As a biomedical sciences student, what initially drew me to this module was my interest in stem cells and genetic engineering. I am currently reading The Genetic Age: Our Perilous Quest to Edit Life by Matthew Cobb, which chronicles the history of gene editing, from its advent in the 1960’s to our current day. In it, he recounts the 1975 Asilomar Conference on Recombinant DNA, and its lasting impact on how scientists maintain their ethical responsibility of public safety.

SV40 and Asilomar

In 1974, Paul Berg was attempting to use tumour-causing simian virus 40 (SV40) to introduce the E. coli lac gene into mammalian cells. He also successfully introduced SV40 into E. coli, which became one of the first successful recombinant DNA experiments. However, this led to concerns from other scientists that the bacteria containing SV40 could escape his lab and cause cancer in infected people. Berg agreed to place a temporary moratorium on all recombinant DNA experiments, leading to a lot of panic in the public, as people rightfully wanted to know just how dangerous these experiments were.

In 1975, Berg and around 100 other scientists in his field gathered at Asilomar Conference Centre, California to draw up safety guidelines for recombinant DNA experiments, with reporters present. Over several days, they discussed bio-safety precautions and which experiments should and shouldn’t be taken. Some took a very utilitarian approach, arguing that a few people hypothetically getting infected by an escaping virus was outweighed by the potential benefits of recombinant DNA technology, and that any guidelines were impinging on their academic freedom as scientists. Others argued that even one person hypothetically getting cancer was too much of a risk. Eventually, the participants were able to agree on safety protocol and containment strategies for recombinant DNA experiments and even prohibited some that were considered too dangerous.

The Lessons of Asilomar

In 2008, Berg published an opinion piece in Nature Magazine reflecting on Asilomar and posing the rhetorical question of whether another similar conference would resolve the current controversies in science at the time: “foetal tissue, embryonic stem-cell research, somatic and germ-line gene therapy and the genetic modification of food crops”.

While Asilomar’s participants didn’t discuss the ethical nor social aspects of genetic engineering and only focused on the health risks of the specific recombinant DNA experiments, it was the first example of wide-scale self-regulation within the scientific community. It created an expectation for the same standard of social responsibility to be applied to all future forms of genetic engineering and its associated technologies.

A re-evaluation of self-regulation

In his Asilomar opinion piece, Berg brings up an important and worrying point: most scientists in recombinant DNA research at the time worked in public institutions whereas scientists today often work for private biotechnology companies. They are at the behest of their employers, forced to place the financial interests of the companies before the health and safety of the public.

In his book, Cobb points out that public decision-making in genetic engineering has been limited so far. At Asilomar, policy was only made between scientists with some input from lawyers. There were reporters present but only for transparency’s sake; public trust was gained, but they weren’t involved in the process itself. He argues that the potential impact of today’s gene editing technologies means that “public involvement in decision-making, on the basis of open experimental data rather than secrecy and suspicion, needs to become widespread and routine” and “it is only because of public disquiet that has prompted the introduction of regulatory control that genetic engineering thus far has been safely deployed”.

My thoughts

I agree with Cobb that there must be an open and stronger line of communication between scientists and the public. Genetic engineering is a constantly evolving frontier of biomedical science, with new frontiers being discovered constantly. It is far too easy to be swept up in the excitement of it all and tumble down the rabbit hole, performing unnecessary experiments in the name of progress and notoriety, like in the case of He Jiankui’s embryo-edited twins. There are numerous ethical implications surrounding genetic engineering; it toes the line between life-saving somatic therapies and flirtations with – if taken too far – eugenics.

Science should be for the benefit of many, not few. All people deserve to have access to important and life-saving technologies and furthermore, should have knowledge of and a say in how those technologies are regulated and applied. In his own opinion piece about Asilomar, pioneering microbiologist and conference participant Stanley Falkow wrote in 2012: “The (very privileged) social contract by which science is sustained depends on the public continuing to understand why this work is beneficial and worthwhile.” And more than a decade later, his words ring truer than ever.

References

Berg, P., 2008. Asilomar 1975: DNA modification secured. Nature, 455(7211), pp.290-291.

Cobb, M. (2022) The Genetic Age: Our Perilous Quest to Edit Life. London: Profile Books.

