We need a different set of institutional arrangements so that many people would be interested in manufacturing vaccines
By: Lorraine Seabrook with Robert Pickens, M.D.
Last week’s Health Matters considered the discipline of medical ethics and took a closer look at genetic disorders and genetic testing. This week’s Health Matters continues to examine the ethics of medicine, including a look at the ethical implications of the current flu vaccine shortage and stem cell research.
Members of our society want and have even grown to expect to live healthier, longer lives, yet relatively few people take into account the many ethical issues that revolve around this quest for health and longevity.
On Thursday at 7:30 p.m. at Princeton University’s Richardson Auditorium, Princeton HealthCare System Foundation is presenting a seminar, titled "Embryonic Stem Cell Research: Prometheus or Pandora?," to mark the 85th anniversary of the University Medical Center at Princeton. The evening which will feature panel discussions by leading experts in the field, including Dr. Douglas Melton, Dr. Ruth Faden, Dr. Gregory Stock and author Gina Kolata will provide members of the community with an excellent opportunity to become involved in the ethical debate.
The topic of one of Gina Kolata’s books, "Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus that Caused It," directly relates to the founding of Princeton Hospital in 1919. In 1918, while news of the First World War was capturing the headlines, more than 25 percent of the U.S. population fell ill. Worldwide estimates on the number of deaths attributed to the flu range from 20 million to 100 million.
By October of that year, Princeton had over 300 reported cases of influenza and 15 fatalities. To prevent the spread of the epidemic, public establishments such as churches, schools, movie theaters and saloons were all closed. Of the seven physicians in town, three had left to join the Army. Overwhelmed Trenton hospitals had to turn away Princeton patients. This brought home the need for a local hospital. .
Ms. Kolata notes that today’s scientists are interested in finding the genetic code of the 1918 flu so that they can recognize it if it returns. There is an ongoing international surveillance effort to track particularly harmful flu viruses and make vaccines against them.
In a WebMD interview following the release of her book, Ms. Kolata explains, "scientists have found two tiny preserved samples of lung tissue from soldiers who died in 1918 stored in a government warehouse. And they found a third lung sample in the body of an Eskimo woman buried in the permafrost in Alaska. All three lung samples have flu virus genes, broken into many pieces. Pushing the limits of molecular biology, scientists are taking those genes out of the lung tissue and piecing them together, like putting together a mosaic. So far, scientists have learned the exact sequence of three of the eight genes of the 1918 flu, and to their surprise, they see nothing unusual. So far, the mystery of the 1918 flu remains a mystery."
This is a mystery that is not only worth solving but also leads one to question the ethics involved in vaccine production. Renowned ethicist Harold Shapiro, president emeritus of Princeton University and professor of Economic and Public Affairs at the Woodrow Wilson School of Public and International Affairs, notes that the most immediate issue regarding the flu vaccine is how to ration the limited supply.
This is a difficult ethical issue, as it is not necessarily an easy thing to decide who needs it most.
The second and more long-term problem is why there are so few producers of the vaccine. This is much tougher to solve because there are inherent dangers in the production of vaccines that are made from animal products that can always carry infection. There is also insufficient financial incentive for people to get into the vaccine business.
In the long run, Mr. Shapiro notes, "We need a different set of institutional arrangements so that many people would be interested in manufacturing vaccines. It would also be helpful to produce vaccines from vegetable matter instead of animal."
When asked about the tangible results of ethical debates, Mr. Shapiro points to the significant changes regarding the doctor/patient relationship that have occurred within the last two decades.
Today’s relationships are less paternalistic and involve much greater participation by patients in deciding what course of action is appropriate. For example, one can suffer from both the disease and the cure, and patients ought to understand and know about this.
In addition, the way we treat human subjects in medical experiments has changed, and vulnerable members of society (such as prisoners, military personnel and children) are no longer appropriate experimental subjects.When asked about the ethics of stem cell research in the short term, Mr. Shapiro points to the irony in this country of whether this research is being done by the totally unregulated private sector or the highly regulated public sector. In projecting how this issue might resolve itself, Mr. Shapiro believes that the pressure from people concerned with developing new clinical treatments will be insurmountable.
While there must be ethical debate in stem cell science, the important issue for researchers today is the science and not the more divisive societal issues.
Dr. Douglas Melton, an investigator at the Howard Hughes Medical Institute, the Thomas Dudley Cabot professor in the Natural Sciences at Harvard University, and the co-director of Harvard’s Stem Cell Institute, will be present at the upcoming seminar.
In March of this year, Dr. Melton made 17 new stem cell lines available to academic researchers at no cost, thus freeing them from constraints that would interfere with their pursuit of knowledge. As reported in the Oct. 25 issue of Newsweek, Dr. Melton received money from Harvard, the Juvenile Diabetes Research Foundation and the Howard Hughes Medical Institute not from the government. Dr. Melton believes that academic researchers ought to have the same access to this material as independent and corporate researchers who are not subject to government restrictions.
Clearly, there are a host of medical ethics questions to discuss. Consider that in Greek mythology, Prometheus erred in stealing fire from the gods but, by doing so, he bequeathed a great gift to humankind.