Caballero 1

Are the Medical Advances Good or Bad?

An Exploratory Research Paper

By
Antonio Caballero
Paul Anderson
English 1010
10 Apr. 2015
INTRODUCTION
There have been many medical advances [that have benefited humanity. For example, Dan
Childs and Susan Kansagra (MD) identified 10 such advances that have impacted the world. 1
These advances include the development of vaccinations (by Dr. Edward Jenner who in 1796
successfully prevented a young English boy from getting smallpox), the discovery of surgical
anesthetic (by William T.G. Morton in 1846, which demonstrated the benefits of ether which
could dull the pain associated with surgery), the creation of (antisepsis which created) a sterile
surgical environment for surgeons, antibiotics and antivirals, as well as improvements in heart
surgery and cardiac care the big killers in our society, and imaging starting with the X-Ray and
1See Health Advances That Changed the World by Dan Childs, Managing Editor of the Medical Unit at ABC
News and Susan Kansagra MD, medical consultant. This article was published in Sept. 20, 2007. (Appendix A)

Caballero 2
now full body scans, etc. At the same time, other medical advances are not so popular and have
been questioned even by some medical researchers. For example: eugenics or create a virus. I
[have decided to] enter this conversation because [I believe that] not all advances in medicine or
science are good [or even moral or ethical.] The purpose of this paper, then, is to explore
the topic of eugenics from different perspectives to see what the various experts in the field have
to say about it. But, before proceeding with these it is important to provide the reader with some
important background information.

BACKGROUND
Recently, medical advances are giving a lot to talk about their progress, especially the word:
Eugenics. On the surface, eugenics sounds like a good thing, especially when it involves
eradicating hereditary diseases, human defects or curing illnesses. But, can it go too far? Should
there be strict guidelines involving moral or ethical consideration guiding this work? Could this
give rise to a new era of eugenics, and even pose dangerous risk to the health of future
generations?2 These questions and many more come to mind in light of a scientific team based at
the Sun Yat-Sen University in Guangzhou, China, [who] set out to see whether it could correct
the gene defect that causes beta thalassemia, a blood disease by editing the DNA of fertilized
2 This was a question posed in the huff Post on April 24, this year (2015)

Caballero 3
eggs.3 However, a consequence of this study was that
unwanted mutations were introduced into some of the
embryos. Dr. Marcy Darnovsky, executive director of the
Berkeley, Calif.-based Center for Genetics and Society, said
in relation to this study No research has the moral warrant
to flout the globally widespread policy agreement against
altering the human germ line. This is because creating
genetically modified human beings could easily lead to new forms of inequality, discrimination
and societal conflict. Dr. Jennifer Doudna, a biochemist at the University of California,
Berkeley and a CRISPR/Cas9 pioneer, said that this study simply underscores the point that the
technology is not ready for clinical application, and that application of the technology needs to
be on hold pending a broader societal discussion of the scientific and ethical issues surrounding
such use. Even the researchers behind the new study agreed that the technique isnt ready to be
used in a clinical setting. We still think its too immature, study co-author Junjiu Huang, a
gene-function researcher at Sun Yat-sen University in Guangzhou, told Nature News. He and his
colleagues called for further research. Lanphier states that genome editing in human embryos
could have unpredictable effects on future generations and this make it dangerous and ethically
unacceptable. It could even have a negative impact on important work involving the use of
genome-editing techniques in somatic (non-reproductive) cells. Hence, there are many issues
affecting eugenics and this makes it a very complex issue. It is not just a scientific issue it is also
a moral and ethical issue. For this reason I wanted to explore the different arguments for and
against eugenics, or genetic engineering.
3 See article entitled Chinese Team Reports Gene-Editing Human Embryos by
Antonio Regalado, published in the MIT Technology Review on April 22, 2015

