Three-parent IVF and Mitochondrial Diseases

June 12, 2013
The report by the Nuffield Council on Bioethics was produced in 2012

The report by the Nuffield Council on Bioethics was produced in 2012

In the past year, two major reports have been published concerning the ethics of “three-parent IVF”, in which a donated egg would be used to overcome disease arising from the small amount of genetic material found within mitochondria, the energy factories of the cell.

The first report Novel techniques for the prevention of mitochondrial DNA disorders: an ethical review was produced by the Nuffield Council on Bioethics (June 2012) – see summary of key findings.

In March 2013 the Human Fertilisation and Embryology Authority published their Advice to Government on Mitochondria replacement.

Both reports were largely in favour of the development. For examples of arguments against the technique see, for example, this post by the Christian Medical Fellowship.

A short animated video on the topic has been produced by second year students at the University of Leicester.


Rise of the Planet of the Apes – a bioethical feast

December 31, 2011

Rise of the Planet of the Apes, now available on DVD, was one of the blockbuster releases in the summer of 2011. A prequel to the classic series of films (5 cinema releases between 1968 and 1973, TV spin-off and Tim Burton’s 2001 remake of the main Planet of the Apes), the new movie tries to offer a plausible mechanisms for the evolution of apes into a dominant global force.

(Warning: contains spoilers!) The new film is a veritable gold-mine for discussion of ethical topics, it would make as excellent vehicle for an engaging “film night”. In terms of bioethical issues, the film touches on all of the following:

  • Research ethics – there are lots of examples where aspects of the conduct of research are raised (some of which are picked out specifically in the list below). The motivations for doing research are touched upon at several points in the film – these include financial gain, fame and a desire to do good, both for mankind in general and specifically for the benefit of a relative in need. GenSys boss Steven Jacobs (David Oyelowo) is the embodiment of profit as a driver for research whereas Will Rodman (James Franco) represents more noble aspirations. A discussion of the ethics of research funding could follow naturally. Read the rest of this entry »

Sister (book review)

October 13, 2010

 

book cover "Sister"

Sister is Rosamund Lupton's first novel

 

(Warning: contains minor spoilers!) Not to be confused with Jodie Picoult’s My Sister’s Keeper, which is about Preimplantation Genetic Diagnosis, Rosamund Lupton’s 2010 novel called simply Sister centres on a gene therapy trial.

The Hemming family know that they harbour the gene for cystic fibrosis (CF); Beatrice – the narrator of the story – has seen her younger brother Leo die of the disease and her pregnant sister Tess has been told that her child will also be a sufferer.

At the start of the book Tess has gone missing and Beatrice flies back from the USA to look for her. As Beatrice recounts the events that follow her search for her sister, it is clear that Tess’s decision to participate in a clinical trial of a gene therapy cure for CF lies at the heart of the story.

In terms of bioethics education and an explanation of some of the ethical tensions associated with gene therapy, the stand-out passage begins on p231 when Beatrice goes to visit Chrom-Med, the company behind the official trial. Chrom-Med use of an artificial chromosome to deliver a working copy of the CFTR gene, which codes for the Cystic fibrosis transmembrane conductance regulator protein.

The passage could be read to a class to introduce some of the issues. I would suggest starting with “At just before 9.30 a.m. I arrived at the Chrom-Med building…” on p231 and running through to “When will you be testing it on humans? You’ll make a killing then, wont you?” on p233. Reading this section aloud takes about three and a half minutes.

Alternatively – the novel was adopted as the Radio 4 Book at Bedtime for ten weekday nights (24th Sept to 1st Oct 2010) and was cited in Quentin Cooper’s Material World on 27th September 2010, so there may be valuable audio extracts there. Unfortunately these shows are no longer on iPlayer but I am investigating availability of audio recordings.


Blood & Guts – A History of Surgery: Spare Parts

February 11, 2009

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vlcsnap-146838Blood & Guts – A History of Surgery: Spare Parts is the third part of the BBC Four documentary series about the “brutal, bloody and dangerous history of surgery” focusing on the development of transplant surgery. The documentary primarily gives a graphic account of the history of transplant surgery, in particular focusing on the work of Alexis Carrel (00:04:24 – 00:22:47),  Joseph E. Murray (00:22:47 – 00:45:32) and Sir Roy Calne (00:36:40 – 00:45:32). However both at the beginning (Start – 00:04:24) and the end of the programme (00:45:32 – End) Michael Mosley (Also seen in BBC’s documentary series Medical Mavericks) discusses some of the ethical concerns that may arise from transplant surgery. Mosley meets with two patients who have both had a hand transplant, however only one of the patients is able to keep his new hand as it illustrates the success and failure of the radical surgery.

