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Is the definition of medicine based on scientific parameters or human values?

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Definitions of medicine, disease and health are some of the most complex and philosophically intriguing discussions one can have in a medical context. There seems to be no universal truth that can be applied to these terms, as each of them can be viewed subjectively through the viewpoint of value-based arguments or through objective, factual definitions. 

The definition of disease through theories such as the biostatistical theory of health, health as well-being, etc. show that the definition of medicine is not entirely scientific, nor is it entirely value based. However, it is a complex and ever-changing mixture of the two, depending on the individual circumstances of how this argument is applied. 

Firstly, the definition of medicine as the “curing people of diseases” can be scrutinised, which is often mentioned as the key defining point of medicine. It can be argued that this is not entirely correct, as there are fields of medicine where the aim of the practitioners is not necessarily to cure the patent of disease but mitigate and reduce the symptoms of that disease. For example, according to the WHO, palliative medicine “improves the quality of life of patients and that of their families.”. Furthermore, any form of symptomatic treatment for diseases, some which may be terminal and so deemed ‘incurable’, is proof that the sole aim of medicine cannot simply be to cure disease. In fact, we can redefine medicine as aiming to improve the quality of life of people with disease, and thus the practice of medicine takes on a more holistic approach. Therefore, we have already deconstructed the first assumption which is commonly stated with regards to the definition of medicine.

However, we have yet to define exactly what is meant by disease. For that we must take a closer look at two different theories of the definition of disease.

Firstly, we take the biostatistical theory of health, as put forward by Christopher Boorse who stated that “a disease is a dysfunction of a subsystem of the body.” Put simply, this theory states that disease is a failure (or dysfunction) of the parts of the body, to carry out functions to statistically ‘normal’ levels, dependent on the age, species, gender, and so on. On the face of it, this theory does make sense; for example, the parameters we use to diagnose high potassium/bilirubin/white blood cell levels in the blood, etc. are based on calculated ranges that are known to be accurately reflective of the statistical normal. However, a key weakness in this theory is that for certain recognised illnesses, a patient may have statistically normal biological indicators of health, for example: mental illnesses or phantom back pain. Therefore, this theory cannot be applied as a universal truth and we cannot define what a biological dysfunction is through scientific or statistical methods alone; hence, this seemingly supports the value-based argument.

The second theory is that of “health as well-being”, which has been aptly defined as “[bringing] values back into the assessment of health, without leaving facts behind.”. Here, well-being is dependent on an individual being able to achieve their ‘vital goals’, which are personalised for every person and are the conditions that must be achieved for a person’s minimal happiness. Therefore this theory seems to suggest that disease must be based on the values of a person, because the vital goals of a person are dependent on his/her values. And so we can argue that the definition of medicine must be more value-based. However, a key point is that although this theory relies heavily on the patient’s subjective view of their own health, that view can be heavily influenced by science, and how scientific methods are applied in the context of that disease. For example, a doctor must use scientific methods to diagnose and understand the cause of disease and decide on the treatment/s needed for that patient. This in turn will affect the patient’s vital goals, and how they predict the outcome of their illness; whether they presume they have a good prognosis is based on the advice of the doctor, which is in turn based on science. So even though the vital goals of a patient are entirely subjective, the way in which those vital goals are seen and adjusted are heavily influenced by science. Therefore, science is still a fundamental part of medicine, and we cannot say that medicine is not entirely scientific and based on values.

In conclusion, we can see how medicine cannot be defined as either completely scientific or completely value based and if we take either of these theories as absolute and try to apply them to all contexts of medicine, then, we will uncover a rabbit-hole of contradictions to these arguments. The key here is to view both theories as complementary, and not mutually exclusive. This allows us to understand that the value-laden definition of disease does not diminish the scientific aspect but instead serves as a way to support and make practical use of its scientific methods. 

Medicine is thus based on the beautiful harmony between science that enables doctors to diagnose and treat physical illnesses, and the experiences and values of the patients that receive treatment for their illness, which may not have any outwardly physical manifestations, but cause distress and discomfort to the patient either way. Therefore, through whichever way you define disease, it is a complementary blend of scientific and ‘non-scientific’ that ultimately best fits the definition of medicine. 