Caballero 4

1. Science vs society: Eugenics

With this background information we can proceed with my selection of articles on the topic. I
commenced my search of the literature using the word: Eugenics, that is The social
movement claiming to improve the genetic features of human populations through selective
breeding and sterilization, based on the idea that it is possible to distinguish between superior
and inferior elements of society, played a significant role in United States (Wikipedia:
Eugenics). From these I selected an article entitled by Lanphier, Urnov, Haecker, Werner, and
Smolenski entitled "Dont Edit the Human Germ Line." It was published on March 12, 2015 in
Nature, an International Weekly Journal of Science. The purpose of the article is to inform and
convince the reader about the possible negative consequences that can bring eugenics nowadays.
Their intended audience includes persuasion using words easy, ethos, pathos and logos for better
understanding and in an organized manner with references. Lately, science is studying and
experiencing some ways to modify the genome (DNA) for the "evolutionary advancement of
society". However, there are serious doubts about this study because it can cause dire
consequences in the future, so that this becomes dangerous and ethically unacceptable. One
should practice this if a truly compelling case arises, like HIV/AIDS, haemophilia, sickle-cell
anaemia and any kind of cancer.4 One of the debates more spoken today is whether
to [the] practice [of] eugenics in humans is morally or ethically acceptable or
justified]. The [M]edical advances have been able [today including the
4 Nature is the world's most highly cited interdisciplinary science journal, according
to the 2013 Journal Citation Reports Science Edition (Thomson Reuters, 2014). In
addition, it is a weekly international journal publishing the finest peer-reviewed
research in all fields of science and technology on the basis of its originality,
importance, interdisciplinary interest, timeliness, accessibility, elegance and
surprising conclusions. (Appendix B)

Caballero 5
modification of to modify the DNA of a fetus
to not have [prevent] any problem in the
future, like Down syndrome, [and] mental
disorders is a good thing; however, [I am not
so sure about efforts to change] also have
changed "other things" like the color of a
person, [their] weight, [or] eyes, etc. This [debate seems to be] has divided
progress made that humanity is divided into two positions: for or against. But
remember that Eugenics is not the only medical breakthrough that is causing
controversy today, there is also something worse than this and only "one
error" of this advance can cause a possible extinction of any living being.

2. A new double-edged sword: a super deadly virus

Sometimes medical advances are often disgusting or incomprehensible, like eugenics. However,
there is a case that goes far beyond these two aspects, the trouble is the little coverage they
received this case in the media, but a note from The New York Times confirmed it, and so isnt
only the abuse of military power, also it is the neglect of the people who does not care about
these things. I commenced my search of the literature using the word: Virus, that is a small
infectious agent that replicates only inside the living cells of other organisms. Viruses can infect
all types of life forms, from animals and plants to microorganisms, including bacteria and
archaea. (Wikipedia: Virus). From these I selected an article entitled by Broad, William,
entitled Bioterror Researchers Build a More
Lethal

Mousepox."

It

was

published

on

Caballero 6
November 01, 2003 in The New York Times. The purpose
of the article is to inform the reader about the possible risk
that has the world with this new super deadly virus and its
consequences. In 2003, went published a note written by
journalist William J. Broad, in the newspaper The New
York Times. It was taken as a military triumph. The US
Army announced its response to possible terrorist bio
attacks in the future, your own super deadly virus: It is a genetically altered smallpox variation,
isn't known how it looks, no one knows what he looks like, but the note said that scientists
reported that annihilated all animals in which they tested, and estimate that beings human would
be worse.5 The author treating us to inform [about] this highly dangerous virus that can wipe out
life on earth. Thanks to this we can see that the [medical] advances have very dark sides, so we
should take our precautions. I have learned that the human is the most dangerous living being in
the world, as it is able to create something that can destroy all. I just hope they can manage this
virus, because it is a "double-edged sword". Also, the article [Bioterror Researchers Build a More
Lethal Mousepox] represents a big issue that can kill us all in seconds. So, we've seen two
negative and terrifying cases of medical advances; however not all is darkness, these advances
also have positive sides that have saved thousands of people and are in the process of achieving
something beneficial for humanity.

