Ethics of Gene Mapping for Personalized Treatment

Ethics of Gene Mapping for Personalized Treatment There are many concerns about the future of the use of gene mapping for the personalisation of medicine. Whilst there are many benefits to the use of genetic testing to allow a more precise diagnosis and tailored treatments for various illnesses there is a risk of the information being abused to harm the patients. The information could be used to harm the patient’s future career prospects or lead to an increase in premiums for health insurance, possibly even an outright denial of coverage. However the US government has introduced legislation to protect the rights of the people and the concerns are outweighed by the benefits to the patient’s quality of life in terms of medical care. Introduction Mainstream medicine’s always had the differential diagnosis of patients decided primarily by generalisations made from a population of patients suffering from similar symptoms. The treatment is then found by knowledge acquired by research done over the entire population of people with similar symptoms(Torrey2013). The personalisation of medicine aims to have diagnosis and treatment tailored to patients to ensure they receive the best quality care possible. This will be done by the studying of their genetic framework to find out early if they have the genes for certain diseases. However, whilst it’ll be beneficial to the treatment of the patient, this has some ethical implications which this paper will aim to discuss throughout this paper and present a balanced argument to each concern as well as coming to a clear conclusion as to whether the benefits outweigh the ethical issues Method Relevant papers were found using medical journal databases subscribed to by both the University of Exeter and the University of Plymouth, the Google Scholar search engine, the BMJ, the NICE database for statistics and MEDLINE(PubMed). I also used Google to find relevant news articles relevant to my case to ensure I included public opinion as well as my own. The key words and phrases I used to search online for papers were various combinations of; â€Å"genes†, â€Å"gene mapping†, â€Å"personalized treatment†, â€Å"discrimination†, â€Å"cost to† and â€Å"NHS†. I then narrowed my search to recent papers and news articles that were relevant to both the United Kingdom and the United States. Discussion What is gene mapping and how can it be used to personalize treatment? The Human Genome Project mapped the approximately 25,000 human genes, determining what genes exist in human DNA and what their roles are in a healthy human being. Knowledge of what those genes look and behave like when they’re normal means that they can be compared with the genes of patients with medical problems to determine whether those patients genes are abnormal(Haga2009). Gene mapping is the process of finding the locations of genes on the chromosomes of patients(Haga2009). It used to be done by a process called linkage analysis, where the closer two genes are to each other, the more likely that they’ll be inherited together(U.S. National Library of Medicine ®2013). From this, patterns can be found, which can be used to determine their location on the chromosome(U.S. National Library of Medicine ®2013). The more modern approach is by the use of small tags achieved by two methods. The first is by the use of genetic markers such as the products of a Polymerase Chain Reaction, where single piece of DNA can be amplified by the production of up to millions of copies of the DNA fragment(Bartlett Stirling2003). The second method is by use of enzymes specialised to bind to and cut very specific areas of DNA called restriction enzymes. The resulting fragments are separated by the process of electrophoresis and overlaps in the genetic information called contigs can be used to find consensus sequences which can be used to figure out which parts of the DNA strand it was originally from, which added together gives a map of the entire sequence(Gregory2005). Once gene mapping’s occurred, it can be used to several ways to personalise treatment for the patients. It can be used to further distinguish between various diseases to insure the patient receives the highest quality and most efficient care available. For example, research done at University College London’s found that there are three different locations on the DNA of patients afflicted with the disease Chrons Disease that were found to be coded for by genes(Elding et al.,2011). The three genes have different functions but were all found to be involved with the patient eventually developing Chrons Disease. This allows for further distinction between different types of Chrohns disease, meaning a further personalised course of treatment. This is similar to a result of the genomic profiling of breast cancer tumours. Four distinct types of breast cancer were found by were found by a research team at Cleveland University Hospital, meaning the cells of each subtype can be broken down and studied(University Hospitals Case Medical Center2013). By knowing the molecular underpinnings of a particular kind of breast cancer, the cure rates and, in the advanced disease setting quality of life and length of life can be improved.(University Hospitals Case Medical Center2013). Another way gene mapping can be used to personalise medicine is by the study of pharmacogenetics, the study of the impact of genetic variation and drug responses(Galas Hood2009). This is to customize the drug treatment and dosage to individual patients to get the most efficient and effective treatment possible. It’d mean the treatment could work faster, cheaper, and fail less often, as there’ll be no need to go through multiple treatments until they work(U.S. Department of Energy Human Genome Project2003). The use of personalised genetic medicine could save the NHS millions of pounds per year. Just purely with the disease of neonatal diabetes a reduce in cost was found as, $30,437 at 30 years, $12,528 at 10 years, and $23,227 at20 years compared to no genetic testing(Greeley et al.,2011). This is just one disease but putting into account all of the diseases this could be used for, overall millions could be saved for the NHS. Healthcare providers can personalise medicine to have more precise diagnoses, higher quality care, better therapies, and access to more precise patient information. Furthermore the genetic information taken can be added to large databases which can be shared with researchers and scientists worldwide.