All views expressed in this editorial are solely that of the author, and are not expressed on behalf of The Analyst, its affiliates, or staff.

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Diseases cured with CRISPR gene therapy

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The possibility of using the popular genome-editing tool CRISPR to treat a number of diseases in humans is becoming a reality. Clustered regularly interspaced short palindromic repeats (CRISPR) are DNA sequences in prokaryotes (unicellular organisms). CRISPR is one laboratory method of altering the DNA and can be used as a tool for gene therapy, whereas standard gene therapy is a complete domain of treating genetic disorders by using a number of techniques of genetic manipulation. CRISPR tools were first identified in E. coli in 1987 by a Japanese scientist, Yoshizumi Ishino, and his team. 

In 2012, George Church, Jennifer Doudna, Emmanuelle Charpentier, and Feng Zhang discovered that by designing guide RNA to target a specific region in the genome, “the CRISPR system” can be used as a “cut-and-paste” tool to modify genomes. As a DNA-editing tool, CRISPR can remove or introduce new genes as well as inactivate or activate genes. George Church and his team also predicted that in the near future, the CRISPR tool may also be used to cure genetic disorders in humans such as sickle-cell anemia and cystic fibrosis. A team of researchers from Boston used CRISPR technology to treat sickle cell patients by editing a strand of DNA in the host body. With the use of this tool, they were able to disable fetal hemoglobin.– a big step towards gene therapy for sickle cell diseases. Scientists have also cured cystic fibrosis by replacing the defective gene with the wild-type gene using the CRISPR system. 

The development of cancer therapy using gene editing has become one of the latest focuses of CRISPR technology. By editing cells to remove genes that can allow cells to be inactivated by cancer cells, adding genes that allow immune cells to better target cancers, researchers provide a way to harness the body’s own defense mechanisms to better treat various cancers. In 2016, Chinese researchers treated the first cancer patient with CRISPR therapy. With the technology, researchers extracted the blood of the patient, disabled the gene that codes for a protein that keeps the immune system in check, and hence shielded cancer cells in the process. The scientists then reinjected the cells and cured the patient.

The medical technology of CRISPR gained further popularity in 2019 when more results appeared from testing the tool in people, and then more studies were launched. Researchers decided that they will look ahead to more applications of CRISPR genome editing that could lay the foundation for treating a couple of diseases ranging from blood disorders to hereditary blindness

  Many scientists believe CRISPR is a much easier tool for locating and cutting DNA at a specific spot, so interest in the new research is very high. Patients of Leber congenital amaurosis (LCA) are good candidates for this treatment. LCA is caused by a gene mutation that keeps the body from making a protein required to convert light rays into signals to the brain, which enable vision. These patients are often born with low vision and this can even deteriorate within a few years. Scientists can’t treat it with standard gene therapy because it is too big to fit inside the disabled viruses that are used to ferry it into cells. In 2020, researchers aimed to edit or delete the mutation in LCA patients by making two cuts on either side of DNA that would reconnect and allow the gene to work as it should. They scheduled several LCA patients for an hour-long surgery to treat the visual impairment. 

Last week, researchers revealed the first evidence that the tool appears to be working and improving vision for patients with the condition of LCA. Carlene Knight was one of those patients and her vision was so bad that she couldn’t even do her job in the call center where she worked using her cane. “I was bumping into the cubicles and really scaring people that were sitting at them,” says Knight, who was born with the rare genetic eye disease. Knight was one of seven patients who volunteered to let doctors modify their DNA by injecting gene-editing tool CRISPR directly into cells that are still in their bodies. Her life completely changed as a result of volunteering for a landmark medical experiment. Her vision has improved enough for her to make out doorways, see objects, sunsets, and colors. The therapy was successful for everyone in the trial and the treatment proved far from curing the patients, and the changes they experienced are significant to have a positive impact on their daily lives.”It’s a really amazing technology and very powerful,” says Dr. Mark Pennesi, professor of ophthalmology at the Casey Eye Institute at the Oregon Health & Science University. He presented the results at an International Symposium on Retinal Degeneration in Nashville, Tennessee. Pennesi cautioned that more patients need to be treated and followed longer to confirm if the approach is safe and to determine just how much it can help visually impaired patients. But the current results are so promising that the researchers have given a green light to move on to the next group of patients. CRISPR genome editing has proved to be a remarkable method to restore vision to the people. It is the kind of advancement which is motivating researchers to come up with new ways to treat hereditary diseases. CRISPR genome editing has revolutionized biological research. The treatment is still in the early phase, but many scientists indicate that CRISPR mediated therapeutic innovation absolutely holds immense promise.

