she was diagnosed with a brain tumor called a glioblastoma in late 2013.
"You start doing research on that type of tumor, and you're saying, 'Oh my God, you're history.' It's like a death sentence," says, Anselmo, now 59.
Only for her it wasn't.
Anselmo's successful treatment shows how precision medicine — tailoring therapy to each patient's genetic needs — is beginning to transform cancer care.
At first, the outlook seemed grim. Although Anselmo's surgeon was able to surgically remove most of her tumor, she couldn't tolerate traditional chemotherapy that was the planned second step, and had to discontinue it.
Find other stories in the Living Cancer series at WNYC.org.
Find other stories in the Living Cancer series at WNYC.org.
WNYC
The chemo failure was the latest in a string of personal setbacks.
The year before she was diagnosed with brain cancer, she'd lost her son to suicide. Weeks after that she was almost killed in a car crash outside a local mall. Her cancer was discovered after she had a dizzy spell, and her husband, Joseph, insisted she return to the hospital to have it checked out.
After all that, Anselmo and her husband weren't ready to give up on her cancer fight. He'd read about advances in targeted therapies — drugs that go after cancer cells at the molecular level.
The family sent samples of her tumor samples for genetic testing to several leading cancer hospitals. Memorial Sloan Kettering Cancer Center, where she was being treated, also did its own sequencing. They all found the same thing. Anselmo's tumor had a BRAF mutation common in skin cancer, but very unusual for a brain tumor.
Her oncologist, David Hyman at Memorial Sloan Kettering, enrolled Anselmo into a new kind of drug trial. Called a basket trial, the study is designed to include people whose tumors have the same kind of genetic fingerprint regardless of where in the body the tumors are found.
Knowing more about the genetic mutations of a tumor enables doctors to find a potentially effective drug much more quickly and accurately. "It's like you're in a parking lot," Hyman says. "And you have a key to one of the cars in the parking lot. And so one option is just to go to each car and try to open the lock. The other is to know that it's the third car on the right. What we're doing now is we're saying, OK, this key fits that lock. And we're only going straight to that car."
When MaryAnn Anselmo sings jazz, her stage name is Mariel Larsen.i
When MaryAnn Anselmo sings jazz, her stage name is Mariel Larsen.
Courtesy of Kendell Mesick
Today, Anselmo is doing well. She's been in the clinical trial for a year now, and continues to take Zelboraf (orvemurafenib generically) daily. The pills have kept her cancer from growing.
There are side effects, of course. She's lost some peripheral vision, though she's been able to compensate. And Zelboraf is expensive, though it's free to Anselmo because she's taking it as part of a study.
Now she can focus again on the things she loves, like singing. Anselmo, a jazz singer who performed under the stage name Mariel Larsen before her illness, is planning a comeback. She's back in training with her longtime vocal coach.
As this kind of genetic sequencing of tumors has become faster and cheaper, more patients have access to this technology. More doctors are taking advantage of the information to treat patients with a targeted approach.
"We took a disease where nothing really works for any length of time and we've given her a year of life, and hopefully much more, where she's been much better," Hyman, her oncologist, says.
Still, he cautions that the targeted treatments can't be considered cures. At some point the drug that is keeping Anselmo's cancer at bay could stop working. "Every patient is different in how long it works," he says. "We all have patients that have been on these drugs for years. But I don't know, I mean, I think if I was being honest eventually our expectation would be that it would stop working."
There's no way to predict when. But in the meantime, patients like Anselmo are grateful to have time they wouldn't have had otherwise.
After all the misfortunes she's been through, it would be easy to think Anselmo has been incredibly unlucky. But she doesn't see it that way. No, she says after rehearsing for her comeback show, "I'm the luckiest."
Also on npr: seaworld responds to critics regarding treatment of whales here...