Deceptacle

April 2009 saw the beginnings of a worldwide flu pandemic in the H1N1 flu virus (also known as “swine flu”). With the media spreading fear about our inability to contain the virus, and our immune system's inability to fend off the flu as easily as the general human influenza virus, the need for some sort of vaccination became paramount. According to the article “U.S. Should give away H1N1 swine flu vaccine” by Ruth Karron, Orin Levine, and Ruth Faden, the U.S. is promising 10% of its swine flu vaccination supply to low-income countries. Unfortunately, this will only protect, at best, 10% of the population in 95 of the poorest countries in the world. The authors suggest that the U.S. and other wealthy countries give away 10 percent of their vaccine supply immediately to the poorest countries, and continue to donate portions of our supply to these countries. It is definitely an altruistic thing to do, and as the H1N1 threat begins subsiding, whether due to vaccination or other measures taken against it, there is less of a reason to hoard the vaccines, and it would be better to squander any potential areas that reemergence could happen.

Due to the differences in the H1N1 virus from the seasonal human virus, the general vaccinations did nothing to change the infection rate of the swine flu (CDC website). Without a readily available means to combat the swine flu virus, the need for a newly developed vaccination was dire, and it was not until the end of September that a successful vaccination was developed. The amount of media attention around this period was also still heightened, keeping it at the forefront of the population's minds. The process for developing a successful vaccination and then producing a sufficient quantity is a very long process. There is definitely a larger capacity for generating these vaccinations than in previous years, but it still takes time, and creating enough vaccinations to provide for the whole world is still difficult (Financial Express).

Another concern for the vaccine that was produced was that the H1N1 strain would return in a more lethal form, similar to the outbreak in 1918, where a mild influenza virus turned into a very dangerous form a few months later and killed millions (Financial Express). If the H1N1 virus did this, the currently developed vaccine would be essentially useless, and a whole new vaccination would need to be created and distributed. This could also severely hurt those developing nations that would be the most vulnerable. After trying to mass produce and donate the first round of vaccines, some of the wealthier nations may be more reluctant to hand out yet another batch of vaccines, especially if the virus became deadlier. Not only would the wealthy nations be losing more money, but there would be significantly more outcry from their citizens if vaccines were not readily available to them.

I would say the world was relatively lucky that the H1N1 virus outbreak was not quite as severe as it could have been. It sort of provided a test run for our current disease prevention frameworks to help work out any kinks or bottlenecks. Having this kind of real world feedback can only help against future threats that may happen in the future. As was mentioned earlier, if the world were faced with a more severe or lethal threat, citizens in the wealthier nations would demand vaccinations or medicine at a greater rate, and could potentially become outraged if the governments decided to donate some percentage of those vaccines or medications before their own people had sufficient access. This definitely becomes an issue because it forces the question of who is more important. Is there more value in one citizen's life than another? Are people in wealthier nations just luckier, and people in the poorer, developing nations are up the river without a paddle?

Any country has an obligation to its citizens over any other country I would say, no matter what the case. It unfortunately just becomes survival of the fittest, and it is truly a sad thing for the people in the nations that can not afford to develop their own vaccines. Wealthy nations should definitely do all they can to aid the poorer countries during a severe outbreak, but I would say donating is out of the question. There would be very few supporters of such a decision if the situation was that dire. Everyone's self preservation instincts would be kicking in, and each nation would need to appease its citizens before turning to the rest of the world to aid them.

Luckily, America is seeing the H1N1 panic slowly subside, but that is not the case in poorer regions of the world. Many Americans are probably not aware of that fact, but countries in Africa, Asia, and Eastern Europe are still suffering from the virus (McNeil). Karron, Levine, and Faden should be seeing their wishes fulfilled, seeing as there is significantly less demand for the vaccine, and countries are trying to get rid of their surplus. Unfortunately, these poor countries are still receiving very few doses. One would think that transferring surplus vaccines to these developing nations would be a relatively simple process, but these vaccines have to go through the World Health Organization. According to Dr. Keiji Fukuda, the chief of pandemic influenza, “It's a mammoth effort by an awful lot of people and organizations and countries, but holy moly, it's a very complex operation” (McNeil). Each country has to follow a certain set of procedures and meet a certain standard before being able to obtain and distribute the vaccines. This includes things like providing plans for storage and the W.H.O. has to certify the vaccines as safe if the country has no means itself.