All views expressed in this editorial are solely that of the author, and are not expressed on behalf of The Analyst, its affiliates, or staff.

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Facebook’s internal research on Instagram reports detrimental mental health effects on teens

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The humble origins of the internet bridged a much-needed gap in networking and communications. It established a means for collaboration and interaction between individuals and computers independent of location. This simple tool revolutionised not only how we access and consume data, but it has also had major influences on our social behaviour through the development of social media sites.

One of the most used social media sites is Facebook, through which the evolution of ever more engaging and interactive social media apps such as Instagram, Snapchat and TikTok have come into inception. Whilst there are many benefits of social media, such as sharing ideas, connecting with family abroad and promoting business, there are concerns about its long-term effects on human psychology. Recent research reveals the potential risks social media carries in facilitating the development of addictive behaviours, especially among the young. Companies need to do more to address these concerns and find solutions to tackle these growing issues, but are they doing enough?   

Last month The Wall Street Journal published leaked reports of Facebook’s internal research into the mental health impact of Instagram on teens. Reports unsurprisingly revealed that Instagram has been negatively impacting the youth’s mental health, particularly that of young teenage girls. Instagram is the second most popular social media app after Facebook in the US and increasingly attracts the attention of the younger population. However, Facebook denies The Wall Street Journal’s interpretation of its internal research and labels it as “not accurate” and limited. Facebook’s UX research team have felt that they are downplaying the reports as well as undermining their employee’s ability to do their job properly.

The detrimental effect social media is having on young minds is not novel as recent research has reported similar conclusions. An article from The Wall Street Journal tells the story of a young Anastasia Vlasova’s development of an eating disorder, influenced through making unhealthy comparisons with herself and the images promoted to her of toned bodies, unrealistic beauty standards and lifestyles. A further study entitled ‘The impact of social media use on appearance self-esteem from childhood to adolescence’ was published this year. It discovered that social media users who view content more – as opposed to posting their pictures online – are more likely to experience low self-esteem. This directly compares to users who post more pictures of themselves and thus are recipients of positive feedback in the form of ‘likes’ which enhances their self-esteem. However, neither ends of the spectrum have a positive effect on the long-term mental health of teens and young adults. Although posting images of oneself may enhance the user’s self-esteem and confidence through likes, the direct association between the two can also act as a double-edged sword whereby it can trigger the brain’s reward system and develop addictive behaviours.

Another major concern for the youth is the regulation of social media content. Content viewed is the outcome of machine learning algorithms which form the underlying framework of how social media app’s function. These algorithms are programmed to collect data on user activity and identify their search patterns to tailor a more personalised experience towards them and ultimately increase user engagement. Increased engagement with certain types of content can also cause users to become entrapped into ‘social media bubbles’ where they are exposed to more polarized content which may either be harmful or beneficial. It has been established that the adolescent brain tends to be more vulnerable to developing addictions, therefore additional protection is needed on apps like Instagram where nearly “ two-thirds of its users are aged between 18-29” and 72% of users in the US are 13–17-year-olds. These concerns have additionally been exacerbated by the Covid-19 pandemic, which has seen a rise in social media usage worldwide

Companies have done little to nothing to address these major causes for concern. Recent efforts were underway by Instagram to develop an “Instagram Kids”, a service for children aged 13 years old and younger – but recent reports tell us that they are pausing development of that feature and placing emphasis on parental supervision. In a recent interview with 60 Minutes Frances Haugen – the Facebook whistle-blower who leaked the reports to The Wall Street Journal suggested Facebook was aware of the negative mental health effects on teens but continuously chose to prioritise the optimization of their financial interests

Tackling these issues requires collective and collaborative effort and should not rely solely on parental supervision. Facebook needs to put morality over profits. If profits are an issue, they should invest in the development of new money-making models that protect vulnerable people. Governments also need to do more by implementing legislation which protects the interests of the public and safeguards the mental health of vulnerable people and children from ill effects of social media. Schools can also play a key role in spreading awareness about these issues and promoting students to adopt a healthy balance between social media usage and recreational activities.