3. A new hope for society: Dengue vaccine

5 The New York Times is a newspaper published in New York City by Arthur Ochs
Sulzberger Jr., distributed in the United States and many other countries. Since its
first Pulitzer Prize in 1851 until 2012, the newspaper has won 108 times.
Furthermore, it is owned by The New York Times Company and is considered by
many the quintessential daily US. (The New York Times, Wikipedia). (Appendix C)

Caballero 7
"Always look on the bright side of things despite how bad it is." (Antonio Caballero, 2015).
Although eugenics and the new creation of a virus by USA is too immoral and disgusting, the
medical advances also have positive things that are helping and encouraging society, such as
vaccines, transplants, treatments, etc. I commenced my search of the literature using the word:
Vaccine, that is a biological preparation that provides active acquired immunity to a particular
disease. A vaccine typically contains an agent that resembles a disease-causing microorganism
and is often made from weakened or killed forms of the microbe, its toxins or one of its surface
proteins. (Wikipedia: Vaccine). From these I selected an article entitled by Ghosh, A., and L.
Dar, entitled Dengue Vaccines: Challenges, Development, Current Status and Prospects." It was
published on January 15, 2015 in EBSC host. The purpose of the article is to inform the reader
that scientists are creating a vaccine against dengue and will be ready in a few years. One of the
most known viruses in the world is the dengue virus (DENV), as it is transmitted by a mosquito
scientifically called: Aedes Aegypti. Each year, approximately 5000 people in each country are
detected with dengue and 2000 die from not receiving medical attention. Currently, no vaccine
against this virus, but there are treatments to counter it. In addition, they are creating a vaccine
against dengue and are giving good results, creating the possibility that in the future, this virus is
not spread more.6 The author treating us to inform [about] the dengue virus is a global problem
that has killed thousands of people and still currently doing; now, thanks to this medical
breakthrough, we may see the vaccine against this virus in a few years more, saving the life of
thousands of people and benefiting society. It's a great way to appreciate the good of medical
6 EBSCOhost is a powerful online reference system accessible via the Internet. It
offers a variety of proprietary full text databases and popular databases from
leading information providers. In addition, it offers customizable basic and advanced
searching supported by Boolean logic, natural language, enhanced subject indexing
and journal searching. Very used at Salt Lake Community College and resorted by
different students. (Appendix D)

Caballero 8
advances. I have learned that there are still good people in
this world, trying to help many and bring hope. The medical
advances, like others, will have their bad side and a good
side, making humans into a debate and join aside: for or
against. Also, the article [Dengue Vaccines: Challenges,
Development, Current Status and Prospects] represents the
benefits that provide the medical advances for society. So, just as the potential vaccine against
dengue, there are other ways in which scientific advances are benefiting society today, such as
therapies, treatments, etc.

4. A big dream possibly creates: AIDS Vaccine

The human being is willing to make mistakes in anything that
happens at any stage of life. However, an apology is not enough if it
were the lives of millions of people at a great risk of death. I
commenced my search of the literature using the word: AIDS, that is a spectrum of conditions
caused by infection with the human immunodeficiency virus (HIV). Following initial infection, a
person may experience a brief period of influenza-like illness. (Wikipedia: AIDS). From these
I selected an article entitled by Iglesias, Enrique, entitled Therapies and clinical trials with
vaccine candidates against HIV-1". It was published on September 2009 in EBSC host. The
purpose of the article is to inform and warn the reader that scientists discovered that current
AIDS therapies are worsening the health of people due to the level of toxicity and would try to
create a new vaccine to control it. AIDS is one of the most dangerous diseases that have existed
in these last centuries, killing millions of people. Scientists have discovered that a current