Falkow, S., 2012. The lessons of Asilomar and the H5N1 “affair”. MBio, 3(5), pp.e00354-12.

Amidst an ethical debate regarding organ donation in an ethics and law workshop, the complexity of the discussion inspired me to delve further into the moral and legal implications of organ donation. While it is true that organ donation is a lifesaving procedure, it is interesting that when it comes to infants with life-threatening illnesses, it’s not so easy.

Case study

For example, Mrs Z, a young, overdue, pregnant woman underwent an ultrasound examination and was told that her baby was anencephalic – A condition where no brain is present except for portions of the brain stem and there is a high likelihood the baby will be born underdeveloped and stillborn. Heart and kidney transplants could be possible.

In light of this, the mother decided to volunteer her baby as an organ donor. Despite her wishes, the moral debate began as physicians became uncertain on what steps to take. If they accepted the mother’s wish to donate organs, is it their duty to try and resuscitate the baby if it was still born? Should they accept her wishes at all? When should or could the baby’s death be pronounced?

Moral Panic

Mrs Z’s case is a controversial debate, predominantly due to the moral and legal obstacles to taking organs from a pre-diagnosed anencephalic new-born.

To start, following the mother’s requests would be a way to alleviate the growing shortage of vital organs for organ recipients in need. Organ size restrictions mean that strategies to increase donation rates may not be of much use. However, there have been cases where ‘miracle babies’ have lived long after expected. How do we determine who takes priority?

In addition, under current law, organs can be taken from patients who are ‘brain-stem dead’. Despite brain absence, an anencephalic infant does not meet this criterion as they retain a functional brain stem that can maintain vital functions. So, by law, the mother’s desire to donate may not be permitted. The baby should be treated as they would ordinarily be treated, regardless of determined death. Would we normally resuscitate a still-born infant? Prolong suffering? Yet, if these organs have the ability to save the lives of dying infants, I believe that the organs should be donated, provided the baby does not suffer.

Finally, in actuality, there is no reason why the parents shouldn’t be able to donate the organs of their baby to suitable recipients, provided it follows the death of their child. But… the glorification following the words ‘organ donation’ makes me wonder if the parents were informed on alternative approaches for recipients, such as stem cells or Norwood staged surgery. Were they aware that the absence of a major part of the brain doesn’t imply instant brain death? Is this pure utilitarianism? I believe it should be standard that families who request organ donation from their anencephalic baby should be given concise information and educational material provided on the practice and its implications.

Final thoughts

In my opinion, if there is a way to donate Mrs Z’s baby’s organs without drastically intervening standard treatment, organ donation should proceed. However, the answer differs if a significant alteration occurs. Going above and beyond to prolong gestation on a distressed infant in order to ‘mature’ organs for donation requires moral reservation.

Nevertheless, recent research has diminished the idea of anencephalic new borns as organ donors, with the exception of theoretical debate and case studies. The American Academy of Paediatrics (1992) concluded that organ donation from anencephalic infants should not be undertaken due to the serious difficulties surrounding the establishment of brain death and limited success rates.  

The stem cell and regenerative medicine workshop introduced me to a new advanced tissue engineering discipline: the use of microbubbles. I was fascinated to learn that many disorders are incurable due to drug delivery transport implications and that the development of microbubbles has the potential to solve many of these difficulties.

Microbubbles (MB) are non-toxic and biocompatible technological structures that interact dynamically with organs at the cellular level. They have a size of 0.1- 10 µm and can be destroyed by ultrasonic radiation (US). The US can be targeted to specific locations, improving selective therapy. Tissue engineering with biomaterials is an innovative and promising technique for increasing human life expectancy, and scientists are interested in integrating MBs with scaffold architecture.

Alzheimer’s disease (AD) is the most common cause of dementia. It affects around 50 million individuals globally, and its prevalence is expected to double by 2050. There are currently no treatments to cure Alzheimer’s disease, although the FDA has approved drugs to treat symptoms. E.B White, the author of my favourite childhood novel Charlotte’s Web, is a notable person who sadly died of Alzheimer’s disease. He has suffered by losing his freedom and forgetting his accomplishments.

