PHIL 3345. Supporting the philosophical study of bioethics, bio-medical ethics, biotechnology, and the future of life, at Middle Tennessee State University and beyond... "Keep your health, your splendid health. It is better than all the truths under the firmament." William James
Coronavirus as a Reminder of the Urgency of Getting Your Vaccines https://www.nytimes.com/2020/04/27/well/live/coronavirus-as-a-reminder-of-the-urgency-of-getting-your-vaccines.html?referringSource=articleShare
Top E.R. Doctor Who Treated Virus Patients Dies by Suicide https://www.nytimes.com/2020/04/27/nyregion/new-york-city-doctor-suicide-coronavirus.html?referringSource=articleShare
Hundreds of Miles From Home, Nurses Fight Coronavirus on New York's Front Lines https://www.nytimes.com/2020/04/28/nyregion/nurses-coronavirus.html?referringSource=articleShare
I Was Ready to Help Fight the Pandemic. Then I Got Sick Myself. https://www.nytimes.com/2020/04/24/magazine/surgeon-covid-diary.html?referringSource=articleShare
A new genetic engineering technology could help eliminate malaria and stave off extinctions — if humanity decides to unleash it.
One early summer evening in 2018, the biologist Anthony James drove from his office at the University of California, Irvine, to the headquarters of the Creative Artists Agency, a sleek glass-and-steel high-rise in Los Angeles. There, roughly 200 writers, directors and producers — many of them involved in the making of science-and-technology thrillers — were gathered for an event called Science Speed Dating, where James and other scientists would explain their work. The sessions were organized, James told me, “in hopes of getting the facts at least somewhat straight.”
Attendees were assigned to different groups, so each scientist had just seven minutes to describe his or her work to one group before running to the next room and starting over. “There were a lot of stairs, so I would get really out of breath,” James recalled. “I would arrive panting.” He also felt a bit overwhelmed. There were executives in expensive suits, young men and women looking unaccountably dressy in ripped jeans and, according to James, a disconcerting number of people wearing hats. Few, if any, had a deep knowledge of genetics; one participant in particular kept referring to “the dark genome,” as though that were a thing. “I had to tell him, ‘Real geneticists don’t usually talk that way,’ ” James said.
James began his presentation with a brief overview of mosquito-borne diseases like malaria and Zika. Then he turned cautiously to talking about his own area of scientific expertise: an obscure but powerful invention known as a gene drive. James began by noting that two brown-eyed human parents can sometimes produce a blue-eyed child, though only if both parents carry a copy of the recessive gene. A gene drive, he explained, was a tool that in some species could turn such events into a near certainty. For one thing, it guaranteed that a particular gene would be inherited, even if only one parent had it. And it would automatically insert the chosen gene into both copies of the offspring’s DNA, effectively turning a recessive trait into a dominant one. That alone, James explained, “lets you change the odds, so you get blue eyes 99 percent of the time.”
What made the gene drive truly strange and remarkable, though, was that it didn’t stop with one set of offspring. Generation after generation, it would relentlessly copy and paste the gene it carried, until it was present in every descendant. “For most of the people in the room, you could tell it was the first they’d heard of this,” James recalled. “You could see their eyes getting big.” (nyt mag, continues)
Comparing the dangerous effects of three diseases with the minimal side effects of their corresponding vaccines.
Vaccines prevent diseases, and being unvaccinated carries a risk. Last year, the World Health Organization ranked vaccine hesitancy, a “reluctance or refusal to vaccinate despite the availability of vaccines,” among the top 10 health threats worldwide, alongside Ebola, H.I.V. and drug-resistant infections.
To state it bluntly, being unvaccinated can result in illness or death. Vaccines, in contrast, are extremely unlikely to lead to side effects, even minor ones like fainting.
As vaccination rates have fallen, highly contagious illnesses like measles have resurged globally. For instance, measles is now widespread in several European countries. In Samoa, a Pacific island nation of about 200,000 people, almost 5,700 measles cases have been recorded since September, resulting in at least 83 deaths. Almost all of those who died were young children.
