Ethical problems

Patient databases with genetic profiles, e.g. for cardiovascular diseases, diabetes, cancer, etc. may play an important role in the future for individual health care, by integrating personal genetic profile into diagnosis, despite obvious ethical problems. The goal is to analyse a patient s individual genetic profile and compare it with a collection of reference profiles and other related information. This may improve individual diagnosis, prophylaxis, and therapy. 

Maner W. Unique ethical problems in information technology. Sci Eng Ethics 1996 2.2 137-54. 

Studies in special groups pose ethical problems that are similar to those associated with studies in healthy yoimg adult subjects. 

Nevertheless, conducting economic analysis from other perspectives, in addition to the societal perspective, is important. This is because the costs of medical care may not be borne solely by the same parties who stand to benefit from it. Economic analysis of medical care often raises vexing ethical problems related to equity, distribution of resources, and responsibility for the health of society s members. Economic analysis from multiple perspectives shed light on the equity issues associated with new interventions. 

The main ethical problem with medical research in economically developing nations in which subjects are medically underserved is that ... 

D. An ethical issue arises when one includes medically underserved patients in a study without providing them with the level of care available to others. Problems with noncompliance, while potentially damaging to a study, do not pose ethical problems in medically underserved populations not encountered elsewhere. Effective study design can overcome problems with generalizing from one population to the next. Subjects everywhere should be... 

Swazey, J. P. and L. Glantz. 1982. A Social Perspective on Compensation for Injured Research Subjects. In President s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Compensating for Research Injuries 2 3-18. 

Klier, A. (1992). Release of genetically modified microorganisms in natural environments scientific and ethical problems. In Gene Transfers and Environment, ed. M. J. Gauthier, pp. 183-90. Berlin Springer-Verlag. 

Cell kinetics is defined as the measurement of time parameters m biological systems. Traditionally, this has involved the use of radioactive precursors of DNA, such as tritiated thymidine (3HTdR), and autoradiography to detect their incorporation into DNA. This technique has provided detailed knowledge of cell kinetics in both in vitro and in vivo experimental systems. The technique, however, is time consuming and arduous and is not readily applicable to human tumor research because of ethical problems involved in incorporation of a radioisotope into DNA. 

The ethical implications also cannot be ignored. Any research that uses human volunteers must examine its motives and methods to make certain that human beings are not being manipulated like objects for purposes they do not understand or share. But in research with powerful mental chemicals that may influence the most cherished human functions and values, the ethical problem is even more acute. The mystical experience, historically, has filled man with wondrous awe... 

Foetal mesencephalic tissue has been implanted in the striatum of patients with the juvenile form of Parkinson s disease and has been shown to develop functional axons this has enabled the dose of L-dopa to be reduced. Both imaging and pharmacological studies have now shown that functional dopaminergic neurons can develop in the brain of the patient following tissue transplantation. However, a major ethical objection has been raised to such transplants as six to seven foetal brains are required to obtain sufficient tissue. In addition, only about 20% of neurons survive transplantation. The ethical problem may be overcome by using brain transplants from domestic animals such as pigs. Such xenotransplants have been shown to survive in the human brain but the main problem with the extensive use of such transplants is the possible spread of viruses and prion infections. 

Until recently, the neonate has been a black box, an eminently valued patient, yet one that is difficult to study and treat effectively. Neonatal research, in particular, is often plagued by ethical problems of invasiveness of protocols, volume of blood to be drawn, inability of the patient to speak on his/her own behalf, etc. Even simple studies that try to address neonatal outcome often pose problems in these areas, requiring volumes of blood that subsequently need to be replaced by transfusion. Because the perceived benefit to both individual patients and to society as a whole is deemed to be highly valuable, such downsides to neonatal research are often accepted as inevitable. The introduction, however, of MS analysis, utilizing low volumes of blood for multiple biomarkers, appears to be a very attractive alternative with great potential. A number of critical areas have already begun to be addressed and include such diverse entities as hypoxic-ischemic brain injury, the infant of a diabetic mother, neonatal renal function, neonatal nutrition, neonatal sepsis, and pharmaceutical development. 

Not covered in this book are ethical issues, which may be harder to solve than some technical problems. Considering ethical issues, it is useful to start by contemplating the Hippocratic Code the patient, after having agreed to be treated by a physician, trusts the physician to act in the patient s best interest no other ethical problem arises. This is an entirely different situation from one in which a physician-scientist s interest is the promotion of knowledge. 

Nowadays, the field of toxicology uses different in vivo models (mouse, rat, rabbit, among others) to evaluate the toxic potential of chemical compounds. These classical tests using animals present significant limitations regarding the applicability of the results to the case of humans, and pose ethical problems due to the use of animals. The application of the current European law implies the sacrifice of 12 million animals, corresponding to 20 billion by 2012. 

Moreover, significant results may be obtained with very few cells. An experiment which may require 100 rats or 1000 humans in order to clarify some point may be statistically equally valid if 100 coverslip cultures or one microwell plate are used. If each cell is regarded as an independent experiment then one coverslip culture may yield more reliable results than a hospital full of people. This is obviously a major advantage as far as man is concerned but also overcomes the ethical problems which often arise when large numbers of animals are used for experimental purposes. However, in the final analysis, many experiments must be performed on whole animals, but this is no justification for not using cultured cells for the preliminary work. 

Calls for matches that go beyond family resemblance and aim at closeness to a specific model entail technical, practical, and ethical problems. The technical problem lies in the fact that even with the help of GC/MS, far more effort is involved in creating a close rather than an approximate match. The difficulties are multiplied if the character of the perfume is considerably modified by the components of the product base and if, as is usually the case, the cost limits are well below the cost of the original fragrance. 

The ethical problems touch upon the interests not of the marketer but of the supplier industry. The economic basis of this industry rests upon profit margins sufficient to recover, within a reasonable time period, the expenses incurred in the development of fragrances. The practice of looking for lower-priced replacements from other suppliers denies such margins to the original supplier. 

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