Alzheimer’s disease is characterised by the production of Aβ senile plaques and the aggregation of tau-mediated neurofibrillary tangles. According to recent findings, eliminating amyloid β oligomers and plaques using monoclonal antibodies may stop progression. However, a challenge is the efficient delivery of therapeutic drugs across the Blood Brain Barrier (BBB) for the treatment of central nervous system (CNS) diseases. The BBB is a thin membrane formed by endothelial cells that removes 98% of small-molecule medications and 99.9% of large-molecule therapies for brain diseases, causing drug transport-related issues. The BBB presents a significant impediment to the delivery of medicines to the brain. Yet, the US-targeted microbubble destruction can promote the entry of therapeutic molecules into specific CNS regions, enhancing gene-carrier absorption in damaged brain areas while preventing the loss of normal cells.

Zhu et al., (2022) investigated the efficacy of US-targeted microbubble destruction (UTMD) in the dual delivery of beta-amyloid (Aβ) antibodies carried by MBs and neural stem cell (NCS) of AD. They used 27 transgenic mice (Tg) and 33 wild-type mice, who were allocated into two groups: control and MB with AB and/or NSCs. The Morris water maze test was used to investigate cognitive and memory processes. As we learned in class, tissue engineering research employs knockout mice, which are a type of Tg. These are genetically engineered mice that receive foreign DNA. The difference between knockout mice and Tg is that the latter has a foreign gene introduced into their gene, e.g., AD. They discovered that the BB opened in Tg mice given a combination of NCS and Aβ antibody UTMD group. Their memory performance and spatial learning improved, and they discovered a reduction in Aβ plaques in the hippocampus and cortex.

In conclusion, the use of MB could open a  plethora of solutions to incurable diseases such as Alzheimer’s. However, further research needs to confirm its efficiency. For example, the US successfully destroyed MB, but what debriefs particles? Could it raise any side effects? Furthermore, given that dementia primarily affects the elderly, some individuals may underestimate the importance of discovering a cure for AD. E.B. White did pass away from old age. Throughout my research, I came across the Alzheimer’s Society website, which collects real-life accounts of dementia patients. I’ve noticed that diagnosis is made to one but it affects the entire family. E.B. White’s son would read him his very popular books, to then be asked who the author was. Alzheimer’s is an emotionally and physically draining disorder that affects members of a family, thus treatment is sought to lessen the pain of diagnosed patients.

When you hear the word eugenics, most people immediately think of the Nazis, but there are still a lot of modern-day ethical issues surrounding the ideas of eugenics. First, let us define eugenics:

‘the study of how to arrange reproduction within a human population to increase the occurrence of heritable characteristics regarded as desirable’.

Now using this definition, we can look at how it relates to what the Nazis did and while not the first-time ideas of eugenics were used, it is the most well-known. They used their ideas of eugenics to ‘euthanise’ those within the state who were deemed to be ‘incurably ill’. This included thousands of disabled people who were considered to be unproductive members of the state and after this followed the larger groups such as the Roma, Sinti, and Jews. Here eugenics were used to justify the death of millions as a way of ‘population control’ which is very clearly a hugely ethical issue. While most people are completely against the Nazi uses of ideas of eugenics, there are some who believe that eugenics could be utilised again today in order to help overpopulation.

I became interested in this topic after covering the historical elements in our ethics and law lecture, so decided to do some more research on the subject and how it affects the world today. During my research I came across the fact that in 2019,  a group of 11,000 scientists signed a statement urging population control in order to slow down the death of the earth due to climate change. This idea that we should control the population in order to sustain resources is not new. However, these ideas have been trialled in the past with poor results, for example China’s one child policy that was implemented to stop the exponential population growth of the country actually led to more of an increase rather than slow its growth. While these ideas of eugenics follow on from historical ones there is a new form that we have seen develop in more recent years, the idea of designer babies.

The concept of designer babies is where genetic testing is done on a child being created via IVF in order to determine whether they will have certain characteristics. The concept of designer babies is arguably the most ethically challenging as originally, this testing was done only to determine whether the child would be healthy, but it is now being used as a way for potential parents to determine whether the child will fit their expectations of that they want them to look like. I would argue that this is a new form of eugenics as it is allowing people to follow the idea of only creating children who have desired characteristics and as stated earlier, this is the definition of eugenics.