These deaths did not have to happen. In the United States, vaccine hesitancy is contributing to three public health threats: the return of measles, deaths from influenza and needless future cases of cervical cancer... (continues)
In 2015, an anti-vaccination campaign in Ireland caused a sudden fall in the uptake of the HPV vaccine. Then Laura Brennan got involved.
TRANSCRIPT
0:00/5:10
Terminally Ill at 25 and Fighting Fake News on Vaccines
We’ll need more than facts to fight medical misinformation
You all know about how fake news is threatening your democracy. But there’s another type of misinformation that’s threatening our very health. And this time, people are dying. I’m talking about medical misinformation. Roughly 49 percent of Americans believe in at least one medical conspiracy theory. When people are diagnosed, with cancer and they go online, they’re often hit with absolute falsehoods. These scare patients. And they either delay their conventional treatment or they sometimes reject it. My name is Dr. David Robert Grimes. I’m a cancer researcher. And when a vaccination confidence crisis came to Ireland, my home country, I found myself on the front line. Let me tell you about the human papilloma virus or H.P.V. Every year about 270,000 women die of cervical cancer caused by H.P.V. infection. But for the first time in our history, we now have a vaccine that prevents against it. It’s difficult to overstate how effective this vaccine has been. In America, H.P.V. infection in young girls has dropped about 88 percent. But then things changed. In Japan in 2013, sustained anti-vaccine activism led to a panic, which saw vaccination rates for H.P.V. dropped from 70 percent to less than 1 percent within a year or two. In 2014, a similar outbreak of panic came to Denmark. In the U.S.A., H.P.V. vaccination rates in adolescence remain critically low, hovering at around 16 percent. “The uptake rate for the H.P.V. vaccine has dropped.” In 2015, panic about the H.P.V. vaccine came to Ireland. “For some girls and young women, the side effects of Gardasil go well beyond a few months.” I couldn’t believe that I was hearing, such dangerous falsehoods about a vaccine that prevents 5 percent of all cancers. “We only ever wanted what was best for our girls.” Within a year or so, Irish vaccination rates had gone from highs of 87 percent to about 50 percent. It starts with this: As rational as we like to think we are, and as logical, the truth is that we emote first and we reason later. “And I watched my baby go boom and hit the ground.” You’ll often see a scare story that says — particularly a teenage girl — has had an adverse effect to this vaccination. “I believe with all my heart that the Gardasil vaccination did this to her.” And it’ll be delivered in a very frightening way that captures your attention. “I was such an intelligent girl and now I’ve just got this fog over my mind.” It doesn’t matter that the stories lack any veracity. What matters is they scare us and in scaring us we remember them. And in remembering them, we afford them more weight than they deserve. And so starts a vicious cycle. This explains why lies about the H.P.V. vaccine were able to do so much damage in so many countries. But in Ireland, what really changed the situation was a woman called Laura Brennan. When Laura was 24, she was diagnosed with cervical cancer, and by the time she was 25, that was metastatic noncurable. Laura was alarmed that people weren‘t getting this vaccine that could prevent women from being in the situation that she found herself in. Her campaigning started with a series of advertisements where she talked to parents directly to them. “Protect our future.” She was on talk shows. She was interviewed in magazines. “If anything good comes out of this, I would hope parents would get their daughters vaccinated. The vaccine saves lives. It could have saved mine.” She said, I am the reality of an unvaccinated girl. “So it just shows you how fast and aggressive my cancer is. But yeah, that’s life.” It’s no good just throwing facts of people until you can show them why those facts matter. In Ireland, thanks in large part to her campaigning, rates climbed back up over 70 percent, and are continuing to climb. It shows that you can reverse some of this damage. “When I found out that my cancer was terminal, I wanted to use my voice for good, and for the last 12 months, I haven’t shut up.” Laura exemplified something really, really important: That you never change minds without changing hearts as well. All the journal articles in the world, all the physicians and scientists in the world, saying something is for nothing if you can’t reach people on a visceral emotional level and show them why something matters. I was incredibly honored and privileged to be close to Laura Brennan. She passed away on the 20th of March 2019, aged only 26. But she leaves behind a legacy that will extend far beyond most of our lifetimes. And she will save more lives than a library of journal articles and scientific experts in isolation could ever hope to achieve. And that’s some legacy to leave behind.
