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Presentation at the Senate Chamber of
Bayero University Kano Nigeria on January 10, 2013 by Professor Omar
HasanKasule Sr. Department of Bioethics King Fahad Medical City Riyadh Saudi
Arabia EM: omarkasule@yahoo.com, WEB: www.omarkasule-tib.blogspot.com
Summary
·
Biotechnological break through induces social re-engineering
·
Current: the oral contraceptive pill
·
Coming: stem cell technology
·
Futuristic: vaccination against addiction.
·
Biotechnology can be used for good or for bad.
·
University curriculum is the only way to ensure good applications of
biotechnology: Malaysian experience in integrating Islamic values in the
curriculum
Is
biotechnology value-neutral?
·
Theoretically it should be value-neutral but the
practice is different
·
Developers of the technology have a value system
that impacts on the way they plan to use that technology.
·
Unstated posterior assumptions, paradigms, and
embedded values
·
Examples: architecture of a house has an
embedded value of a nuclear or extended family, hospital architecture may have
an embedded value regarding mixing / separation of genders.
THE
ORAL CONTRACEPTIVE PILL
The
oral contraceptive pill: an introduction
·
The oral contraceptive pill was cited as the
most important technological innovation of the 20th century[i].
·
On its introduction in 1960 it soon replaced
sexual repression and other less effective methods[ii] to
become a mass phenomenon in fertility control.
·
Its impact has been compared to major
discoveries such as discovery of fire, discovery of electricity, and discovery
of atomic energy[iii].
Development
of the pill
·
There is some indicative evidence that the
development of the pill was not an accident but had a background agenda.
·
There was a strong desire among family planning
agencies and the feminist movement to get an effective contraceptive that would
let the woman control her sexuality.
·
Margaret Sanger of Planned Parenthood
spearheaded the campaign to produce a safe and effective contraceptive.
·
With funding provided by Katharine Dexter
McCormick, Planned Parenthood invited Dr Gregory Pincus (a biologist) to
develop a safe pill, a task achieved in 1950.
·
This pioneering work set the stage for 2 sexual
revolutions that will be discussed below.
The
pill and the first sexual revolution: 1960s and 1970s
·
The US Federal Drug Administration (FDA)
approved the oral contraceptive pill on 23rd June 1960.
·
The oral contraceptive pill (OC) was the first
effective contraceptive that gave women a reliable and private control of
fertility[iv] that
could be used without any worries about pregnancy since its failure rate was
low being less than 1 percent[v].
·
The launch of the pill triggered a sexual
revolution[vi] that
started in earnest in the early 1960s and laid the foundation for the second
sexual revolution of the 1990s that is still evolving[vii].
·
The first sexual revolution was a drastic change
in sexual behavior of the masses involving all social classes and eventually
all countries of the world.
·
This revolution has had far-reaching effects on
the fabric of society, the family, disease patterns, gender roles etc.
Major
paradigmatic shifts due to the pill
·
The pill allowed sexual intercourse at any time,
in any condition, and without any prior preparation
·
The pill separated sexual enjoyment from
reproduction and its parental responsibilities[viii].
·
From married couples the impact spread to the
unmarried. Schools have started teaching children about safe sex[ix].
·
The mass media have been very active players in
the sexual revolution by encouraging sexuality among youths
Evidence
linking the pill to change in sexual behavior
·
Studies within the first 10 years of the use of
the pill explored its impact on sexual behavior[x][xi].
·
The evidence linking the pill to the sexual
revolution is circumstantial but is very convincing.
·
It is unlikely that the sex revolution following
on the heels of the introduction of the pill could have an alternative
explanation.
·
It may be true that the sex revolution was
already on the way but the pill accelerated it by providing a more effective
contraceptive which removed the inhibitory fear of pregnancy.
Plugging
the holes
·
The sexual revolution based on liberation of
fear of pregnancy started with the pill and was completed by two major later
developments:t he morning after pill and legal abortion on demand
·
Assurance that if the pill failed there was a
way out of parental responsibility
·
These 2 removed any lingering fear of unwanted
pregnancy that had remained even with the use of the pill.
The
second sexual revolution: 1980s and 1990s
·
The mass use of the pill and the major changes
in sexual mores soon led to a second sexual revolution that is also referred to
as the neo-sexual revolution[xii].