All views expressed in this editorial are solely that of the author, and are not expressed on behalf of The Analyst, its affiliates, or staff.

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Approved malaria vaccine may reduce child deaths in the African subcontinent

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The World Health Organization (WHO) recommended the widespread use of the malaria vaccine recently. This drug was administered in three African countries, Ghana, Malawi, and Kenya and it showed positive results in all of them.

The malaria vaccine aims to kill the disease which aims at children under the age of five. Additionally, a lot of work was done by African scientists to develop the vaccine. According to Dr. Akpaka Kalu, a WHO Regional Advisor for Tropical and Vector-borne Disease, “the datasets that were generated in these studies and field trials were by African scientists,” adding “we hope that the same technology used for Covid vaccines will be used to manufacture malaria vaccines and other vaccines in the future.”

The RTS, S/AS01 (RTS, S) malaria vaccine is recommended to be used in sub-Saharan Africa and other regions with high P.falciparum malaria transmission by WHO. The WHO Director-General Dr. Tedros Adhanom Ghebreyesus said that “this is a historic moment. The long-awaited malaria vaccine for children is a breakthrough for science, child health and malaria control,” and “using this vaccine on top of existing tools to prevent malaria could save tens of thousands of young lives each year” This vaccine was proven effective six years ago but was recently approved by WHO to be administered all over the African continent.

Malaria is a disease that mostly affects children and infants. This is a prevalent disease in Africa that affects more than 260,000 children under five, annually. Since it is caused by mosquitoes, drugs to kill the parasite, insecticide to kill mosquitoes, and bed-nets have all reduced the rate of the infection. However, Africa still has a pretty high rate of infections.

Clinical trials have proved that this vaccine offers 39% protection to infants and children under five. Sadly, the effects of the vaccine fade over time. This is why Dr. Doyin Odubanjo, a public health expert stated that “the vaccine is effective enough in reducing the cases of severe malaria though it is not generally highly effective and its effect wanes quickly as too,” adding “this means that we must not abandon the other tools.”

According to Dr. Pedro Alonso, “we’ve been looking for a malaria vaccine for over 100 years now, it will save lives and prevent disease in African children.” So, finding a vaccine that will help combat this infection is a historical achievement. The WHO needs to ensure the vaccine reaches all parts of Africa while other preventive methods are still in action. If done effectively, malaria may no longer be a concern in the near future. 

All views expressed in this editorial are solely that of the author, and are not expressed on behalf of The Analyst, its affiliates, or staff.

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Impact of booster COVID vaccines – Health Report

As the US considers booster COVID vaccines, our experts discuss their impact and the rates of COVID vaccinations around the globe

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All views expressed in this editorial are solely that of the author, and are not expressed on behalf of The Analyst, its affiliates, or staff.

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WHO’s stance on the future of COVID-19 – Health Report

Our panel of physician experts discuss the current and future outlook of COVID-19 and the stance of the World Health Organisation on the future of the virus

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All views expressed in this editorial are solely that of the author, and are not expressed on behalf of The Analyst, its affiliates, or staff.

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Small cell lung cancer: Diagnosis, treatment options, and ongoing research

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As of 2019, according to the United States National Cancer Institute, the mortality rate from cancer was 158.3 per 100,000 men and women every year in the United States. In 2018, the estimated national cost for cancer treatment was approximately $150.8 billion, and is projected to increase, especially since the population is aging which can lead to a heightened risk of being diagnosed for cancer. However, treatments for cancer are improving, such as for small cell lung cancer (SCLC), a rare form of cancer. 

What is SCLC? 

SCLC is one of the two main types of lung cancer – the other type is non-small cell lung cancer (NSCLC). According to the American Cancer Society (ACS), SCLC is responsible for approximately 13% of all patients with lung cancer, but is not as prevalent as NSCLC within those patients. Yet, SCLC is aggressive, more so than NSCLC, which allows the cancerous cells to metastasize, or spread, throughout the body, and is usually detected after it has spread, thus making treatment and recovery more difficult. One reason for delayed diagnosis is due to the fact that SCLC is usually asymptomatic, meaning that those with SCLC often do not display any symptoms. 