With these new forms of ideas of eugenics, it seems as though we have come full circle. From the Nazis using eugenics as their reasoning for murdering millions of innocent people, to modern day ideas of a way to protect our finite resources and then to creating IVF children with specific characteristics, eugenics seems to be an inescapable way of thinking. There is no way to justify these ideas as they put lives at risk. They fell under the radar as an ethical issue after WWII but with the concept of designer children and a need to protect our planet they are once again becoming an ethical issue within our society.

Total knee replacement surgery (TKRS) involves the removal of damaged and painful areas of the knee joint and replace it with specialised metal and plastic. A lecture by Dr. Nick Evans reflected on the disadvantages and problems with prostheses. He highlighted that internal prostheses comes with many issues, such a finite lifespan and can only be used for certain problems. 

With this surgery comes many serious complications of joint replacement surgery, and these include: wound infection, blood clotting, malfunction of prosthesis or nerve injury. Upon reading these statistics, it made me feel inclined to research and find alternative, less invasive treatments for those in need of knee replacements.

Knee osteoarthritis is a degenerative joint disease that breaks down joint cartilage and mostly affects middle-aged and older adults. It is the most common reason for knee replacement surgery, with 4.7 million estimated to have undergone TKRS in 2010. Mobility is significantly reduced and patients often experience constant pain even when resting. It is evident that this type of knee damage can be a burden for those suffering from it and I understand why people consider surgery to resolve it.

Common current treatment options

The most common surgical treatment for knee osteoarthritis is a cemented prosthesis. This is the process in which a layer of bone cement is placed in between the patient’s natural bone and prosthetic joint component. The advantages of cemented prostheses is that bone cement is fast-drying (10 minutes) upon application so there is confidence that the prosthetic is firmly in place, as well as early pain relief. However, with all surgery options, there are drawbacks. These include irritation of surrounding soft tissues and inflammation as a result of cement debris, and breakdown of cement can cause loose artificial joints in which patients would need to undergo another surgery. So if this current treatment for knee replacement is too invasive for the patient, then what other treatments are available that come with less serious complications and disadvantages?

Other treatment options

Something that shocked me was that there are many different alternative treatments for knee replacements. Here are some that particularly stood out to me, and ones that I would consider if I suffered from knee osteoarthritis. 

Cartilage regeneration is the replacement of cartilage instead of the entire joint for joints with limited arthritis. Autologous chondrocyte implantation (ACI) is a procedure that involves taking a sample of the patient’s cartilage cells, growing them in the lab and surgically replanting them into the knee. This may be a treatment offered for those effected by cartilage loss, with this implantation producing good/excellent results in 90% of patients with femoral condylecartilage loss (Minas and Chiu 2000). This may be promising for those who are looking at alternative treatment plans before fully committing to TKRS.

Current research has revolutionised TKRS with a new technique called the minimally invasive total knee replacement (MITKR). This involves smaller incisions than regular TKRS, which requires less muscle dissection and results in quicker and less painful recovery. This approach is said to have potential for dramatically reducing pain for muscles and tendons that have previously been cut during the standard TKRS. These benefits for this surgery has paved the way for less complications like less blood loss during surgery, and increased range of motion sooner after surgery. Overall, this promising and innovative minimally invasive total knee surgery has the potential to be the more commonly used treatment over others like cement prostheses. Video of this procedure can be found here.

Concluding thoughts

As I researched more into the field of alternate knee replacement treatments, I didn’t think that there were this many other forms available. I believe that it is beneficial for those in need of knee replacements to have many treatments available, especially for those that are unsure about fully committing to TKRS due to its invasive nature and serious complications. I personally would choose MITKR over the standard knee replacement surgery if I suffered from knee osteoarthritis, with its promising benefits and minimally invasive nature. With developing surgical treatments, such as MITKR, I will definitely keep up to date on the current and emerging treatments for knee replacements to further enrich my knowledge.

Three-dimensional motion analysis is often used in therapy to observe a pattern of movement in an individual. For example, patients in rehabilitation after a prosthetic leg replacement can be observed to check for any rigidity in movement. Since it’s an upgrade from 2-dimensional motion analysis, which introduced parallax and perspective errors, it’s allowed us to measure the angles in more than one plane in a 3D space. Our lecturer spoke about how this method was used to help her teach piano to her students, and this inspired me to look at the potential uses of this in sports.