(The Genetic Information Nondiscrimination Act2008) They can use this information to take research forward at greater rates and will be beneficial. Ethical concerns Whilst there are many ways gene mapping can be beneficial to the treatment of patients, there are many concerns regarding how the process can be abused to violate the rights of the patients as well as have an overall negative result for the well being of the patient. One concern is how the genetic tests will be evaluated and regulated for accuracy, reliability, and utility.(Haga2009) Whilst the treatments will be tailored to the patients to a certain degree it can never be completely specialized. The human population that this treatment will be used for will still be quite a lot of people instead of just that specific person. This will mean the tests will still have some degree of generalisations made for populations leading to less accuracy and reliability in the treatments. There could be factors leading patients to no longer fit the assumptions such as underlying conditions or lifestyle that could reduce the effectiveness of the treatments. Furthermore whilst the populations will be large enough to have generalisations made, they’ll be small enough to mean less reliable results. The sample size will be small meaning the results could be less accurate as smaller populations would be more unpredictable and less stable. Another concern is whether testing should be performed on patients suffering from incurable diseases. Pharmacogenetic testing could find gene expressions associated with an unknown disease for which no known treatment is known, or a disease that’s known to be incurable(Guttmacher Collins2003). This could lead to the patient being upset about something they’ve no control over and becoming depressed(Guttmacher Collins2003). There’s potential for a large amount of decrease in mental well-being for the patient as well as a decrease in quality of life due to this depression. However, whilst the disease is currently unknown, and no treatment has yet been formulated, it doesnt mean there wont be one found in the future. Despite there being no known treatment, or information at all, for diseases the genetic mapping could be useful in the future once a treatment’s been found. Lastly the process of genetic mapping may be vital in identifying or finding a treatment for the disease. In fact, some people were found to be willing to undergo testing simply to further science, in hopes it’ll benefit their descendants.(G.I.N.A. 2008) Another major concern of the use of gene mapping is how the information gathered will be used and who has access to it. One fear that’s commonly expressed is that the information could be used to harm people, for example, deny them access to health insurance, employment, education, and even loans. The information could be used to discriminate between patients seeking medical insurance by increasing the price of insurance if they’re found to be susceptible to diseases, or completely deny them coverage. Insurers insist that they don’t currently perform genetic tests to obtain information, but the information should become available to them, citing the need to avoid moral hazard- the risk that patients who know they’re susceptible to certain diseases will try and get insurance before they die at normal rates.(Torrey2010) Employers may deny jobs to potential employees or restrict hours they can work if they’re found to be susceptible to diseases. They m ay even go as far as force early retirement on them if the potential for diseases are found whilst they’re already working for them. However the US government’s put in place certain legislations to protect the rights of the people. The Genetic Information Non-discrimination Act (G.I.N.A.) of 2008 is an Act of Congress of the U.S.A. designed to stop the use of genetic information in health insurance and employment(Boston Business Journal2008) The act stops insurers from denying coverage, or charging unfair amounts based solely on information found via genetic testing showing a predisposition to developing the disease in the future(Boston Business Journal2008) The legislation also stops employers from being able to use information found from genetic testing when making decisions to do with the initial hiring of employees, the firing of employees, or any decisions concerning the employees position in the company such as promotions and demotions.(Boston Business Journal2008) The National Human Genome Research Institute(NHGRI) states that NHGRI believes that legislation that gives comprehensive protection against all forms of genetic discrimination is necessary to ensure that biomedical research continues to advance. Similarly, it believes that such legislation is necessary so that patients are comfortable availing themselves to genetic diagnostic tests. (Godfrey2012). Whilst the legislation is slightly overly broad and may lead to an increase in frivolous law suits, it can be made less ambiguous and protect the rights of the people to lessen concerns over the future of the use of genetic mapping to personalise medicine(Godfrey2012). Conclusion However despite these concerns I feel that the government, especially in the USA, is on the right tracks to providing clear legislation that’ll protect the rights of people seeking to have genetic testing done with no repercussions on their lives. The legislations are fairly vague on some points but as the personalisation of medicine becomes more commonplace, a better idea of what the legislation will require can be formed and the legislation can be adjusted accordingly. I conclude that I feel cost benefits as well as the increase on quality of life for patients outweigh any major concerns about the genetic testing and concerns regarding how the information will be used and who has access to it is currently well established and there are currently measures put in place that protect the rights of people that can be adjusted as the use of gene mapping becomes more common. References

How far, and why, did traditional Catholicism decline during the reign of Elizabeth?