·
The first sexual revolution saw the separation
of sexual enjoyment from reproduction, the second sexual revolution saw the
separation of sex from reproduction altogether.
·
Using technologies of assisted reproduction such
as in vivo insemination and in vitro fertilization with surrogate mothers or
fathers, it became possible to produce children without coitus.
·
Reproductive cloning is a further development
that may usher in reproduction without involvement of any gametes and will
negate the traditional concept of descent from a parent.
·
It is conceivable that the brave new world of
medical technology will soon breach the reproductive barrier between humans and
animals with unimaginable consequences.
The
social impact of the pill
·
The impact of the pill was not limited to sexual
freedom. Sex without reproduction soon gave way to sex outside marriage.
·
Devaluation of the family, divorce, teenage
pregnancy, fatherless families, and teenage problems such as teenage suicides[xiii] and
drug addiction.
·
The second sexual revolution has seen the
elevation of homosexuality from a closet secret to social respectability with
several jurisdictions legislating for same-sex marriages.
·
The gay or lesbian couples have also had the
audacity to claim parental rights by adopting children or trying to produce
children using artificial means.
·
Kindergartners in New York City were taught that
gay and lesbian families are the same as heterosexual families[xiv]
Conclusion:
Medical Technology leading to social change
·
This paper presents the thesis that the oral
contraceptive pill is a prime example of a technology that leads to major
social change and has with time led to an ideological change by affecting the
way people think about marriage, reproduction, and family.
·
I do not agree with the views of the developers
of the oral contraceptive pill, Gregory Pincus and John Rock, who argued that
technology does not determine behavior[xv].
·
They could have said this to avoid the guilt of
having introduced a technology that in essence could be good but was applied in
a wrong way with profound negative effects on society.
STEM
CELL TECHNOLOGY
Description
of stem cells
·
A stem cell is able to divide and replicate
itself almost indefinitely and can be grown to produce a more specialized or
differentiated cell.
·
Monipotentstem cells are already differentiated
or specialized and can be grown to produce only specific specialized cells.
·
multi-potent or pluripotent cells are more
specialized or differentiated and can be grown into a wide range of specific
cell types.
·
Totipotent cells are completely undifferentiated
and can be grown into any cell type.
Sources
of stem cells
·
Multipotent cells can be found in adult blood,
adult bone marrow, and umbilical blood.
·
Embryonic stem cells are totipotent. They are
able to develop into any type of body cell or tissue.
·
The nucleus of the stem cell can be removed and
can be replaced by the nucleus of a patient who has a damaged tissue. The cell
can grow into the desired tissue.
·
Embryonic stem cells are more efficient than
adult stem cells.
Diseases
likely to be treated using embryonic stem cells
·
Serious medical conditions are candidates for
cure using stem cells by producing replacements for damaged tissues: diabetes,
stroke, spinal cord injury, and neurodegenerative disorders such as Parkinson's
disease.
·
Stem cells could be grafted at a site of spinal
cord injury.
·
Stem cells grafted in the pancreas could produce
insulin that is deficient or lacking in diabetics.
·
It is envisaged that a whole organ can be
developed from a stem cell.
·
Stem cells technology can solve the problem of
shortage of organ for transplantation.
·
The brave new world of spare organs like car
spare parts.
·
The difference between and old and young will be
blurred but not by much.
·
. Stem cells generated under the patient’s own
genetic control will be fully immunologically compatible unlike donated organs
that can be rejected by the patient.
Ethical
controversy about embryonic stem cells
·
The use of adult stem cells or cells from the
umbilical cord raises few ethical controversies.
·
Embryonic stem cellsare a source of ethical
controversy because they are obtained from embryonic tissue, either
pre-implantation or post-implantation.
·
Use of embryonic tissue involves violation of
the purpose of preserving life. Since the cell is a potential human life its
use in research or transplantation involves denial of that life.