00:00
5:09
5:09Terminally Ill at 25 and Fighting Fake News on Vaccines
We’ll need more than facts to fight medical misinformationCreditCredit...RTÉ TelevisionBy David Robert Grimes Dec. 11, 2019 Video by Adam Westbrook
In 2019, measles cases in the U.S. have been on the rise, much of it driven by false claims about the safety of the vaccine.
In the Video Op-Ed above, a cancer researcher, David Robert Grimes, confronts the rising trend of medical misinformation. From herbal remedies for cancer to vaccination horror stories, fake medical news is spreading fast on social media.
The effects can be severe, with anti-vaccination movements partly responsible for the resurgence of measles and other preventable illnesses.
In 2015, an anti-vaccination campaign in Ireland caused a sudden fall in the number of HPV vaccines administered, given to young girls and boys to prevent cervical cancer. Dr. Grimes tells the story of how, with the help of a remarkable woman named Laura Brennan, they were able to reverse the trend, and what countries like the United States can learn in their fight against medical misinformation.
David Robert Grimes (@drg1985), a cancer researcher and physicist, is author of “The Irrational Ape: Why Flawed Logic Puts Us All at Risk and How Critical Thinking Can Save the World.”
Ethics is a more inclusive matter than morality; it concerns character whereas morality concerns actions. Our actions will mainly of course flow from our character, but the targets of enquiry in ethics (seeking answers to What sort of person shall I be?) and in debates about morality (What is the right thing to do in this case?) are obviously not the same... A.C. Grayling, The History of Philosophy
In 1920s America, a mix of nativist sentiment and pseudoscience led to the first major law curtailing immigration. Okrent focuses on eugenics, which argued that letting in people of certain nationalities and races would harm America’s gene pool...
Written before her death last year from cancer at the age of 42, Yip-Williams’s book is a remarkable woman’s moving exhortation to the living.
== ‘THE UNDYING: Pain, Vulnerability, Mortality, Medicine, Art, Time, Dreams, Data, Exhaustion, Cancer, and Care’ By Anne Boyer (Farrar, Straus & Giroux). Boyer’s extraordinary and furious book is partly a memoir of her illness, diagnosed five years ago; she was 41 when she learned that the lump in her breast was triple-negative cancer, one of the deadliest kinds. But her story, told with searing specificity, is just one narrative thread in a book that reflects on the possibility — or necessity — of finding common cause in individual suffering.
Much of what we accept as legal in medical billing would be regarded as fraud in any other sector.
I have been circling around this conclusion for this past five years, as I’ve listened to patients’ stories while covering health care as a journalist and author. Now, after a summer of firsthand experience — my husband was in a bike crash in July — it’s time to call out this fact head-on. Many of the Democratic candidates are talking about practical fixes for our high-priced health care system, and some legislated or regulated solutions to the maddening world of medical billing would be welcome.
My husband, Andrej, flew over his bicycle’s handlebars when he hit a pothole at high speed on a Sunday ride in Washington. He was unconscious and lying on the pavement when I caught up with him minutes later. The result: six broken ribs, a collapsed lung, a broken finger, a broken collarbone and a broken shoulder blade.
The treatment he got via paramedics and in the emergency room and intensive care unit were great. The troubles began, as I knew they would, when the bills started arriving.
I will not even complain here about some of the crazy high charges: $182 for a basic blood test, $9,289 for two days in a room in intensive care, $20 for a pill that costs pennies at a pharmacy. We have great insurance, which negotiates these rates down. And at least Andrej got and benefited from those services... (continues)
COLORADO SPRINGS — Biology textbooks used in American high schools do not go near the sensitive question of whether genetics can explain why African-Americans are overrepresented as football players and why a disproportionate number of American scientists are white or Asian.
But in a study starting this month, a group of biology teachers from across the country will address it head-on. They are testing the idea that the science classroom may be the best place to provide a buffer against the unfounded genetic rationales for human difference that often become the basis for racial intolerance.