Considering that on the accession of Elizabeth I the majority of men and women in England and Wales were Catholic – from the evidence of wills Protestant loyalty was limited to the south-east where even there it represented a minority – and that by the end of the reign English Catholicism had diminished to only one or two percent of the population, it is fair to say that the extent of the decline in traditional Catholicism was great. The reasons for this can be found by splitting the reign into three time periods where the presence and threat of Catholicism differ significantly. An interesting argument has arisen concerning the explanation of the decline of Catholicism. The historian J. Bossy argues that conservative gentry and clerical leadership did not produce any organized resistance to the 1559 settlement and instead allowed the laity to drift into conformity by attending Protestant church services. He goes on to suggest that it was only the later arrival of the seminary priests from Douai and the Jesuits that saved English Catholicism from complete extinction. Another historian C. Haigh counters this suggesting that Catholic survivalism was strong in the 1560s and that its demise can be attributed to ‘strategic and logistical errors' made by the seminary priests and the Jesuits. It is perhaps easier to agree with Bossy as during the 1560s many Catholics reluctantly accepted the new church, often because of a lack of strong leadership from the papacy. Pope Pius IV hoped to persuade Elizabeth to join the catholic fold and Philip II feared that if the queen was overthrown Mary Queen of Scots would succeed thus driving England into the arms of France. Also the penalties issued to Catholics under the terms of the 1559 settlement were deliberately made light in order to steer them away from attempted opposition. Indeed, the Catholic threat remained dormant during the 1560s and this decade can be seen as the first time period where Catholicism was certainly on the defensive. However, it is a mistake to see the Catholics as completely inactive during this time. The Marian priests who stayed at their posts and had not been either imprisoned or chosen to go into exile, did not conform meekly to Protestantism. Catholic rituals were kept alive within the parish church and accounts show that some churches retained their Catholic altars and priests continued to say masses for the dead. This survivalism remained strongest in the north and as bishops started to complain about the presence of church papists in their dioceses, the government became increasingly aware of the situation. However, to avoid confrontation with the Catholics, Elizabeth preferred to utilize persuasion instead of punishment to deal with the problem. Thus action was only taken if individuals openly defied the law. This approach, which led Catholicism to survive throughout the 1560s, also ensured that the religion was doomed to eventual failure. Until 1569 when the Northern Rebellion broke out, few felt pressurised into recusancy and rebellion and therefore the Elizabethan regime had time to establish itself and win over conservative landowners. It is from 1568 onwards that the Catholic decline halted, and the government was alerted to a potential threat. The lack of any conspiracies or disturbances during the majority of the 1560s demonstrated a decline in the Catholic faith but when continental influences began to halt this decline soon after, serious problems were created for the government. The year 1568 saw a major development which rapidly forced the government to reassess its policy towards Catholics. The arrival of Mary Queen of Scots, a woman with highly-powered contacts in the Catholic courts of Europe, presented an automatic focus for both the plots of English and foreign Catholics. Her presence in England was made especially explosive because she became a pawn in the intrigues of Spain; a nation grown impatient with England's continued heterodoxy, and also her military opposition in the West Indies and Netherlands. Indeed, each of the four main Catholic conspiracies against Elizabeth involved replacing her with Mary with the aid of a Spanish invasion force. Although no such force was to embark until 1588, to have Europe's premier Catholic power and the strong-arm of the Counter-Reformation seeking to undermine the administration was deeply worrying to Elizabeth. The Papacy provided another threat. Its equivocal stance of the 1560s could not withstand Elizabeth's continued heterodoxy, and when Catholic passivity foiled the Rising of the Northern Earls in 1569 Pius V was stirred to issue the Bull â€Å"Regnans in Excelsis† in excommunicating Elizabeth and commanding her subjects â€Å"not to obey her†. In effect, it was now the duty of all good Catholics to repudiate the Queen's authority, but in practice the general apathy and obedience of the Catholic community made an uprising against Elizabeth's authority unlikely. The real threat lay in that it gave foreign