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What comes to your mind when anyone talks of ethics? Maybe, choosing between good and bad or right from wrong, that would be the basic idea and bulecopavillon gioie-di-gea 24bottles borsegabsoutlet tatacalzature guardianiscarpe 24bottles kleankanteenkinder gioie-di-gea ovyeshop tatascarpe gioie-di-gea mandarinaducksaldi von-dutch gigasportoutfitdamenilding on that, ethics is a study of moral principles and refers to a code of morals followed by an individual or a group. They prescribe what we ought to do and affects our behaviour and decision making. Ethics is a vast area of study with many fields, so let’s focus on how we apply it in medicine. 

Medical ethics refers to the moral values that govern medicine. It applies to clinical medicine and associated scientific research. One of the oldest written documents on ethics is the Hippocrates oath, which is still used today albeit somewhat modernised, to initiate doctors in their practice. In the doctor-patient relationship, the conduct of the doctor should follow the four pillars of medical ethics. They are autonomy, beneficence, non-maleficence and justice.

Let’s take an example, a 25 year old female who is a Jehovahs witness sustained serious injuries in a car crash, but she has refused blood transfusions despite losing a lot of blood.

Autonomy refers to the right of a patient to make decisions for themselves. It involves the principle of informed consent as well. In the above case the doctor would have explained the risks of not undergoing a transfusion but would have to respect the patients decision. (Jehovahs witnesses refuse blood products as it is against their beliefs) In such cases there is conflict between autonomy and doing what’s best for the patient. The latter is also called beneficence. Non-maleficence refers to doing no harm and justice is  fair distribution of resources.

Research is done, simply to find things out and it commonly involves humans, specially with regards to medicine. Therefore ethics are needed to protect participants and to make sure the study is of value to the society. Research should be conducted so that the knowledge produced can be used and shared widely and the participants should be treated with respect and dignity.

The principles of ethics in research are not only limited to the basic four principles but includes what is mentioned above like social value and respect for participants, also scientific validity, fair subject selection, favourable risk benefit ratio, independent review and informed consent. Not abiding to these principles has led to several tragedies and tarnished reputations of individuals and institutions.

Infamous examples of research conducted with no regards to human rights have been documented throughout history.

In 1932, a group of 400 black men with syphilis were recruited in a study to track the progression of the disease, which had no cure at the time. However in 1942, penicillin became the treatment of choice for syphilis but it was not offered to the participants. Due to the publishing of the study in a newspaper the ethical aspects were brought to attention only in 1972, after which the study was stopped. As a result many died and their wives and children were infected.

In a similar timeline, German scientists conducted experiments of a horrendous nature on concentration camp prisoners which ended with the scientists being penalised in the Nuremberg trials. As a result the Nuremberg code was compiled, which was the first international code of ethics for research on human subjects. Later on the World Medical Association published the Declaration of Helsinki which was a result of significant effort of the medical community to regulate research.

So in a way people have learnt from the mistakes of their peers but the question remains “Is it necessary to risk the lives of some for the benefit of many?” Somewhat of a trolley problem, isn’t it?  This was a thought experiment on ethics and psychology and is as follows, say a runaway trolley is heading  towards five people who are tied to the tracks. If it continues on its path they would be killed but if you pull a lever the trolley would deviate to a different track but would kill 1 person. What would you do?

Let’s look at this problem from a modern angle. The covid pandemic has caused millions of deaths and millions more infected. From the beginning it was apparent that a vaccine was necessary but this process usually took several years to complete. However due to streamlining resources and collaborations this process was accelerated to produce a vaccine by the end of 2020.

A crucial step in vaccine development is the challenge test which is usually done in the preclinical study in an animal model but for covid 19 and some other diseases this is not available. Thus Controlled Human Infection(CHI) was needed. It sounds like unsafe experimentation but people volunteered due to the importance and necessity of a vaccine.