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Michael Mosley (00:02:00 - 00:04:24): "I'm really intrigued by David (patient because to me this is something more than just incredible surgery. The whole idea of living with a dead man's hand is one I find fascinating but also disturbing. A lot of people I've talked to are really freaked by the idea of having something like an arm transplant, its also true frankly of all the buts of the body that show like; noses, eyes, and faces probably the freakiest of them all. No other form of surgery impacts on our sense of self in quite the way transplants do. There is something profoundly strange about swoping body parts, melding your flesh with others. And these days there seems to be no limits."

Read the rest of this entry »


BBC Radio 4 – Cancer Tales

February 4, 2009
Listen again to Cancer Tales via the BBC iPlayer (available until Monday 2nd February 2009)

Listen again to Cancer Tales via the BBC iPlayer (available until Monday 2nd February 2009)

On Monday 26th January 2009 BBC Radio 4 broadcast Cancer Tales as the Afternoon Play (aired at 2.15pm). This interesting and emotional radio adaptation was based on the play of the same name written by Nell Dunn (first published in the UK in 2002 by Amber Lane Press) which provides fictional accounts of experiences of cancer diagnosis and treatment. The accounts are very emotional and moving, and include the perspectives of the patients themselves, their family members and, occasionally, members of their clinical care teams. Dunn’s narratives are based upon the real-life experiences of cancer patients and offer a true-to-life snapshot of their experience of cancer diagnosis and treatment. Thus, Cancer Tales provides an opportunity to see many aspects of medical care and services from the patients perspective. This is particularly the case with the recent Radio 4 adaptation, which, within it 45minute running time, focusses on three of the narratives contained in the original script. These are all female experiences and explicitly dealt with experiences of clinical services (as opposed to wider social and psychological themes connected to cancer diagnosis). Read the rest of this entry »


DNA – The Promise & The Price

January 26, 2009
"A child born in 1953, the structure of DNA has just been discovered. 1989 and this babies genetic fingerprint can be identified. The first single gene for Huntington's disease has been discovered. 2003 this child's entire genetic code can now be read and faulty genes in his DNA can be adjusted. Another birth, but this time no ordinary miracle. The babies sex and eye colour were decided before she was conceived; also her hair, the shape of her nose and her intelligence. The date of her birth? Perhaps only a few years from now. She's born from a revolution in genetics. A revolution where each new step brings new questions of ethics and responsibility. And as the promises of the science gets greater, so do the questions for all of us get bigger."

Narrator Bill Paterson: "A child born in 1953, the structure of DNA has just been discovered. 1989 and this baby's genetic fingerprint can be identified. The first single gene for Huntington's disease has been discovered. 2003 this child's entire genetic code can now be read and faulty genes in his DNA can be adjusted. Another birth, but this time no ordinary miracle. The baby's sex and eye colour were decided before she was conceived; also her hair, the shape of her nose and her intelligence. The date of her birth? Perhaps only a few years from now. She's born from a revolution in genetics. A revolution where each new step brings new questions of ethics and responsibility. And as the promises of the science gets greater, so do the questions for all of us get bigger."

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DNA – The Promise & The Price provides an excellent resource for discussing the ethical implications of advancing genetic research, focusing on; gene therapy, stem cells and cloning. The documentary examines the frontiers of genetic science, revealing how researchers attempt to fulfil DNA’s potential to help cure and prevent disease. It also questions how some aspects of these novel technologies may have significant consequences for individuals and society. Bill Paterson: “Much is promised by genetic science, the manipulation of our genes. But can it deliver? And if it does are we ready to take responsibility for meddling with the very fabric of life itself: our DNA”.

"When it comes to medical research, any medical technology

Professor Steve Jones: "When it comes to medical research, any medical technology that works, it is very quickly accepted by the public. Ethicists may not like it, scientists may not like it, but the public, if they believe it works they will accept it, and the legislation will always follow. Ethics has always followed science, it's never led it and I don't see any reason why genetics is going to be any different. Ethicists would love to tell geneticists what to do, but I'm afraid the geneticists are not going to listen."

The topics found in DNA – The Promise & The Price include: genetics; genetic diseases; gene therapy; transplantation; stem cells; and cloning can all be found in the UK National Curriculum. Please note all timings mentioned  include advertisement breaks – (00:04:51 – 00:08:00, 00:25:31 – 00:28:40 and 00:46:50 – 00:50:00) 

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Blood and Guts – Bleeding Hearts

December 10, 2008
This short post focuses on Bleeding Hearts, the second part of the BBC 4 series Blood and Guts: A History of Surgery, presented by Michael Mosley (Also seen in BBC 4 documentary Medical Mavericks). This episode traces the historic journey of cardiac surgery. Initially, progress was very slow with surgeons fearful of operating; the main difficulties being the need to maintain blood supply to the vital organs of the body (especially the brain), and preventing the patient bleeding to death. The documentary illustrates how heart surgeons managed to maximise the time they could work on the patient without major post-operative health consequences. For the purpose of teaching bioethics, this short post will focus on a section (00:42:45 – 00:52:00) which examines how surgeons have to seek out hearts for transplantation when their patient’s own heart is damaged beyond repair.     