As the mania that surrounded H1N1 fades, and it proves to be less dangerous than previously thought, many of the wealthy countries that placed large orders are trying to cancel these orders, since they are not needed. France is attempting to sell 50 million doses since public interest has waned and the doses are no longer needed. Many of the countries that placed large orders could find themselves in a dangerous position the next time a pandemic comes around if they tried backing out of their commitments. These countries should just let the orders go through, store some, and donate or sell at drastically lower prices to the countries that still need these vaccines.

According to the W.H.O., there is definitely a decline in the transmission of the virus worldwide, but vaccines are still needed. So far, the W.H.O. confirmed that there are over 209 countries with confirmed cases of H1N1, and there are at least 15,000 deaths. While the fatality of the H1N1 seems relatively low, keeping the H1N1 from reemerging should be a priority to prevent a more lethal recurrence. The first outbreak officially recorded happened in Veracruz, Mexico, which has an Human Development Index of 0.7457 as of 2004 (Wikipedia), which ranks it as a moderately developed area. Keeping the poorer countries healthier can only help the global population as a whole, since it helps prevent such outbreaks from spreading too severely. There is evidence that the H1N1 virus had been spread prior to that first official finding, but this situation is similar to any containment policy. Being from New Hampshire, I experienced the West Nile panic that was predominant around 2005 and 2006. In order to limit the potential spread of the disease through mosquitoes, disease control attempted to contain the mosquito population by spraying breeding grounds and recommending that people do not leave standing water on their properties. Being able to keep poorer nations vaccinated and healthy helps reduce the ability for diseases to breed and reach dangerous levels.

While I am skeptical about America being required to play big brother to parts of the world, I do believe that it is our responsibility to aid developing nations with vaccinations and to try our best to keep people of those areas healthy. It can be expensive, but prevention tends to be cheaper in the long run than reaction. If we can keep humanity healthier as a whole, then we will have less to worry about, and should a pandemic arise, we will hopefully have a sufficient infrastructure in place. The H1N1 outbreak definitely provided a good test for our current pandemic handling methodology. Hopefully procedures and policies can be tweaked to prevent bottlenecks from forming in the system, and hopefully a better method can be developed to get surplus vaccinations to where they are needed the most.

Works Cited

"2009 flu pandemic vaccine." Wikipedia, the free encyclopedia. Web. 01 Feb. 2010. <http://en.wikipedia.org/wiki/2009_flu_pandemic_vaccine>.

"Effectiveness of 2008--09 Trivalent Influenza Vaccine Against 2009 Pandemic Influenza A (H1N1)." Centers for Disease Control and Prevention. 09 Nov. 2009. Web. 01 Feb. 2010. <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5844a5.htm>.

Karron, Ruth A., Orin S. Levine, and Ruth R. Faden. "U.S. should give away H1N1 swine flu vaccine." San Francisco Chronicle. 16 Dec. 2009. Web. 01 Feb. 2010. <http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2009/12/16/EDD51B4JTJ.DTL>.

McNeil Jr., Donald G. "Progress Is Slow on Moving Surplus Swine Flu Vaccine to Countries That Need It." The New York Times. 01 Feb. 2010. Web. 02 Feb. 2010. <http://www.nytimes.com/2010/02/02/health/02flu.html>.

"Pandemic (H1N1) 2009 - update 86." World Health Organization. 05 Feb. 2010. Web. 06 Feb. 2010. <http://www.who.int/csr/don/2010_02_5/en/index.html>.

"Preparing for the worst." Financial Express. 08 May 2009. Web. 02 Feb. 2010. <http://www.financialexpress.com/printer/news/455987/>.

Download: Final Paper: America and Vaccinations

Cloning tends to be a highly controversial and talked about topic in the area of bioethics. One of the major factors fueling the debate surrounding this subject is its use throughout various media forms, primarily science fiction. Unfortunately, this is often the sole exposure that the general public gets regarding cloning, and so they form a prejudice against a topic that they know little about, and that they are misinformed about.