At a recent training in Colorado, the dozen teachers who had volunteered to participate in the experiment acknowledged the challenges of inserting the combustible topic of race and ancestry into straightforward lessons on the 19th-century pea-breeding experiments of Gregor Mendel and the basic function of the strands of DNA coiled in every cell.
It also challenges a prevailing belief among science educators that questions about race are best left to their counterparts in social studies.
The history of today’s racial categories arose long before the field of genetics and have been used to justify all manner of discriminatory policies. Race, a social concept bound up in culture and family, is not a topic of study in modern human population genetics, which typically uses concepts like “ancestry” or “population” to describe geographic genetic groupings.
But that has not stopped many Americans from believing that genes cause racial groups to have distinct skills, traits and abilities. And among some biology teachers, there has been a growing sense that avoiding any direct mention of race in their genetics curriculum may be backfiring.
“I know it’s threatening,” said Brian Donovan, a science education researcher at the nonprofit BSCS Science Learning who is leading the study. “The thing to remember is that kids are already making sense of race and biology, but with no guidance.”
Human population geneticists have long emphasized that racial disparities found in society do not in themselves indicate corresponding genetic differences. A recent paper by leading researchers in the field invokes statistical models to argue that health disparities between black and white Americans are more readily explained by environmental effects such as racism than the DNA they inherited from ancestors... (continues)
Supporting the philosophical study of bioethics, biomedical ethics, biotechnology, and the future of life, at Middle Tennessee State University and beyond... "Keep your health, your splendid health. It is better than all the truths under the firmament." William James
===
Our anchoring theme: the psychological and social dimensions of medicine and the life sciences from birth to death, with a special emphasis this semester on the “biopolitics” of new and emerging biotechnologies such as assisted reproduction, human genetic modification, and DNA forensics.”
Texts 2020 We’ll begin with these texts:
Bioethics: The Basics (Campbell) ”...the word ‘bioethics’ just means the ethics of life…”
Beyond Bioethics (Obasogie) “Bioethics’ traditional emphasis on individual interests such as doctor-patient relationships, informed consent, and personal autonomy is minimally helpful in confronting the social and political challenges posed by new human biotechnologies…”
Each student will also choose and report on an additional relevant text, thus enabling us to extend our study of the field by “crowd-sourcing” many more of the crucial issues it raises.
For more info contact phil.oliver@mtsu.edu, or visit http://bioethjpo.blogspot.com/
Letting Go Modern medicine is good at staving off death with aggressive interventions—and bad at knowing when to focus, instead, on improving the days that terminal patients have left.by Atul Gawande Thomas Monopoli was pregnant with her first child when her doctors learned that she was going to die. It started with a cough and a pain in her back. Then a chest X-ray showed that her left lung had collapsed, and her chest was filled with fluid. A sample of the fluid was drawn off with a long needle and sent for testing. Instead of an infection, as everyone had expected, it was lung cancer, and it had already spread to the lining of her chest. Her pregnancy was thirty-nine weeks along, and the obstetrician who had ordered the test broke the news to her as she sat with her husband and her parents. The obstetrician didn’t get into the prognosis—she would bring in an oncologist for that—but Sara was stunned. Her mother, who had lost her best friend to lung cancer, began crying.
The doctors wanted to start treatment right away, and that meant inducing labor to get the baby out. For the moment, though, Sara and her husband, Rich, sat by themselves on a quiet terrace off the labor floor. It was a warm Monday in June, 2007. She took Rich’s hands, and they tried to absorb what they had heard. Monopoli was thirty-four. She had never smoked, or lived with anyone who had. She exercised. She ate well. The diagnosis was bewildering. “This is going to be O.K.,” Rich told her. “We’re going to work through this. It’s going to be hard, yes. But we’ll figure it out. We can find the right treatment.” For the moment, though, they had a baby to think about.