Caballero 9
therapy for AIDS does not eliminate the viral infection if not used for all life. However, while
these therapies are used, the toxicity of the body and the risk of death increase. That's why many
researchers are trying to find a vaccine against AIDS to eliminate the virus or to retain it and not
to harm humans.7 AIDS is a virus that has existed since the last century, tormenting people and
killing them mercilessly. But now, thanks to medical advances, they came to discover that current
treatments are highly toxic to humans, so they try to create a vaccine to hold it and if possible
eliminate it. The medical advances are a "double edged sword"; in other words, when they
search, create or discover something is good for the moment. However, when the technology is
advancing, they discover that what they have done is wrong and to try to improve it. My advice
is: question everything. So humans can get anything with effort and dedication. That is very good
because it has perseverance and patience. But when is time to show their creation, always think
about money. And much worse if it comes to a cure for a disease.

5. A difficult dream to achieve: the cost of a treatment for lung cancer

With only see the title of the article, we know that this is all about. Cancer is not a virus, like
AIDS or dengue fever, is a disease that has affected many people and is difficult to detect on time
to cure. The solidarity of the people and hope for a better world is being lost, and all this because
of money. I commenced my search of the literature using the word: Cancer, that is a group of
diseases involving abnormal cell growth with the potential to invade or spread to other parts of
the body. Not all tumors are cancerous; benign tumors do not spread to other parts of the body
(Wikipedia: Cancer). From these I selected an article entitled by Hui-Chu, Lang, entitled
7 EBSCOhost databases and discovery technologies are the most-used, premium
online information resources for tens of thousands of institutions worldwide,
representing millions of end-users. Also, is very used at Salt Lake Community
College and resorted by different students to search journals. (Appendix E)

Caballero 10
Willingness to Pay for Lung Cancer Treatment". It was published
on October 2010 in EBSC host. The purpose of the article is to
inform the reader about the excessive cost of having a cure for lung
cancer. The cost of treating lung cancer is causing controversy
worldwide. The purpose of this journal is to talk about on the costs of this treatment and
convince people to be paid less than what it says, the government and the insurance cover it.
After many years of research, they could create some pills that help control lung cancer.
However, people should pay for their own wallet and the insurance does not cover any of the
above mentioned.8 The human being is losing solidarity with other people and this is very bad
because life would be at stake. Unfortunately, when something new is created, the scientists
always think about how to get great economic income regardless of the economy of others. In
other words, the scientist thinks of themselves. The medical advances have their good sides;
unfortunately the selfishness of the creators can harm the lives of many people. Money makes
creating impure hearts and merciless. In addition, the article [Willingness to Pay for Lung Cancer
Treatment] represents the solidarity that has the scientists at the medical advances. This helps me
to allow the reader to question whether the cost of medical advances should cost: too expensive
or not. Reminds people who have long suffered this disease.

Conclusion
It is difficult to recognize the reality of these advances: some are very good that can create a
before and after in medical history; however, they also have an evil side, a side that can kill
8 EBSCOhost interface is the search and retrieval of information available online via
the Internet. The system itself has the advantage of looking for articles and journals
for user comfort. It covers documents since 1975 in all areas of academic study,
updated daily. (Appendix F)

Caballero 11
millions of people, damaging the image of medical advances. For me, if I were asked: "Are the
medical advances "good" or bad", I would respond: the medical advances are good and bad for
society, depending on your point of view who sees it.

Appendixes
Appendix A: Health Advances That Changed the World
Sept. 20, 2007

Caballero 12
By DAN CHILDS and SUSAN KANSAGRA, M.D.
ABC News Medical Unit
Managing Editor, Medical Unit

Whether it's the technology that allows us to peer deep into the body or medicines that extend the
lives of those with chronic diseases, it's easy to see how advances in HEALTH and medicine
have touched the lives of nearly every person on the planet.

Yet considering the ubiquitous nature of these developments, it is easy to see how many people
take for granted the technologies and PRACTICES that, at one point or another, almost
certainly saved their own lives or the lives of people they've loved.

The list below encompasses 10 advances in health and medical practices that have changed -and in many ways CONTINUE to change -- the world today.

