After attempts to use non-human primates as a source of scarce organs for transplant, doctors have turned to pigs for a variety of reasons. They’re now making great progress against the largest hurdle—rejection. One of the world’s foremost xenotransplantation experts discusses how the process might work and what the future might look like for millions of potential organ and tissue recipients.
Dr. David Cooper, Professor of Surgery, University of Alabama at Birmingham and Co-Director, UAB Xenotransplantation Program
Since their creation, vaccines have had a long history of being controversial. Many of the problems surrounding vaccines that we hear about have to do with recent controversies. Yet, their conception has been the center of ethical debates since the 1960s. The founding of vaccines is an important point in history that has allowed for the development of understanding the balance between need and ethics in medicine.
Vaccines were founded from the eminent need to stop the spread of the next horrific epidemic. Dr. Meredith Wadman, reporter for Science magazine and author of The Vaccine Race: Science, Politics, and the Human Costs of Defeating Disease, explains that the devastation of the Rubella epidemic that occurred from 1964 to 1965 influenced the race to find a vaccine to help prevent the breakout of another epidemic. However creating vaccines involves reproducing the viruses which can only be done with cells. Originally, scientists used monkey kidney cells, but Dr. Wadman explains that these were expensive to obtain and they came with a number of safety issues. So, Leonard Hayflick, a researcher, developed the idea of using human cells, a concept that, Dr. Wadman, explains has garnered the attention of ethics debates because he used cells obtained from a fetus without the consent of the women who had given up the fetus. The cells from this fetus that were used in the 1960s are still being used today in order to develop more vaccines that have been used to save hundreds of millions of people.
How do scientists justify the ethics of this decision to people who do not agree with abortion? Dr. Wadman explains that it is important to look at the larger picture because it is not an ongoing process. Since 1960, this one fetus has been used to save the lives of a number of people. But, this reasoning should not be used to justify all unethical matters. Dr. Wadman explains that the race to find a vaccine was later used to rationalize an abuse of power during World War II in which researchers in America began to test on institutionalized people, prisoners, and even premature newborns and intellectually disabled children, in order to create a vaccine against influenza. At the time, these practices were not regulated, but over time protections and rules were implemented that no longer made it possible for experiments of this nature to take place. While the need for a vaccine can appear to be vital, especially when there are lives on the line, it is important that researchers do not forfeit ethics.
Dr. Meredith Wadman, reporter at Science magazine and author of The Vaccine Race: Science, Politics, and the Human Costs of Defeating Disease
Anesthesia is one of the most commonly used medical practices. It is used on patients who are undergoing surgery in order to make them unconscious for the duration of the procedure. Despite being a well used practice, doctors admit that they do not know how anesthesia actually works–only how to control it.
Since anesthesia is an important aspect of surgeries because it ensures that the patient has no recollection of the pain, anesthesiologists must be well trained. Dr. Henry Jay Przybylo, Associate Professor of Anesthesiology at Northwestern University School of Medicine and author of Counting Backwards: A Doctor’s Notes on Anesthesiology,explains that anesthesiologists must first finish medical school, and then they receive additional training. While administering anesthesia is a simple task on most patients, he explains that some patients can react differently and the anesthesiologist must be able to adjust to it.
In the 1990s, technological advancements not only made the medical practice easier, but they also made it safer. Dr. Przybylo explains that it became easier to measure the gases that were being inhaled and exhaled by the patient because they now had monitors and screens to better track these measures. Despite improved technologies that make anesthesia more simple, some patients are still more afraid of losing consciousness than they are of the actual procedure. But, Dr. Przybylo states that the pain and trauma experienced during the procedure is probably much better off forgotten by the patient. Listen to Dr. Przybylo talk about the history of anesthesia, and how doctors have learned to use it over time despite having little understanding of how it really works.
Dr. Henry Jay Przybylo, Associate Professor of Anesthesiology at Northwestern University School of Medicine and author of Counting Backwards: A Doctor’s Notes on Anesthesiology
Synesthesia is a condition involving cross wiring in the brain that allow senses to overlap. Dr. Joel Salinas describes his experience with his mirror touch synesthesia. His sight translates into his touch, and he is able to feel the pain from his patients. “If you are gasping for air, I feel it in my body. If you are having a panic attack, I feel it in my body,” says Dr. Salinas, neurologist at the Massachusetts General Hospital and author of Mirror Touch: Notes From a Doctor Who Can Feel Your Pain. “The vision part of our brain and the touch part of our brain will both activate when we see other people either moving, or being touched, or in pain. And this happens without us knowing.” While most people may cringe or wince at the sight of a car accident or painful fall, Dr. Salinas says he feels the pain of anyone he sees, including his patients. He shares a story about a patient who was unable to be restrained by her nurses. He came to help, and immediately felt a crushing pain in his chest. When Dr. Salinas realized that this patient was having trouble breathing, he ordered for a specific test to be done which found that she had serious blood clots. While this gift allows him to help his patients in significant, unusual ways, it also may cause him stress, discomfort, and serious pain. The first time he saw a patient die, Dr. Salinas underwent the feeling of death, which he describes as a long-running air conditioner that has gone silent. He had to will himself to breathe again, and has since used small tactics to “ground” himself such as focusing on the feeling of his toes.
Dr. Salinas says he had has mirror-touch synesthesia for as long as he can remember, and that he experiences letter-color synesthesia as well. When he visualizes certain words, each letter will have a distinct color that contributes to its meaning. Dr. Salinas also shares that roughly 4% of all people have some form of synesthesia, and most go on to hold careers in the arts, where their thoughts and feelings are translated into their work. Many well-known musicians are synesthetes, including Billy Joel, Kanye West, and Lorde. It is even suspected that artist Vincent Van Gogh had synesthesia, from how he described his artwork to others.
Since the introduction of antibiotics in World War II, doctors have prescribed courses of treatment that typically ran longer than necessary. Bacterial resistance is forcing a reevaluation, shortening courses sometimes to just a few days and even prompting doctors to advise not using all pills if patients feel better.
Doctors have often been advised to avoid emotions regarding patients in order to keep their decisions objective. However, this has led many patients to believe doctors don’t care about them. A new movement in medicine seeks to reverse the trend and put compassion back in medicine, led by a “Healer’s Art” class in many medical schools. Experts who teach the class explain.
Many patients want certainty in diagnoses, especially when they’ve had expensive diagnostic tests. However, those tests are often less certain in their results than people think, making patients sometimes doubt doctors’ competence.