The myths that surround cloning cause severe damage to the stance that the general public takes regarding its continuation. These myths arise from literature and film, and they are remarkably varied, ranging from the idea that cloned humans are direct copies, including age, personality, memories, and the like, to the idea that clones could be harvested for organs. Many of these myths do share a common root, that being the notion that cloning creates a direct copy of an existing individual. With regards to organ harvesting, by the time a cloned individual would actually be able to use the organ, it would probably already be too late. This fact generally gets overlooked by a layperson though when they formulate their opinion regarding cloning since they do not know any better.

Gregory Pence breaks the formulation of traditional moral arguments into two categories: direct and indirect. Direct arguments tend to involve the actual act and the immediate consequences of cloning, while indirect arguments lean more towards potential future problems, such as social or medical, which may or may not become an issue. The arguments that are used against cloning have aspects of the “yuck” factor, whether through religious beliefs or through instinctual tendencies, as well as concerns for a cloned human's future. Arguing against the “yuck” factor tends to be difficult because it tends to be a highly personal reaction, but as for the future aspect, this is much easier to discuss. One concern is the “right to unique genetic identity.” Pence throws a solid counter in when he asks “since so-called 'identical' twins share 99.9 percent of their genes, is their right to a unique identity violated by being a twin?” (Pence 147). This is a perfect example of why cloning should not be a problem. If the general public could be convinced of the fact that cloning is essentially like having a twin sibling years later, then maybe it would gain more acceptance. One could suppose that mother's would not appreciate this if their children played an April Fool's day joke on them by surprising her with their cloned child, but that shouldn't stop research into the area.

A very real objection to cloning that comes up though is the concern about abnormalities. According to Pence, “a high rate of abnormalities plague efforts to create primates by somatic cell nuclear transfer” (Pence 148). With such risks present, it keeps cloning from being human testable until cloning techniques improve drastically. As the ability to clone other mammals becomes more successful, this argument will lose ground and become a non-issue.

Cloning does have some real potential benefits though, and I personally believe that aside from the limitations on knowledge thus far, there should be no real opposition to cloning. Taking the genetic make up of a healthy adult alleviates much of the burden of worrying about genetic diseases that may be passed on through typical reproductive means. Assuming cloning techniques are greatly improved, it would mean one less thing to worry about for the parents of the child.

Allowing for people to have a child is also a very strong argument for cloning. While adoption is definitely one way to go, it can often be a complicated and difficult process, and many adults prefer to have a genetic bond with their child. Cloning could be viewed as yet another option that adults have for attempting to conceive a child. Whether it's because they waited too long or they are just having trouble conceiving, cloning could be one day added to the list of potential solutions that would ensure a genetic bond with the child, and would have the added known genetic health benefit.

At the very least, since cloning is similar to creating a twin years later, I see no real harm in allowing research into cloning to continue. As long as research is not being done on humans until the techniques are improved, it should not be any more controversial than any of the other reproductive research being done. There will always be naysayers who tout their religion as a logical reason against such research, but that should not be used when creating legislation. There may be some who are just repulsed by the idea of cloning, but I would question their reaction. Such a response should not happen if cloning becomes perfected. If cloning is perfected, a cloned birth would produce a healthy baby who will probably look very similar to the genetic provider. I would think that the age difference would be significant enough that such similarities in looks would not be an issue as well. I could see some repulsion if the age difference was only a few years, but if cloning is used for reproductive means, then that gap would be at least twenty five years at least.

While cloning is still in its early years, there is a lot of mixed feelings surrounding it. Most of these feelings are based off of science fiction and myth, but there are some much more reasonable concerns regarding cloning. As our ability gets better, and cloning become perfected, I would not be surprised to see it used as one of the various ways that a couple could reproduce. The genetic bond that parents and their children share is a strong one and cloning would be just another way in which to achieve that bond.

Download: Response Paper 2

Organ donation is a very hot topic in biomedical ethics because of the complicated issues surrounding it. From attempting to decide who should get the organs to how can more organs be found, there are many differing opinions and solutions proposed by many people in a variety of professions. Gregory Pence portrays a few of the potential solutions within Medical Ethics, and I will attempt to lay out what I believe to be a more ideal solution to the problem of distributing organs.