Vaccines

Throughout HISTORY , communicable diseases have had a tremendous impact on human

history. So too, then, has the development of one of the most effective ways to defend against
rampant viral infection -- vaccination.

Dr. Edward Jenner first introduced the idea of vaccinations in 1796, when he successfully
prevented a young English boy from getting smallpox.

Caballero 13
The concept of vaccination was propelled further by scientists such as Louis Pasteur, and in the
modern era, when large groups of soldiers were successfully vaccinated in World War I and II
against such diseases as tetanus, diphtheria and typhus.

"Polio vaccine is one that people think of because it had such an impact," said Dr. Jeffrey Baker,
director of the history of medicine PROGRAM at the Duke University School of Medicine.
But from the global health standpoint, Baker said Jenner's INTRODUCTION of the smallpox
vaccine may have had an even more significant impact in terms of lives saved.

Surgical Anesthetic and Antisepsis

Without a doubt, surgery used to be a much graver proposition than it is today. One of the chief
reasons for this is that before the middle of the 19th century, anesthetic simply wasn't an option.

That changed Oct. 16, 1846, when William T.G. Morton demonstrated the mysterious wonder of
ether -- a substance powerful enough to dull the pain and agony that had long been associated
with surgery.

But while anesthetic was a great advance in and of itself, another advance that occurred at
roughly the same time may have been even more beneficial -- antisepsis, or the creation of a
sterile surgical environment.

"Anesthetic made it possible to operate on a patient without pain," Baker NOTES , "but without
antisepsis they'd die anyway."

Caballero 14
Antibiotics and Antivirals

As with vaccination, the advent of antibiotics hailed a new era in the treatment of communicable
disease.

Improvements in Heart Surgery and Cardiac Care

HEART DISEASE remains at the top of the list of the country's killers. Despite this, numerous
important advances in its treatment have made a considerable impact, extending and improving
the lives of its sufferers.

Not the least of these advancements is surgeons' ability to operate on and repair the heart -without putting the patient at an unreasonable amount of risk.

"Maybe the breakthrough moment was the rise of the heart-lung bypass, which made it possible
to operate on the heart for more than just a few minutes at a time," Baker said. "This was
followed by coronary artery bypass grafting, which is, I believe, a most important procedure."

Radiologic Imaging

Before the development of radiologic imaging technologies, beginning with the use of the Xray, DOCTORS were usually relegated to looking only for external signs of injury or damage.

Caballero 15
Today, the ability to peer inside the body and determine the cause, extent, or presence of disease
has revolutionized the very way medicine operates and has saved countless lives in
the PROCESS .

Appendix B: Dont Edit the Human Germ Line

<http://www.nature.com/news/don-t-edit-the-human-germ-line-1.17111>

It is thought that studies involving the use of genome-editing tools to modify the DNA of human
embryos will be published shortly.

Caballero 16
There are grave concerns regarding the ethical and
safety implications of this research. There is also fear
of the negative impact it could have on important work
involving the use of genome-editing techniques in
somatic (non-reproductive) cells.
We are all involved in this latter area of work. One of
us (F.U.) helped to develop the first genome-editing
technology, zinc-finger nucleases (ZFNs), and is now
senior scientist at the company developing them, Sangamo BioSciences of Richmond, California.
The Alliance for Regenerative Medicine (ARM; in which E.L., M.W. and S.E.H. are involved), is
an international organization that represents more than 200 life-sciences companies, research
institutions, non-profit organizations, patient-advocacy groups and investors focused on
developing and commercializing therapeutics, including those involving genome editing.
Genome-editing technologies may offer a powerful approach to treat many human diseases,
including HIV/AIDS, haemophilia, sickle-cell anaemia and several forms of cancer. All
techniques currently in various stages of clinical development focus on modifying the genetic
material of somatic cells, such as T cells (a type of white blood cell). These are not designed to
affect sperm or eggs. In our view, genome editing in human embryos using current technologies
could have unpredictable effects on future generations. This makes it dangerous and ethically
unacceptable. Such research could be exploited for non-therapeutic modifications. We are
concerned that a public outcry about such an ethical breach could hinder a promising area of
therapeutic development, namely making genetic changes that cannot be inherited. At this early
stage, scientists should agree not to modify the DNA of human reproductive cells. Should a truly
compelling case ever arise for the therapeutic benefit of germline modification, we encourage an
open discussion around the appropriate course of action.