powers, most notably Spain, a papal license to threaten England; thus it can be seen that the Papacy indirectly influenced the sending of the Armada in 1588. Incidents such as the Ridolfi Plot in 1571 where a Florentine merchant led a failed attempt to overthrow the Queen, and the Massacre of St Bartholomew's day in 1572 where six thousand Protestants were murdered in France show that the Catholics were capable of serious actions and that these incidents highlight that they were not in decline just yet. The final major Catholic threat were the missionary priests from William Allen's seminary in Douai in the Netherlands. Though the priests were young English gentlemen they had continental training and had links with the Jesuits. Beginning in 1568, their secret preaching undoubtedly saved the Catholic faith from dying out among the gentry, but the threat they posed is harder to determine. They were not politically motivated and did not attempt to directly stir up a Catholic rebellion. It was hoped, however, that the introduction of the Jesuits in the 1580s would breed a new sense of zeal and fanaticism into the generally loyal and patriotic Catholic gentry, so that when a chance came for a restoration of the old faith, enough of them would be prepared to sacrifice their secular obedience for spiritual belief. But the events of 1588 show how they failed in this aim, for, whilst the conspiracies and the Northern Rising had shown an increase in Catholic militancy, when the hoped-for rebellion of the Catholic community failed to materialise in response to the Armada, the English once again showed their reluctance to cause civil strife; all the Catholic gentry families pledged their allegiance to the Queen. The majority of English Catholics were content to retain their beliefs in private, and the attempts by foreign-based missionaries to radicalise their loyalties was probably doomed to failure. However, one must not allow hindsight to make us dismiss the threat and presence of the Catholics simply because they failed to remove Elizabeth. Indeed the government became so perturbed during the 1570s and 1580s that they greatly tightened anti-Catholic legislation such as the increase in recusancy fines to twenty pounds a month and the treasonable offence of being a priest â€Å"ordained beyond the seas†. To Elizabeth, the plots, foreign threat and missionary activity provided a very real threat. So it is not untrue to say that for a period of twenty years the Catholics remained a thorn in the side of Elizabeth's reign and rather than declining the religion stayed put and caused the government problems. However, the decline did come and there is a third period that we must look at in order to highlight the extent of this defeat. A series of events in the 1590s occurred which certainly helped limit the Catholic threat and presence in the country and caused the religion to diminish to the one or two percent that were thought to have been left in 1603. As we have seen, there was loyalty towards Elizabeth shown by the Catholics in their lack of desire to support the Armada. Then in 1587 Mary Queen of Scots was executed due to her involvement in the Babington Plot the previous year. This death deprived the Catholics of a major focal point for their religion and her replacement was to be James VI, a protestant, which did not aid their cause either. Another death, that of the founder of the college for seminary priest William Allen, was also a problem, as now those priests who were attempting to inspire the Catholic community had no inspiration themselves. Indeed the priest allowed squabbles to develop in their midst which distracted them from their aim of mounting a united assault on Protestantism. There was also a rivalry between the secular priests and the Jesuits which surfaced most prominently in 1598 with the ‘Archpriest Controversy'. The argument occurred when the Pope agreed to appoint George Blackwell, an admirer of the Jesuit mission, to have authority over secular priests training in seminaries. The secular priests were outraged and determined to keep their independence appealed to the Pope against his appointment thus earning them the name ‘the Appellants'. Not only did this controversy poison relationship it also uncovered important differences of principle among the priests. In conclusion it is hard to say that by the end of the reign the Catholics were not in decline and perhaps if it were not for the input of the seminary priests then the religion would have become nothing other than a superstitious ritual practiced only in backward communities. Apart from a period where they provided a sustained, yet exaggerated threat causing the government to rethink its policy, the Catholics were weaned from their faith by a slow exposure to Protestantism. Propaganda, persuasion and persecution made the Catholics (although some of the most committed became recusants) drift into conformity. The decline of Catholicism was a steady but expected process.