One of the first methods of distributing organs was basically just hoarding them. Hospitals would store organs and would rarely share them with others, essentially wasting them. Seeing this, the government created the United Network for Organ Sharing (UNOS) (Pence 265). This organization is responsible for deciding who gets organs and who doesn't. Pence lays out a few different methods for selecting patients to receive organs: sickest first, the rule of rescue, selection by committee (God Committee), and lottery (Kantian ethics).

Choosing the sickest first path creates the problem of knowing whether the transplanted organ will lead to a significantly longer life, or if the organ will be wasted because the patient was too sick to make the transplant worthwhile. While it is generally believed that a moderately sick person holds the greatest potential to maximize the organ's years, the idea is often rejected. “Even if it wastes an organ, they feel that after waiting for years on the list for an organ, they deserve their one chance to live” (Pence 269). Unfortunately, it is hard to remain rational and impartial when a loved one is close to death, but until organ supply is not such a big issue, choosing the sickest first leads to far too many wasted organs. Even though one person may get their one chance to live, there could be another who doesn't, who was moderately sick at the time, but continued to degrade while waiting for an organ. Both patients and their families would be hard pressed to come to an agreement, especially when the moderately sick person's future was unknown.

Rule of rescue is really an unfortunate side effect of the sensationalistic reporting of the media. Whoever has the sadder story, or the most marketable one will be able to win out while plenty of other equally deserving patients suffer in obscurity. Pence doesn't really make this out to be an actual viable solution, but it is definitely one of the possible (albeit highly unlikely) avenues a sick patient can take. This form of deciding who gets organs could also undermine any impartial systems that get set up. Propelling someone to the top of the waiting list says that not everyone has a necessarily equal chance. One patient who may be quiet and reserved would probably decline any sort of media attention, but it could cost his spot on the list if the media pushes another patient.

Selection by committee is a reasonable methodology, providing that a solid set of criteria or some method of determining worth is achieved. This is exactly the problem that many people have with this method. The cases of Mickey Mantle and Robert Casey are prime examples for the controversial decisions that can be made by such a committee (Pence 266). Critics claim that Mantle was only chosen because of his celebrity status, and the fact that he was an alcoholic should have disqualified him, or put him much lower on the list. I'm sure there would have been plenty of backlash though if the media twisted the story to say that Mantle was denied the chance to continue living by a governmental agency. With Casey, the belief that he was given his transplant so quickly is definitely a negative outcome. Even with the claim that he had been on for a while, it still sheds a bad light over the selection process.

The only way a committee system can be effective is if there is a definitive set of criteria that qualifies a patient for the transplant. Determining worth as a human being is extremely difficult because often the committee is made up of more conservative members of a community. This means they will probably lean more towards a teacher or a scientist instead of an artist, even though their contributions to society may be just as valuable as the others. The notion of a point system (Pence 265) in order to determine social worth is definitely better than just some community members determining themselves. A point system can be spread out across a number of different fields, and making the minimum score would put you in the lottery. This means that an alcoholic (which might bestow a number of negative points) could still make it to the lottery if they are also a successful business person with a family who gives back to the community. The number of qualifications would definitely be more numerous than this example, but it shows that one negative trait shouldn't completely rule someone out.

The most impartial way would be a straight up lottery, and I feel that this would be the best course of action to take. Patients would still be able to track down their own donors if they want, but the rest of the patients would be given an equal chance to get a donated organ. Since the determination of social worth is still difficult, even with an elaborate system, and going strictly sickest first doesn't maximize the use of the organs, it would follow that leaving it to chance would be the simplest solution. This way, there are no mishaps with celebrity status or rule of rescue, unless it brings forward a donor. Allowing the patients to find a donor allows the donor to play the role of the selection committee, since the donor makes the final decision about whether to donate said organ, or leave the patient to the hands of fate.

Organ donation is a tricky subject because of the emotional context that generally surrounds the decisions that get made. Coming up with a sure-fire, make everyone happy method is essentially impossible because someone will be put at a disadvantage. Using a lottery method seems to be the most impartial method that would also boast the greater maximum benefit (who doesn't love winning something?) Other methods generally have a major flaw which stems from the human element of the decision, whether a family pressuring a physician to help their extremely sick relative to sensationalistic media hyping up one patient while ignoring hundreds of others.

Download: Response Paper 1