Appendix C: Bioterror Researchers Build A More Lethal Mousepox

<http://www.nytimes.com/2003/11/01/us/bioterror-researchers-build-a-more-lethalmousepox.html>
Scientists have created a highly lethal virus in an effort to develop stronger protections against
supervirulent forms of smallpox that terrorists might turn on humans, researchers said yesterday.

Caballero 17

The genetic engineering involved a virus known as mousepox,

which infects mice but is not known to hurt people. Into that
virus the scientists spliced a single gene that made it
superlethal, and then tested it on mice treated with different
combinations of a smallpox vaccine and drugs. The scientists
said the results showed that the best defenses proved quite
effective in preventing deadly disease not only in mice, but
probably in humans exposed to customized smallpox of similar
design.
This type of research has been debated for years, with critics arguing again yesterday that superviruses
created in laboratories could inspire terrorists to create their own deadly diseases. The mousepox
scientists countered that the research could help deter terrorism by demonstrating the emergence of more
potent medical defenses. The mousepox research was done at St. Louis University as a project financed
by the National Institute of Allergy and Infectious Diseases meant to find new protections against
smallpox, which kills one in three victims.
The leaders of the research said that the lethal mouse virus would have no effect on humans even if it
somehow escaped from the laboratory, which they said was safeguarded at biosafety level three, the
second-highest degree of security. ''To my knowledge, there's no scientific evidence to suggest that this
kind of research poses any sort of human health risk,'' said Mark Buller, a professor of molecular
microbiology at St. Louis University who directed the mousepox research. Many experiments have shown
that mousepox does not cause disease in humans, he said.
It goes beyond similar research on mousepox that Australian scientists reported in early 2001. They
warned that their genetic technique, which they said they stumbled onto, could overpower existing
vaccinations and produce deadlier kinds of biological weapons. The news prompted heated scientific
debate internationally. Yesterday, Dr. Buller said the St. Louis researchers had also made a designer form
of cowpox, another cousin of smallpox, to better understand how easy or difficult it would be to apply the
same kind of genetic engineering to the human smallpox virus and make it more lethal.
Experts said both the threat of such developments and the federal response seemed part of a theoretical
debate, not something to worry about for now. They split over whether the research was prudent. Some

Caballero 18
argued that, given the accelerating pace of advances in genetic engineering, it was wise to investigate
worst cases and responses.
''If we do not act across a wide range of areas we will be failing in our responsibilities as global citizens,''
said Ken Alibek, a former leader of the Soviet Union's germ weapons program. Other experts called such
research a slippery slope that could aid terrorists, and argued that the research should have had the kind of
rigorous peer review that a National Academy of Sciences panel called for last month in new
recommendations.
''This is bigger than the original Australian work,'' said Elisa D. Harris, a Clinton administration arms
control official now at the University of Maryland. ''They knew the mousepox results and deliberately set
out to build upon that work in a way to create a more deadly virus.'' ''There was a need here,'' she added,
''for consequential research to be reviewed to weigh the potential risks and benefits before the work
proceeded, and that apparently didn't happen here.''
Dr. Lawrence D. Kerr, a senior official at the White House Office of Science and Technology Policy,
agreed, noting that the research began before the recommendations were issued and would have
undergone such scrutiny if begun now.
''This is the exactly the kind of scenario'' that federal officials worry about, he said in an interview.
Eradicated two decades ago, smallpox no longer exists in nature or human populations. Officially, only
the United States and Russia have stocks of the virus, under tight security. But federal experts suspect that
clandestine supplies of the virus exist or could be fabricated.
The mousepox research was first reported in the current issue of New Scientist, a British magazine.
It involved inserting into the mousepox virus a mouse gene that controls interleukin-4, a primary
chemical in the immune system's response to invaders. In the Australian case, the designer virus so
crippled mice's immune system with extra production of interleukin-4 that the microbe reproduced wildly,
killing mice that had been vaccinated and leaving others permanently disabled.