Book Analysis: Jack Sprat’s Wife

Everyday she goes out to the market In order to buy meat, her husband's favorite food. She had read many books in order to know how to Improve her cooking for him. He ate all the beef and she ate the fat. Then, we learn that she exercises at the municipal pool and that she does not enjoy having sex with her husband because she is not comfortable with her body. Later on, surprisingly we discover that she had killed, packaged him and labeled his meat inside the freezer in order to eat him over. She starts vomiting in order to get thin, as it is socially expected.Soon after, we learn she had cooked some meals with him, and ate them because â€Å"she deserved It†. In the story she thinks she Is Invisible. ND one possible reason for her health situation could be that she eats in order to be visible. On her husband's birthday his mother-in-law goes to visit her. She tells her that her husband had gone on a trip and later on, The first concepts, subordination and subversion are shown in the main feminine character, through her food problem, it is, apparently due to her own vision of herself, an Incomplete human being, subordinated not only to her husband, but also to food.Her only around Is preparing food for her husband and she â€Å"tames time† by eating. The feminine character attempts to change her reality, to subvert things, cause she thinks her husband's meat was the key, as he ate all the healthy part of meat, she eating him over would get healthy, according to her , he is â€Å"the antidote to what ails me†. The other concepts, public and private spheres are shown through the idea that what we consume, conscious or unconsciously can heavily affect our private life.In the case of this story, there is a woman whose private life had been greatly affected by the media and the opinion of other people when someone is not skinny. The capitalism has a great Influence over these Issues, In order to gain an economic and the social effect it carries. It is socially established that being thin is to be beautiful. In the case of this female character, as she is fat, she is embarrassed of going out, she does not enjoy sex, and she thinks that her husband does not like her, despite the fact that he actually loves her and cares for her.Our minds are filled with the idea that if we consume such a product or we eat such a thing we are going to be beautiful and successful. This affects our feelings, thoughts and desires. It also changes the way we actually live. To sum up, I would like to add that we should analyze the publicity before we actually take for granted what they say to us.

Analysis Of The Book The Necklace - 988 Words

Pride and selfishness are intense and insatiable desires that can never be fulfilled. These unquenchable needs can be demonstrated by the main characters in the short stories â€Å"The Necklace†, which exemplifies the destructiveness of pride and selfishness from a woman that feels entitled and desires what’s beyond her means and the grandmother in â€Å"A Good Man Is Hard To Find† that puts her needs before others at all costs. Although these two stories are completely different in ways that â€Å"The Necklace is written in an earlier time in Paris about a young couples difference in frugalness and â€Å"A Good Man Is Hard To Find† is written in a later date in the state of Georgia about a grandmother and her burden on her family, the two main characters share similar traits such as selfishness and pride. The grandmother in â€Å"A Good Man Is Hard To Find† remains nameless and is portrayed as a very old-fashioned, self-righteous woman that is, â €Å"Seizing every chance† (O’Connor 1) to manipulate those around her for her own selfish reasons. She lives with her only son and his family in a southern setting in Georgia. She has an immense amount of pride and considers herself morally superior to others. The grandmother views herself as a â€Å"Lady† which is how she manipulates her family to satisfy her own selfishness. However, her idea of being a â€Å"lady† is a very skewed image in the way that morally and consciously, she is quite the opposite. 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