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Michael Mosley: “The heart possesses a mystique, a romance that sets it a part from any other organs. This difference helped make heart surgery an extremely dangerous procedure. Not just for the patient but also for any surgeon prepared to operate on it.”

Read the rest of this entry »


To ‘Opt in’ or ‘Opt out’? – Organ Donation in the UK

November 20, 2008
NHS 'Transplants save lives' website

NHS 'Transplants save lives' website

Organ donation is one of the miracles of modern medicine; the ability to transplant tissue from one person to another without rejection has brought dramatic improvements in the day to day lives of thousands of people, in many cases it is literally life-saving.

At present, however, the sad reality remains that demand outstrips supply. According to the Transplant Activity in the UK report for the financial year 2007/2008: 3235 transplant operations took place, but 7655 people were waiting for a transplant (up more than 6% from previous year), and 506 patients died while waiting for an organ transplant, (it is thought that this number could actually be as high as 1000 per year).

The debate that surrounds organ donation is fuelled by society’s moral obligation not to allow these people to die needlessly. When a person dies and they are not on the Organ Donation Register (ODR) and/or their family do not grant permission for their organs to be donated, then none can be used to help those suffering on the waiting lists.

The UK Government is desperate to improve the number of organs available for transplantation. In 2006 this led to the establishment of the Organ Transplant Taskforce, chaired by Elizabeth Buggins, in order to ‘identify barriers to organ donation and recommend actions needed to increase organ donation’.  Their most recent report The potential impact of an opt out system for organ donation in the UK, published 17th November 2008, has received widespread media coverage. With the aim to increase the number of people on the organ donation register, they examined potential benefits and the viability of a move from the current ‘opt in’ organ donation system, to a ‘opt out’ system where by every citizen in the UK is automatically registered to donate their organs when they die unless they actively decide not to.  

This post highlights relevant and useful online clips whilst briefly discussing the central ethical arguments presented by the report. It also complements this with suggested questions to use while discussing the topic.  

Read the rest of this entry »


Superdoctors – Miracle cures

October 20, 2008

Robert Winston introducing the programme

Commenting in the second episode of the three part Superdoctors series that “one of the most exciting frontiers of our age is stem cells“, Robert Winston goes on to ask “how will these cutting edge technologies change the way that you, and I, and are children are treated?” (Start – 00:04:02). Stem cell therapy is at the beginning of its expected transition from the laboratory to the clinical application. The programme seeks to distinguish the hype from the genuine developments and to examine some of the hard decisions that need to be taken. Several of the key ethical issues associated with stem cell research have been considered in posts about other programmes (see for example Are hybrid embryos an ethical step too far? – The Big Questions and Bioethics Briefing – Stem cells). This episode, however, is particularly useful for consideration of two issues:

  • Public understanding of science and the management of expectations
  • Clinical trials and “therapeutic misconception”

Read the rest of this entry »


Her-2: The Making of Herceptin, a Revolutionary Treatment for Breast Cancer – Bazell (1998)

September 4, 2008
Bazell (1998)

Bazell, R. (1998). "Her-2: The Making of Herceptin". New York: Random House.

In his interesting and insightful account of “the making” of Herceptin, Robert Bazell, shows how the creation of a new drug is not only a scientific process, but also a social endeavour involving patients, doctors, regulators, funders, politicians, activists and the media. This is particularly so when it comes to clinical trials for a new product, and Bazell’s description of this procedure for Herceptin (Trastuzumab) is detailed and would form an excellent resource for illustrating its complexities and/or discussing its complications.

While the book deals with much more than the clinical trials of Herceptin – including the sources of early interest in the Her-2/neu receptor in breast cancer and the collaborations that eventually brought the potential of this monoclonal antibody to the attention of Genentech’s management – this post focusses on the clinical trials that formed the basis for its licensing by the FDA (Food and Drug Administration) in the US and subsequent worldwide use as an adjuvant therapy in advanced (metastatic) breast cancer.

This post is accompanied by a BioethicsBytes Extended Commentary on the making of herceptin (available here), which discusses some additional bioethical issues raised in this post.

Read the rest of this entry »


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