Caballero 19
Yesterday, Dr. Buller said the St. Louis research made the killer germ more lethal by inserting the
interleukin-4 gene into an unimportant region of the virus's DNA, unlike the central part of the genome
that the Australians chose. That allowed the virus to multiply even faster, he said.
''It can't affect humans,'' he emphasized repeatedly.
The human smallpox vaccine offered no protection to mice exposed to the superlethal virus. ''They all
died,'' Dr. Buller said.
The antiviral drug cidofovir similarly failed to give protection. But a combination of the drug and
vaccine, he added, saved some mice. The researchers found that the best protection was a combination of
cidofovir with a monoclonial antibody drug that fought the effects of interleukin-4. ''We protected all the
mice from a very high dose'' of the virus, he said.
He added that he planned to submit the research for publication and had no qualms about disclosing the
exact location of the gene transfer. ''It's irrelevant'' to the design of a human weapon, he said.
Dr. Buller said that colleagues at the Army's biodefense institute at Fort Detrick, Md., were planning to
test the superlethal cowpox virus on mice. Yesterday, neither the White House nor Fort Detrick would
comment on whether those plans had been approved. The cowpox virus can infect humans, though the
resulting disease is usually mild. Still, critics worry about the ramifications of such research, for safety
and for precedent. ''The issue here,'' Dr. Harris said, ''is the potential of this research being misapplied for
destructive purposes.''
Photo: Dr. Mark Buller of St. Louis University led the mousepox project. (Photo by Tim Parker for The
New York Times)

Appendix D: Dengue vaccines: Challenges, development, current status and prospects

<http://web.a.ebscohost.com.dbprox.slcc.edu/ehost/pdfviewer/pdfviewer?sid=2107ab78-ad4b40c6-9928-c3b03be2a7ad@sessionmgr4001&vid=4&hid=4101>

Caballero 20
Infection with dengue virus (DENV) is the most rapidly
spreading mosquito-borne viral disease in the world. The
clinical spectrum of dengue, caused by any of the four
serotypes of DENV, ranges from mild self-limiting
dengue fever to severe dengue, in the form dengue
hemorrhagic fever (DHF) and dengue shock syndrome
(DSS). Increased rates of hospitalization due to severe
dengue, during outbreaks, result in massive economic
losses and strained health services. In the absence of specific antiviral therapy, control of
transmission of DENV by vector management is the sole method available for decreasing
dengue-associated morbidity. Since vector control strategies alone have not been able to
satisfactorily achieve reduction in viral transmission, the implementation of a safe, efficacious
and cost-effective dengue vaccine as a supplementary measure is a high public health priority.
However, the unique and complex immunopathology of dengue has complicated vaccine
development. Dengue vaccines have also been challenged by critical issues like lack of animal
models for the disease and absence of suitable markers of protective immunity. Although no
licensed dengue vaccine is yet available, several vaccine candidates are under phases of
development, including live attenuated virus vaccines, live chimeric virus vaccines, inactivated
virus vaccines, subunit vaccines, DNA vaccines and viral-vectored vaccines. Although some
vaccine candidates have progressed from animal trials to phase II and III in humans, a number of
issues regarding implementation of dengue vaccine in countries like India still need to be
addressed. Despite the current limitations, collaborative effects of regulatory bodies like World
Health Organization with vaccine manufacturers and policy makers, to facilitate vaccine
development and standardize field trials can make a safe and efficacious dengue vaccine a reality
in near future. [ABSTRACT FROM AUTHOR]