“So Sara and I looked at each other,” Rich recalled, “and we said, ‘We don’t have cancer on Tuesday. It’s a cancer-free day. We’re having a baby. It’s exciting. And we’re going to enjoy our baby.’ ” On Tuesday, at 8:55 p.m., Vivian Monopoli, seven pounds nine ounces, was born. She had wavy brown hair, like her mom, and she was perfectly healthy.
The next day, Sara underwent blood tests and body scans. Dr. Paul Marcoux, an oncologist, met with her and her family to discuss the findings. He explained that she had a non-small cell lung cancer that had started in her left lung. Nothing she had done had brought this on. More than fifteen per cent of lung cancers—more than people realize—occur in non-smokers. Hers was advanced, having metastasized to multiple lymph nodes in her chest and its lining. The cancer was inoperable. But there were chemotherapy options, notably a relatively new drug called Tarceva, which targets a gene mutation commonly found in lung cancers of female non-smokers. Eighty-five per cent respond to this drug, and, Marcoux said, “some of these responses can be long-term.”
Words like “respond” and “long-term” provide a reassuring gloss on a dire reality. There is no cure for lung cancer at this stage. Even with chemotherapy, the median survival is about a year. But it seemed harsh and pointless to confront Sara and Rich with this now. Vivian was in a bassinet by the bed. They were working hard to be optimistic. As Sara and Rich later told the social worker who was sent to see them, they did not want to focus on survival statistics. They wanted to focus on “aggressively managing” this diagnosis.
Sara was started on the Tarceva, which produced an itchy, acne-like facial rash and numbing tiredness. She also underwent a surgical procedure to drain the fluid around her lung; when the fluid kept coming back, a thoracic surgeon eventually placed a small, permanent tube in her chest, which she could drain whenever fluid accumulated and interfered with her breathing. Three weeks after the delivery, she was admitted to the hospital with severe shortness of breath from a pulmonary embolism—a blood clot in an artery to the lungs, which is dangerous but not uncommon in cancer patients. She was started on a blood thinner. Then test results showed that her tumor cells did not have the mutation that Tarceva targets. When Marcoux told Sara that the drug wasn’t going to work, she had an almost violent physical reaction to the news, bolting to the bathroom in mid-discussion with a sudden bout of diarrhea.
Dr. Marcoux recommended a different, more standard chemotherapy, with two drugs called carboplatin and paclitaxel. But the paclitaxel triggered an extreme, nearly overwhelming allergic response, so he switched her to a regimen of carboplatin plus gemcitabine. Response rates, he said, were still very good for patients on this therapy.
She spent the remainder of the summer at home, with Vivian and her husband and her parents, who had moved in to help. She loved being a mother. Between chemotherapy cycles, she began trying to get her life back... (continues)
As public-health officials confront the largest outbreak in the U.S. in decades, they’ve been fighting as much against dangerous ideas as they have against the disease.
“People seem to think measles is some happy Norman Rockwell rite of passage,” New York’s health commissioner said.
One day in the early sixties, Saul Zucker, a pediatrician and anesthesiologist in the Bronx, was treating the child of a New York assemblyman named Alexander Chananau. Amid the stethoscoping and reflex-hammering of a routine checkup, the two men got to talking about polio, which was still a threat to the nation’s youth, in spite of the discovery, the previous decade, of a vaccine. At the time, some states had laws requiring the vaccination of schoolchildren, but New York was not one of them. In his office, on the Grand Concourse, Zucker urged Chananau to push such a law, and shortly afterward the assemblyman introduced a bill in the legislature. The proposal encountered resistance, especially from Christian Scientists, whose faith teaches that disease is a state of mind. (The city’s health commissioner opposed the bill as well, writing to Chananau, “We do not like to legislate the things which can be obtained without legislation.”) To mollify the dissenters, Chananau and others added a religious exemption; you could forgo vaccination if it violated the principles of your faith. In 1966, the bill passed, 150–2, making New York the first state to have a vaccination law with a religious exemption. By the beginning of this year, forty-six other states had a version of such a provision; it has proved to be an exploitable lever for people who, for reasons that typically have nothing to do with religion, are opposed to vaccination. They are widely, and disdainfully, known as anti-vaxxers... (continues)