VACCINES
AGAINST ADDICTION
How vaccines can work against addictive substances
•
Vaccines reduce or
eliminate neurological effect of addictive substances
•
Vaccines generate
specific immune resistance to an addictive drug
•
Antibody binds to drug
and prevents it from reaching the neural sites
•
Slow release vaccines
may have ti be used to eliminate immune protection can be overcome by
increasing the dose of the addictive substance requiring repeat vaccination
which has low acceptability. Slow release vaccines may have to be used
Nicotine vaccine: review #1
·
In an attempt to improve long-term quit rates
and blunt the reinforcing effects of nicotine in the brain,
the nicotineconjugate vaccine was developed
·
Vaccine administration
produces nicotine-specific antibodies that bind to nicotine from
exogenous sources, creating a large unit that is not able to cross the
blood-brain barrier, which limits the rate and extent
of nicotine absorption into the brain.
·
Results of clinical trials indicate that
individuals achieving high nicotine-specific antibody levels with
the nicotine conjugate vaccine have greater success with
smoking cessation at 12 months compared with those with lower levels.
·
Adverse effects associated with
the nicotine conjugate vaccine have been primarily mild and
localized in nature, with minimal systemic effects: tenderness and ache at the
injection site, general discomfort, headache, and muscle ache.
·
Awaiting results of phase III trials
·
Ottney AR. Nicotine conjugate vaccine as a novel
approach to smoking cessation.Pharmacotherapy. 2011
Jul;31(7):703-13. Source Department of Pharmacy Practice, North Dakota
State University, Fargo, North Dakota 58108-6050, USA.
Nicotine vaccine: review #2
·
Nicotine vaccines are among newer products
seeking approval from the FDA. Antidrug vaccines are irreversible, provide
protection over years and need booster injections far beyond the critical phase
of acute withdrawal symptoms.
·
Interacting with the drug in the blood rather
than with a receptor in the brain, the vaccines are free of side effects due to
central interaction.
·
For drugs like nicotine, which interacts
with different types of receptors in many organs, this is a further advantage.
·
Three anti-nicotine vaccines are today in
an advanced stage of clinical evaluation.
·
Results show that the efficiency of the vaccines
is directly related to the antibody levels, a fact which will help to optimize
the vaccine effect.
·
Escobar-Chávez JJ, Domínguez-Delgado CL, Rodríguez-Cruz IM. Targeting nicotine addiction: the
possibility of a therapeutic vaccine.Drug
Des DevelTher. 2011;5:211-24. SourceUnidad de
InvestigaciónMultidisciplinaria, Facultad de
EstudiosSuperioresCuautitlán-Universidad NacionalAutónoma de México,
CuautitlánIzcalli, Estado de México, México.
Heroin vaccine: review #1
·
A vaccine capable of
blocking heroin's effects could provide an economical, long-lasting and
sustainable adjunct to heroin addiction therapy without the side
effects associated with available treatment options.
·
Heroin, however, presents a particularly
challenging vaccine target as it is metabolized to multiple
psychoactive molecules of differing lipophilicity, with differing abilities to
cross the blood brain barrier.
·
In this review, we discuss the opiate
scaffolding and hapten design considerations to confer immunogenicity as well
as the specificity of the immune response towards structurally similar opiates.
·
In addition, we detail different strategies
employed in the design of immunoconjugates for a vaccine-based therapy
for heroinaddiction treatment.
·
Stowe GN, Schlosburg JE, Vendruscolo LF, Edwards S, Misra KK, Schulteis G, Zakhari JS, Koob GF, Janda KD. Developing a vaccine against multiple psychoactive targets: a
case study of heroin. CNS
NeurolDisord Drug Targets. 2011 Dec;10(8):865-75. Source
Departments of Chemistry and Immunology, The Skaggs Institute for Chemical
Biology and Worm Institute of Research and Medicine (WIRM), The Scripps
Research Institute, La Jolla, California 92037, USA.
Cocaine review #1
·
The challenge in developing an
anti-cocaine vaccine is that cocaine is a small molecule,
invisible to the immune system.
·
Linking a cocaine hapten to a highly
immunoigenicAd capsid proteins would elicit high-affinity, high-titer
antibodies against cocaine, sufficient to sequester systemically
administered cocaine and prevent access to the brain, thus
suppressing cocaine-induced behaviors.
·
In pre-clinical studies, the product evoked
persistent, high titer, high affinity IgG anti-cocaineantibodies, and was highly
effective in blocking cocaine-induced hyperactivity
and cocaine self-administration behavior in rats.