This raises many ethical issues and no matter the urgency of the situation, research ethics should be maintained. These moral dilemmas are difficult to navigate and promote thinking rather than provide an exact solution.

To make sure that researches are designed and conducted ethically, governing bodies called ethic review boards have been established in order to safeguard the rights and wellbeing of participants. Additionally when a study is being published, the researcher should act with integrity. They should avoid fabricating, falsifying data and plagiarism. This tend to happen when people are desperate, say they’re running short on a deadline or maybe just to reap the benefits without actual hard work. Hence mutual respect for other researchers ensures the creation of a conducive environment for the advancement of science and research.

If one is thinking of becoming proficient in research then learning its ethical aspect is integral. An obligation of the already skilled researcher is to teach the future generations on the importance of ethics and the duty of the student is to learn and apply the concepts properly so as to avoid repeating past mistakes.

References

1. What is ethics in research? https://www.niehs.nih.gov/research/resources/bioethics/whatis/index.cfm

2. Vaccine experiments – scandal-hepatitis-experiments-hideous-truths-of-testing-vaccines-on-humans/?sh=e17bc8e279c8

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7675299/

The human body has the natural ability to heal itself in many ways. A cut to the skin, broken bones mend and a living-donor’s liver regenerates in a few weeks. What if scientists can make use of the body’s innate ability to heal itself, to replace daysrelax gigasport-online von-dutch fracominaabiti von-dutch lamilanesaborse 24h-bottle blundstoneoutlet kleankanteenkinder 24bottlesclima 24bottlesclima coralbluescarpe tatacalzature ynotoutlet tatacalzaturedamaged organs or tissues? Well that’s what regenerative medicine is all about….

According to Dr. Heather Greenwood et al., “regenerative medicine is an emerging interdisciplinary field of research and clinical applications focused on the repair, replacement or regeneration of cells, tissues or organs to restore impaired function resulting from any cause, including congenital defects, diseases, trauma and aging”. It’s an emerging branch of medicine which shows a promising future. The currently used treatment option of transplantation to replace damaged or diseased organs and tissues has many drawbacks. There is a limited pool of donors and the recipients have to be on lifelong immunosuppression which makes them susceptible to many opportunistic infections. And to mention the fact that there is a huge risk of graft rejection which will render the entire procedure moot as well as the highly feared host vs. graft reactions. Taking all of these matters into consideration, regenerative medicine seems like a more appropriate and convenient option at present.

Several principles are being used in this field:

1. Tissue engineering and biomaterial

Here biologically compatible scaffolds are implanted at the site where new tissue is to be formed. This will attract cells and give rise to a new tissue of the desired shape.

• Cellular therapy

This is also known as stem cell transplantation which will be discussed in more detail later in this article

• Medical devices and artificial organs

Although we consider regenerative medicine as an emerging field in medicine, it has its roots set way back in history. A common example is the tale of Prometheus that appeared in 8th century BCE. Prometheus, an immortal Titan in Greek mythology who stole fire and gave it to humanity for them to use, defying the gods in consequence. As punishment, Zeus decreed that he was to be bound to a rock where an eagle would feast on his liver every day and said liver would regenerate itself every night, leading to a continuous loop of torture. There are many other legends as this one in different cultures suggesting that regenerative medicine is no new concept to mankind.

However this became a possibility once  scientists like Alexis Carrel (who invented the technique of cell culture) were finally able to keep cells and tissues alive outside of the body allowing  them to study the mechanisms of cell renewal, regulation, and repair. The initial trials began by experimenting on the largest and most well known regenerative organ of the human body, the skin. The very first product of regenerative medicine called as the Epicel was created in 1979. This technology consisted of isolating keratinocytes from a skin biopsy and having them proliferate outside of the body to make cell “sheets” that were then used as an autologous treatment for burn patients. The next technology was Apligraf, found in 1981 which could regenerate both the dermis and epidermis of the body. Scientists were also looking into cartilage regeneration at the same time. The next big step in regenerative medicine was the discovery of stem cells and the coining of regenerative medicine with stem cell transplantation. By this time many scientists were invested in this field and many discoveries were made in the following years such as, the implantation of a genetically engineered bladder in 2006 and the widespread use of hematopoietic stem cell transplants as a curative therapy for blood disorders and immunodeficiency. Thus the field of regenerative medicine was booming!

