Blood & Guts – A History of Surgery: Fixing Faces

February 16, 2009
Michael Mosley performing a facial surgery technique on a Mannequin/dummy

Michael Mosley performing facial surgery on a mannequin/dummy

In the fourth part of the BBC 4 Blood and Guts series, Fixing Faces looks at the evolution of plastic surgery. True to form, Michael Mosley presents a graphic account of how brutal attempts to reconstruct patients’ diseased or damaged faces have led to a modern medical speciality which is now believe to be on the eve of the first full face transplant. This episode describes and illustrates the history of this area of surgery: showing the work of the 16th century Italian doctor Gasparis Taliacotii (00:05:06 – 00:18:02); the beginning of the Botox era (00:18:02 – 00:30:00); and the work of Sir Harold Gillies and Sir Archibald Mclndoe, who developed both surgical techniques and the need for psychological support for patients undergoing reconstructive facial surgery (00:30:00 – 00:50:00) (Please see this Student BMJ article – ‘A brief histoy of plastic surgery’).

This episode highlights two main ethical topics for discussion: functional Magnetic Resonance Imageing (fMRI) and Neuroethics (00: 01:54 – 00:05:06); and face transplants or facial allograft transplantation (00:50:00 – End).

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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."

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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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Holby City – “If you can’t…look after yourself, then why should we?”

January 21, 2009
Watch this episode via the BBC iPlayer (available until January 27th 2009)

Watch this episode via the BBC iPlayer (available until January 27th 2009)

The issue of resource allocation in the NHS has cropped up several times in recent programmes (see, for example, Dom’s on the Case regarding the “postcode lottery”. The present post examines the ethical issues implicit in a different aspect of resource allocation in healthcare: the potential for conflict between traditional medical ethics and core NHS values and increasingly prominent views of the individual as both responsible and accountable for their own health status. This tension came to the fore in Just, a recent episode of the BBC drama Holby City (first broadcast on BBC1 at 8.00pm on 20th January 2009), and is captured nicely in one particular quote from the programme in which surgeon Ric Griffin challenges his patient, an obese smoker, “if you can’t be bothered to look after yourself, then why should we?” (00:38:07)

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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.”

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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.  

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My Shocking Story – Human Face Transplant

November 13, 2008

At a military hospital in China, Professor Guo Shuzhong is striving to advance the necessary medical techniques to complete a full face transplant for one of his patients. Celebrated as one of China’s best plastic surgeons, Professor Guo is anxious to improve the lives of people with severe facial disfigurements.

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Professor Guo: "We Chinese pay a lot of attention to the face, if you have a problem with the face and go outside, a lot of people stare at you, look at you, you feel very uncomfortable... Some people are that disfigured that they do not look like human beings anymore. Some people in China call then ghosts. These patients are discriminated against in society; I deal with them every day and understand their suffering. They are in a great deal of pain. They do not expect to be beautiful after surgery, they just want a normal life again" (00:02:27 - 00:04:52).

Professor Guo believes that the only way to improve the life of his patients is to build on the well established techniques of plastic surgery and move towards partial and full face transplants. In November 2005 Isabelle Dinoire underwent the world’s first partial face transplant in France (00:12:34 – 00:13:32) (See Face transplant – Horizon). Professor Guo is encouraged by this and hopes that his research can build on the medical breakthrough.  

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More tricky decisions – Inside the ethics committee

August 12, 2008
Visit the Inside the Ethics Committee homepage at BBC Radio 4

Visit the Inside the Ethics Committee homepage at BBC Radio 4

The fourth series of BBC Radio 4′s bioethics programme Inside the Ethics Committee began on August 6 2008, and discussed some of the ethical issues involved in the creation of ‘saviour siblings’ (first broadcast on BBC Radio 4, at 20.00, August 6 2008 and repeated on August 9 2008, at 22.15). Vivienne Parry and a panel of experts discuss the ethical issues around real-life medical cases, on this occasion the dilemma involves a young child, Catherine, and her medical treatment. Previous BioethicsBytes posts have noted the utility of this series (see the post Making tricky decisions – Inside the ethics committee), and this episode is no different.