What are symptoms of SCLC? 

When symptoms appear, they may appear as the following (but are not limited to): shortness of breath, facial swelling, and loss of appetite. Chest pain or discomfort, persistent coughing or hoarseness of voice, and wheezing may also occur. 

What does diagnosis of SCLC look like? 

SCLC is diagnosed as one of two stages: limited stage lung cancer, and extensive stage lung cancer. Limited stage indicates that the cancer is confined to one side of the chest, and is small enough that it may need treatment in only one area. On the other hand, the extensive stage is when the SCLC has spread to the other lung, throughout both lungs, or to other parts of the body such as the lymph nodes. 

How is SCLC diagnosed? 

SCLC can be diagnosed in multiple ways. For example, a variety of imaging tests may be used to determine possible abnormalities in the lungs. For instance, computerized tomography (CT) scans, magnetic resonance imaging (MRI) scans, and positron emission tomography (PET) scans. In addition, a sample of the patient’s mucus may also be taken to determine if SCLC is present. Furthermore, a biopsy (removal of a small piece of tissue) may be conducted on the chest. Additionally, a technique known as bronchoscopy (which uses a thin, lighted tube to observe the airways directly) may also be used. 

What factors influence the risk of getting diagnosed with SCLC?

Those who smoke are at an increased risk for SCLC, while those who do not smoke have rarely been found to develop SCLC. The risk for developing SCLC is proportional to the number of years that a patient has been smoking, as well as the amount of cigarettes they smoke per day. Thus, those who have been smoking for years and consume large amounts of cigarettes daily are at the greatest risk for developing SCLC. A popular misconception is that smoking cigarettes that are “low-tar” would decrease the risk of developing SCLC – this is not true as smoking in general causes damage to the lungs. In addition, being exposed to secondhand smoking regularly may also increase the risk of being diagnosed with lung cancer by approximately 30%, according to the American Lung Association (ALA). Furthermore, environmental factors can also influence the risk of being diagnosed with SCLC, such as, but not limited to: diesel exhaust, inhaling radon, inhaling asbestos, and being exposed to outdoor air pollution. 

What are current treatment options? 

One treatment option is to use surgery to remove the tumor – however, this is generally only performed when the cancer is small and only present in the lung, and the patient is healthy enough to undergo the procedure. Another treatment option is to use radiation, which kills the cancerous cells. Yet, radiation therapy (also known as chemotherapy) can cause numerous side effects, including but not limited to: fatigue, body pain, and loss of appetite. In addition, patients may also undergo immunotherapy, which supports the human immune system in fighting off the cancer.

What is the focus of current research?

Currently, there are clinical trials being conducted in numerous areas. First, targeted antibodies are being investigated as a possible treatment for SCLC. These antibodies specifically target slowing down or stopping the growth of the cancerous cells through the mitosis process (mitosis is the process by which cells grow and divide, and malfunctions during cancer). Another focus is on immunomodulators, which are a class of drugs that are able to influence how the immune system responds to cancerous cells, such as checkpoint inhibitors (these are present in mitosis, and prevent mitosis from occurring if the cell’s deoxyribonucleic acid (DNA) is damaged, for example). Further, adoptive cell therapy is another form of treatment, where immune cells are removed from the body and fortified against cancer, and then re-inserted into the human body to assist the immune system. In addition, cancer vaccines are also being investigated as possibly assisting the body to recognize cancerous cells and their features, thus allowing for a much quicker and larger response should the person have cancer in the future. 

Are diagnosis rates improving? 

Yes, diagnosis rates have been falling throughout the years due to a decrease in smoking rates. Tobacco is the leading cause for the diagnosis of SCLC because of the damage that is caused to the lungs. 

In conclusion, SCLC is one of the two main types of lung cancer, and is an aggressive form of cancer that can metastasize easily. Although its diagnosis is often more during the advanced stages of the cancer, recovery is possible with multiple treatment options available. Currently, ongoing research is investigating multiple innovative solutions, such as immunotherapy, to not only understand this cancer further, but to also improve the quality of life for SCLC patients. 

All views expressed in this editorial are solely that of the author, and are not expressed on behalf of The Analyst, its affiliates, or staff.

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