There are 4 types of regenerative medicine being used at present.

1. Stem cell treatments

Stem cells are the body’s raw materials from which differentiated cells arise. In regenerative medicine, stem cells are being guided to give rise to the organ that we need. People who might benefit from stem cell therapies include those with spinal cord injuries, type 1 diabetes to reduce the progression to complete insulin resistance , Parkinson’s disease, amyotrophic lateral sclerosis, Alzheimer’s disease, heart disease to strengthen the heart, stroke, burns to regenerate the lost skin, cancer and osteoarthritis.

• Cartilage regeneration

Healing of cartilage is difficult due to its poor blood supply. This technology is used to regenerate the musculoskeletal system. Healthy cartilage is taken form the damaged joint and grown in vitro and then the new cells are injected to replace the damaged tissue.

• Platelet rich plasma (PRP)

This concept is based on the belief that platelets posses a regenerative capacity. Blood drawn from the patient is centrifuged and concentrated platelets are injected back to the site needed.

• Prolotherapy

In prolotherapy, a doctor injects a watery solution containing substances like saline and dextrose into the injured area. These injections usually contain a numbing agent like lidocaine as well.The injection irritates the injury site, triggering the body’s healing response. As a result, the body will grow new connective fibers to repair the damaged tissue. 

Currently a vast number of FDA approved products are available on the markets and are being used in the curative as well as preventive aspects of medicine. Biologics such as autologous fibroblasts in improving nasolabial fold appearance, autologous chondrocytes for cartilage defects, cord blood for hematopoietic stem cells for immune reconstitution are used. Also cell based medical devices like dermagraft with allogenic fibroblasts for the healing of diabetic foot ulcers, cell extractions like cellution to transfer autologous adipose stem cells are being widely used. Bio pharmaceuticals like platelet derived growth factors are being used for periodontal defects and diabetic foot ulcers.

Although the field of regenerative medicine had seen many advances, it has much more potential. Many researches are being carried out and many new developments are being made.New inventions are being studied, such as bioengineering livers, tendons and artificial vascular systems.

There are a few challenges such as regarding the safety following a stem cell transplantation. How will they continue to grow? Will it be harmful to the recipient? Hence tight regulation and monitoring is required. Secondly, vascular anastomoses fro the newly regenerated organ with the host vascular system is needed. This could be tricky and should be done with care to prevent further complications. On the other hand more studies are required to find out about how age, diseases state and micro biome of the recipient will affect the regenerative capacity.

However to date the filed of regenerative medicine has led to life changing discoveries and will continue to do so. It’s almost as if the field is itself regenerating!

References

Dr. Nael Shanti. 2021. 4 Types of Regenerative Therapy Treatments – Dr. Nael Shanti. [online] Available at: <https://www.shantispinesurgery.com/types-of-regenerative-therapy-treatments/> [Accessed 20 October 2021].

Greenwood, H., Thorsteinsdottir, H., Perry, G., Renihan, J., Singer, P. and Daar, A., 2006. Regenerative medicine: new opportunities for developing countries. International Journal of Biotechnology, 8(1/2), p.60.

Jacques, E. and Suuronen, E., 2020. The Progression of Regenerative Medicine and its Impact on Therapy Translation. Clinical and Translational Science, 13(3), pp.440-450.

Mao, A. and Mooney, D., 2015. Regenerative medicine: Current therapies and future directions. Proceedings of the National Academy of Sciences, 112(47), pp.14452-14459.