How does it work?

The process works by placing a series of cameras around the person and creating a capture volume. The cameras are then calibrated with respect to each other and the room. Markers are placed on the area of interest as well as surrounding it, specifically on any bony areas. these markers can then be followed in each frame of the video as the person moves. The advantage of having multiple cameras is that it allows precise recording of any markers that would otherwise be hidden from a camera. As long as at least 2 cameras could clearly record the marker, we can work out the point and angle of flexion of muscles.

Uses in sports

Motion analysis can also be used for analyzing movement in sports. it’s currently used a lot in sports such as football, which I am very keen on. I have been playing football for a year in university and I think it’s amazing that people can benefit from technology such as this, in order to improve their gameplay. This is often used to train Olympic athletes and help them discover their weaknesses. It is done by creating a skeletal structure of the athlete to match their body shape and size. Trainees are often asked to wear a mocap suit which mimics the athletes’ movements and shows the movement of all the joints. This technology can capture details of movement within milliseconds, allowing coaches to precisely pinpoint the errors.

Another benefit of using this technology is that it can be used in matches in real time to help referees locate the exact movement of the players and call out a fair judgment. I think this is really useful in the field of sports especially since the idea of ‘false judgment’ can start a lot of fights amongst the audience, and with technology to clearly showcase the evidence, it makes the game smoother.

In addition, it can also be used to simulate football players’ movements in video games such as FIFA 22. I really like this game because I feel like it truly showcases the strategies used in gameplay and has refined movements for each character, which adds a sense of realism.

Overall, I really like how improvements in technology transitioning from 2D to 3D motion capture have helped with a wide range of activities, including football, which I’m very passionate about. I hope that technology like this will help the players improve and eventually be introduced into smaller football training camps, to help young aspiring players improve.

References:

For more information, check out this website:

https://www.rokoko.com/insights/motion-capture-in-sport

Ethics in the sciences has always been something that I have been interested in. During our first lecture, we watched a clip from a professor of research saying that he thought ethics was nonsense. The idea that scientists weren’t willing to look at and understand the ethical implications of their work surprised me.

Learning about how over many years philosophers have viewed and explained ethics in such different ways and how in each theory there are flaws. So how do we know what the right theory is? I ponder this question and decide to investigate how ethics are used in decision-making around the allocation of medical devices. How does a medical professional decide who gets what? A specific example of this was the allocation of ventilators during the Covid-19 pandemic. Ventilators are machines, known as artificial lungs, that pump air into the lung. This occurs in a normal breathing pattern allowing for inhalation and exhalation of air. How a ventilator works is demonstrated in the video below. They are used when a person cannot do this themselves. Ventilators are expensive, with the average price being £18,300, and require a high level of training to operate.

The nature of the pandemic meant that there was a huge strain on medical services globally and all the companies developing devices that could be used to help treat this disease. One of the major devices that could be used to help people who were very sick with Covid-19 was a ventilator. Before the pandemic, the NHS had 7,400 mechanical ventilators with models showing that they would need up to 90,000 beds with ventilators to be able to treat the expected number of patients just for Covid-19. This number did not include any other illnesses that might require ventilators, such as accidents, strokes, or flu. With this huge difference between the number of ventilators available and the expected amount of patients needed the decision of who gets them was put onto the doctors.

When I think about having to make these decisions it seems overwhelming and a big responsibility. To try to understand more about how these decisions are made by doctors I spoke to a friend of mine who is a doctor at Plymouth Hospital. We spoke about how decisions are made around treatments for patients. It was interesting to hear the way he spoke about how they take a holistic view of each patient. Asking questions like, how likely are they to survive? What will their quality of life be like after the treatment? And very basic questions such as can they walk up and down stairs, cook for themselves or do the shopping? To get an overview of the patient’s lifestyle before making these decisions. After talking about this it made me understand that to trained medical professionals these decisions weren’t as daunting, they were part of everyday working life. In saying it was clear that if there was an alternative to having to make these decisions that would’ve been better.