Shortly after she was born Catherine was diagnosed with Diamond Blackfan Anaemia (DBA). DBA is a rare blood disorder caused by a genetic mutation. In general, its treatment is “gruelling” (00:02:27) and the prognosis is poor. As in several previous cases (notably, the Whitaker, Fletcher and Mariethoz families), Catherine’s parents were offered the option of using preimplantation genetic diagnosis (PGD) for tissue typing alone in order to create a ‘saviour sibling’ whose umbilical cord blood could be used to treat Catherine’s DBA.

Many of the ethical issues involved in this choice have been dealt with in past BioethicsBytes posts (see The Future of Our Families? and the extended commentary that accompanies that post), however this edition of Inside the Ethics Committee brings consideration of these issues up to date. Though the majority of the ethical issues raised are covered in our existing posts, some of the additional details noted here about DBA and the testing procedure introduce new complications into the ethical debate.

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A suitable donor? – Hollyoaks

January 23, 2008

I have to say from the outset that I am not usually a Hollyoaks fan and, as this post will show, I’m way off the pace as far as who’s who. However, turning on slightly early for the Channel 4 news on Tuesday 22nd January 2008 I happened to catch the end of that day’s episode of the Chester-based soap opera (TRILT code 007CA973) and was intrigued.  The storyline involved Charlie, a baby recently diagnosed with Acute Myeloid Leukaemia (AML) and in need of a bone marrow transplant. The first clip I caught was the doctor informing Charlie’s ‘dad’ Jake Dean that a blood test revealed he was not a suitable donor for the baby – on the grounds that he was not, in fact, the boy’s biological father.

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Frankie, Nancy and Jake

Recognising the potential benefit of this clip for teaching about transplantation and/or genetic testing, I decided I ought to check my facts.  This, it turned out, is more complicated than I had anticipated. So (deep breath) the woman standing anxiously by the baby’s bedside is not Charlie’s mum, she is Nancy, Charlie’s aunt (no pun intended). Charlie’s mum Becca is dead, stabbed in prison by her cellmate.  She was in prison having been found guilty of engaging in a sexual relationship with Justin, who was underage at the time. Despite the relationship being consensual, Justin made false claims of coercion based on his anger at being dumped by Becca. Justin is now with Katy Fox, Jake and Nancy are in a relationship of their own (keep up!).  Knowing about Becca’s infidelity with Justin, Jake had ordered a paternity test in January 2007, but decided not to open it, choosing instead to remain in ignorance and bring up Charlie assuming that he was the biological father.  This latest turn in the story shows that he is not. Read the rest of this entry »


Exploiting Genetic Knowledge – Visions of the Future (2)

January 11, 2008

The Biotech Revolution, the second episode of the BBC4 Visions of the Future series, continues to describe ways in which humanity is making a “historic transition from the age of scientific discovery to the age of scientific mastery”. Presenter Michio Kaku suggests that unlocking the basic code of life will allow us to “predetermine the destiny of life itself” and to manipulate it at the most fundamental level (Start-00:02:00).

The programme begins with Kaku having his “medical future rather than history” diagnosed via a series of genetic tests for complex diseases such as heart disease, diabetes and Alzheimer’s. He describes this as an “owner’s manual” which will enable him to have greater control of his health, and to allow others to perhaps prolong their life by decades (00:02:20-00:06:20 and 00:20:05-00:23: 20). As a scientist, he is eager to discover what secrets his genome may contain however, as a person, he says “wait a minute, this could be a Pandora’s Box… I’m looking at a side of me I have never seen before, a side that has potential medical problems lurking there”.

Some of the issues raised here mirror those found in the ITV1 broadcast The Killer in Me, which illustrated particularly well the anguish associated with having such tests and the way actions could be taken in light of the results. In this programme, in contrast, there is greater emphasis placed on the potential impact on relatives and wider society that may result from taking the tests. “We really want to respect your privacy and the privacy of your relatives” the physician emphasises to Kaku.  Much of the future of this testing, if not the present, relies upon “the last great discovery of the 21st century, the Human Genome Project”.  Kaku believes that this event holds such significance that we will look at the history of medicine in two eras, “before genome and after genome”. “Having unravelled the fundamental code of our biology the stage is set for us to manipulate it” he adds (00:06:25-00:09:20). Read the rest of this entry »


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