·
Future studies will be designed to expand the
efficacy studies, carry out relevant toxicology studies, and test dAd5GNE in
human cocaine addicts.
·
Koob G, Hicks MJ, Wee S, Rosenberg JB, De BP, Kaminsky SM, Moreno A, Janda KD, Crystal RG. Anti-cocaine vaccine based on coupling a cocaine analog to a disrupted
adenovirus.CNSNeurolDisord
Drug Targets. 2011 Dec;10(8):899-904. Source Department
of Genetic Medicine, Weill Cornell Medical College, New York, NY 10065, USA.
Problems with vaccines
•
Vaccination will have
to be compulsory to be effective
•
Vaccines will change
human behavior and individual life style and identity
•
High potential for
misuse of the vaccines
•
Use of medicine to
solve a non-medical problem
Ethical issues: benefits
•
Compulsory vaccination
justified by high benefit, individual and public.
•
Vaccination of
students improves educational achievement and discipline.
•
Compulsory vaccination
of people in sensitive occupations like pilots.
•
Compulsory vaccination
of criminals
Ethical issues: risks
•
Withdrawal effects.
•
Vaccines will stay in
blood for ever: no confidentiality.
•
Elimination of the
possibility of therapeutic switching ie future good uses for addictive
substances.
•
Repeat injections and
Immune resistance
Ethical issues: informed consent
•
Vaccination under
coercion with an irreversible vaccine.
•
Cultural issues: what
drug to vaccinate against; alcohol is accepted in many societies
•
Vaccination of
detainees and prisoners
•
Drug addicts not
competent to consent
•
Parents deciding for
children
Ethical issues: justice
•
Research on vaccines
takes resources away from treatment because addiction is not a normal disease
•
Unjust distribution of
the vaccines
THE WAY FORWARD: INTEGRATION and INNOVATIVE SELF RELIANCE
The rationale for a morally- based medical education
·
The physician and
applications of medical technology
·
Physicians and taking
a moral stand
·
Physicians and
influence on social opinions and practices
·
Physicians as
initiators of social change
·
The islamic input into the medical curriculum:
Islamic values and legal medicine, fiqhtibbi
The
story of 2 countries
·
In 1965 2 countries decided to develop a steel
industry as a basis for industrialization
·
After a quarter century #1 was industrialized
and country #2 was still undeveloped
·
Country #2 hosted the President of the Science Council of country #1 and asked him: we started at the
same time how come you are far ahead and we have not moved
·
The Professor asked them to explain how they
started the program? They said they called in experts. ‘Stop…I know the rest of
the story’
·
The Professor told them how country #1 did: sent
students to study science, buy any old/abandoned factories and ship home, look
around and photography any useful information
The
Prophet’s warning about the lizard hole phenomenon
·
You will follow those who came before you, inch
by inch and foot by foot until they enter a lizard and you follow them
·
Need to have a vision for the revitalization of
the ummah
·
Need for self confidence, assertiveness,
self-reliance without ruling out inter-dependence
·
Need for critical appraisal of all what is
presented; a lot is false
Remember others have their own interests
[iii]www.fda.gov/fdac/departs/2000/400_word.html
accessed June 24th 2006
[iv]Fraser
IS. Forty years of combined oral contraception: the evolution of a
revolution. Med J Aust.2000 Nov
20;17310:541-4.
[v]www.science-spirit.org/new_detail.php?news_id=545
– accessed June 30, 2006
[vi]www.science-spirit.org/new_detail.php?news_id=545–
accessed June 30, 2006
[vii]www.science-spirit.org/new_detail.php?news_id=545–
accessed June 30, 2006
[viii]
www.en.wikipedia.org/wiki/Oral_contraceptive#Social_and_cultural_impact–
accessed June 30, 2006
[ix]Besharov DJ, Gardiner KN. Trends in teen sexual
behavior. Child Youth Serv Rev. 1997;195-6:341-67..
[x]
Black S, Sykes M. Promiscuity and oral contraception: the relationship
examined. SocSci Med. 1971 Dec;56:637-43.
[xii]Sigusch V. The neosexual revolution.Arch Sex Behav.
1998 Aug;274:331-59.
[xiv]
Brown J. Contraception and abortion: the deadly connection. Family Found. 1993
Sep-Oct;202:9.