During the pandemic engineering researchers at the University of Canterbury, New Zealand alongside medical professionals in New Zealand, Belgium, and Malaysia designed an adaptation to a ventilator that would double the capacity, allowing two patients to be treated by one ventilator. Demonstrated in the video below. This ventilator works in series so the amount of air doesn’t half when delivering to two patients. In series means they pump at different times. A life-saving invention that would help to prevent doctors from having to make decisions about who receives the ventilator. With this technology implemented into the NHS, it would double the number of ventilators available. Going from about 30,000+ ventilators with the potential to treat 30,000 patients to 60,000 patients. This adaptation is low cost as well which also means that it is not met with the issue of expense as ventilators can be very expensive.

With the pandemic in the past and all the lessons we have learned from treatment and management at the forefront of everyone’s mind, I think that technologies like the one from the researchers at the University of Canterbury will become more common. But with this comes a whole new set of ethical questions that will need to be discussed moving forward. As learn more about science and technology I understand that ethics will always be an important part of this industry and I believe it should be a topic that is more widely discussed to ensure that ethics are upheld in all aspects of research.

Having grown up with mild to moderate bilateral sensorineural and conductive hearing loss, I have always worn hearing aids. This sparked an interest in audiology and hearing technology which has inspired me to research the intricacies of cochlear implants, particularly as we will be learning more about this later in the module.

So, what is a cochlear implant….

A cochlear implant (CI) is a device that allows people with severe to profound hearing loss to experience sound by transmitting electrical signals via the auditory nerve. The user interprets these sensations as sound. In contrast, my hearing aids only amplify the frequencies I cannot hear.  

A CI is composed of external and internal components, as illustrated in the diagrams below. External components include a microphone, speech processor and transmitter, whilst the surgically fitted internal components are a receiver and an electrode array.  

The mechanics behind CIs is relatively straightforward. Externally, the microphone transmits sound to the speech processor which converts sound into a digital signal. This signal is sent, using a magnet, via a transmitter to a receiver located under the skin. The receiver circulates signals to the electrode array in the inner ear that stimulates nerve fibres triggering the auditory nerve in the cochlea. As a result, the brain recognises incoming sounds. Remarkable!

A helpful video on cochlear implants is below:

Whilst researching CIs, what astounded me the most was the rehabilitation process. It had never occurred to me just how difficult it would be to adjust to sounds if the user has no hearing memory and therefore struggled when sound was different to what they perceived it might be.

To understand this, I contacted a friend who is profoundly deaf in both ears since she was 21 months old.  She received her left CI at 2½ years and right CI aged 8. Her CI has hugely benefitted her communication with others and listening to music, both of which she previously found challenging.

The hardest part of her rehabilitation process was undergoing years of speech therapy to adjust to the new sounds. To adapt to the second CI, she read her schoolbook aloud only wearing the second CI. After several months she could hear properly through it. However, she found it difficult to adjust to the new directionality of sound introduced by the right CI. Unfortunately, this meant she never fully acclimatised to hearing through both CIs and for that reason she only wears her first CI.

This intrigued me further to investigate what facilitates the rehabilitation process.

According to the British Cochlear Implant Group, rehabilitation is a structured programme, known as auditory training, involving exercises and a Speech and Language Specialist. This helps users to interpret and differentiate sounds, as well as translate words into speech.

Whilst my friend was unable to recall her auditory training, another blog highlighted strategies for successful rehabilitation:

• Commit to daily exercises incorporating them into everyday activities (e.g., listening and repeating categories of words in quiet and loud environments)
• Listen to audiobooks and podcasts altering volume, speed and accents
• Use interactive apps (e.g., Cochlear CoPilot)

My final closing thoughts …

Writing this blog has opened my eyes to the incredible resilience and dedication required by a CI user when adapting to new sounds. Furthermore, a CI is an amazing device that significantly improves the user’s quality of life and therefore socioeconomic opportunities. One paper illustrated a 21% increase in self-reported benefit as well as an average word perception increase up to 53.9% (Boisvert, et al., 2020).

Further interesting links include:

• Rehabilitation – British Cochlear Implant Group (bcig.org.uk)
• Cochlear Implant Surgery Explained | Cochlear
• What is a Cochlear Implant? – Oxford University Hospitals (ouh.nhs.uk)