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”

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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.

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Science and Ethics of Drug Trials – Class Clips

July 21, 2008

The BBC’s Class Clips series does exactly what it says on the tin – the programmes are collections of short clips for use in classroom teaching. New in 2007, Class Clips programmes on a variety of subjects have since been transmitted overnight in the Learning Zone on BBC2 on several occasions and it looks like the website is gearing up to offer them via iPlayer, which will be a bonus in terms of availability (although, at the time of writing, the links are not yet active). The intended audience is advertised as Key Stage 3, but they could certainly be used with older students too.

The Biology section of Class Clips Science 2 is the most directly relevant for bioethics education since it includes two short sections on drug trials; one looks more at the procedures, the second at the ethics. However, if you are teaching at other times about modern medicine then don’t be put off by the physics-only sounding section on the electromagnetic spectrum – each of the clips on waves of different lengths (from gamma rays through to radiowaves) is looked at with explicit reference to their medical applications. Read the rest of this entry »

WIT: A window on tensions in clinical trials

June 12, 2008

(Warning: contains plot spoilers!) Adapted from Margaret Edson’s 1999 Pulitzer Prize winning play, Wit tells the tragic story of Professor Vivian Bearing (Emma Thompson). Vivian, a ruthless scholar of 17th Century English poetry, is diagnosed with advanced stage 4 metastatic ovarian cancer. Dr Harvey Kelekian (Christopher Lloyd), Vivian’s consultant physician and leading figure in this area of medical research, explains that the most effective treatment option she has is an aggressive experimental chemotherapy at the full dose.

Professor Vivian Bearing

Professor Vivian Bearing (Emma Thompson)  

She cautiously consents to the therapy and embarks on a degrading regime of eight cycles, which no other patient has completed before. With a fearless determination, Vivian does everything the doctors ask of her, and as such illustrates the central ethical issue observed in this film; the conflict of interest witnessed between clinical therapy and clinical research. Throughout, this is entangled with clinical incompetence, issues of informed consent, end of life decisions and Vivian’s frustration with the hospitals insensitive mechanistic approach to their patients, having been asked repeatedly “How are you feeling today?” (00:04:10 – 00:05:25) Read the rest of this entry »

The vivisection debate: Animals (More4)

October 16, 2007

Part of a season of programmes about aspects of animal use in research, this drama/documentary was first broadcast in December 2005. In the fictional story we are introduced to a research scientist involved in animal testing and to an animal rights activist intent on stop him.  The narrative develops from about 1997, when a TV documentary exposed genuine mistreatment of some animals at Britain’s largest animal research facility, Huntingdon Life Sciences (HLS), see 00:16:07 – 00:17:31. Throughout the programme, Animals examines real life actions taken by animal rights activists and incorporates them in the plot of the story. A series of interviews with people who were directly involved in these events is also interspersed, and provides interesting insights into their personal experiences. Read the rest of this entry »

Animal Research – Monkeys, Rats and Me

October 8, 2007

In the spring of 2004, work started on the new Oxford University Biomedical research laboratory, which would be partially used for animal experimentation. From the very first day of construction, the site was bombarded with verbal abuse and relentless physical damage to machinery, offices and supplies by animal rights protestors. This subsequently forced the building work to be halted for 18 months. Monkeys, Rats and Me, a documentary commissioned by the BBC, joins the story when construction is restarted in November 2005, and follows the activities of those who campaign for and against the use of animals in medical experimentations. The site of the new facility had become the epicentre for a grand battle between the two polar views of experiments on animals. On the one side you have those who wish for total abolishment of vivisection and on the other there are those who see animal experimentation as an essential tool for advancing science and developing new cures. The narrator suggests that this dispute revolves around the central ethical question of whether “the benefits to patients justify the harms to the animals”. To address this, the documentary attempts to see if animal experimentation works and even, if it does, “is it ethical?” Read the rest of this entry »