Appendix E: "Therapies and Clinical Trials with Vaccine Candidates against HIV-1"
<http://web.b.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=192d459d-7e93-4411-90bc455d103152ee@sessionmgr198&vid=5&hid=128>

Caballero 21
Antiretroviral therapies combining three or more compounds
frequently diminish the viral load (VL) in blood to un-detectable
levels (< 50 copies of RNA/mL), being considered as optimal. In
contrast, more than 100 clinical studies with different vaccine
candidates have barely achieved modest results and some studies
have been discouraging. Therapies are, however, unable to
eliminate viral infection. At the same time, they are a threat to the
health of patients because of the accumulated toxicity derived from their prolonged use. Many
researchers, therefore, believe that an effective (or even partially effective) vaccine might
substitute therapies, eliminating the virus or at least controlling the VL through immunemediated mechanisms. However, immune correlates for protection remain unknown requiring a
strategy to evaluate the clinical effectiveness of vaccine candidates. Hence, the experience
accumulated with therapies is highly valuable. This papergives an update on some of the main
results of antiretroviral therapies and therapeutic vaccination, giving recommendations in the
field of vaccination against HIV-1. [ABSTRACT FROM AUTHOR]

Appendix F: "Willingness to Pay for Lung Cancer Treatment"

<http://web.a.ebscohost.com.dbprox.slcc.edu/ehost/pdfviewer/pdfviewer?sid=8dab1e03-6c4a4c90-8975-3c34adbf424b@sessionmgr4005&vid=21&hid=4209>
Objectives: The increasing health-care cost of lung cancer
treatment has caused debates regarding the reimbursement
of new medications. The purpose of this study was to
estimate patients' willingness to pay (WTP) for a
hypothetical new drug. Methods: Patients with lung cancer
were recruited through referrals by senior specialists from
two

medical

centers

in

Taiwan.

Double-bounded

dichotomous choice questions and follow-up open-ended questions were employed to elicit
patients' WTP. The contingent valuation question assumed that a novel medication was available,
which provided a cure for lung cancer; however, patients would have to pay for this new cure out
of their own pocket. In addition, the question was asked as to how much patients would be

Caballero 22
willing to pay for supplementary hospitalization insurance? Interval regression and linear
regression were used to estimate the maximum WTP. Results: A total of 294 patients were
recruited; their mean age was 67 years; 74% were male and 26% were female. The results show
that patients were prepared to pay New Taiwan dollar (NTD) 7416 or NTD 7032 per month to
purchase this new medication. Sex, religion, income, the Karnofsky Performance Scale score,
and having family that takes care of you are significant factors influencing a patient's WTP.
Conclusions: Patients would like to pay less than the actual price of the new medication for their
lung cancer. Thus government and health policymakers should consider the ability to pay when
making their decision regarding the coverage of new drugs. [ABSTRACT FROM AUTHOR]

Works Cited
Lanphier, Edward, Fyodor Urnov, Sarah Haecker, Michael Werner, and Joanna Smolenski.
"Dont Edit the Human Germ Line." Nature. 12 Mar. 2015. Web.

Caballero 23
Broad, William. "Bioterror Researchers Build a More Lethal Mousepox." The New York Times. 1
Nov. 2003. Web.
Ghosh, A., and L. Dar. "Dengue Vaccines: Challenges, Development, Current Status and
Prospects." Indian Journal of Medical Microbiology Vol. 33.Issue 1 (2015): P3-15.
13p. EBSCO Host. Web.
Iglesias, Enrique. "Therapies and Clinical Trials with Vaccine Candidates against HIV1."Biotecnologia Aplicada Vol. 26.Issue 3 (2009): P.190-198. 9p. EBSCO Host. Web.
Hui-Chu, Lang. "Willingness to Pay for Lung Cancer Treatment." Value in Health (WileyBlackwell) Vol. 13.Issue 6 (2010): P743-749. 7p. EBSCO Host. Web.