This month I am living in a plague house. Someone should mark the door posts. Or fly a yellow quarantine flag over the house. My son came home from Singapore, where he is working for a start up, but he did not bring home some exotic communicable disease like the Hong Kong flu. No, he came home and went to visit friends of his who have a toddler. And toddlers go to day care, where they become walking petri dishes, petri dishes that somehow are inoculated with every virus known to science (and some as yet unknown) within a 100 mile radius.
He played with this kid and, within 12 hours, was bed ridden. I will not go into the level of hypochondriasis that I have inadvertently induced in my family, but this time my son was really sick. I isolated him in one room, put hazmat stickers on the door, gave him his own waste disposal bags for his snotty tissues, and put Lysol spray and alcohol hand gel in every room. No one else here got sick…yet!
The next week, I went to Washington DC and, on my way home, I contracted something similar, probably on the plane. I heard an infectious disease researcher say that you should regard every surface, every object in an airplane toilet like it is radioactive. I did and I still got nailed. My illness was not unlike my son’s… immobilized for two days, unhappy for a few more, but I was fully recovered by the time I left for a European holiday on Christmas morning. And then…
Coming home, somewhere over Ohio, my husband turned the color of old parchment paper, and sunk into the depths of despair and sinusitis. By the time we landed, he was full on sick. He has been in bed with fever, congestion, non- productive cough and myalgias for the past two days. This evening, he is being resurrected and reanimated, returning from the realm of the zombies.
The main feature of this sickness is being absolutely down for the count for two days. I have conducted a highly scientific study, calling several friends and relatives. One friend cancelled a trip to visit her brother in UT, since everyone in that household had the same thing. Another acquaintance visited friends in central CA and everyone there had the same crud. My brother in Alabama reports the same symptoms in his friends and co-workers.
After sharing these highly sophisticated epidemiological surveillance data with my husband, he asked a logical question: is this a weaponized virus? At least it seemed like logical question given that we watched the movie “Contagion” on the plane going over to Europe and, given the article in the NY Times yesterday (1/2/12), about two teams of scientists that have genetically modified the Avian H5N1 virus, facilitating the potential for aerosol person-to-person transmission. H5N1 imposes a human mortality rate of 50%, but is generally not transmitted by person to person contact. With very little manipulation, infectivity can be enhanced. A minor mutation in the gene called PB2, enabling the virus to replicate at lower temperatures found in the nose, enhances the likelihood of spread, and then another alteration to the HA gene, changing the hemaglutinin spike on the virus, increases cellular binding and potential infectivity.
Generally, a highly transmissible strain of a virus, when coupled with high lethality, causes the virus to burn itself out. High transmissibility, low lethality is more adaptive, if you are a virus. Human papilloma virus (HPV) is an example of a successful, highly infective agent with a low lethality. Even when HPV induces cervical cancer, malignant degeneration takes almost two decades and, during that interval, the virus can be spread far and wide. But viruses designed as biological weapons would not serve the evolutionary “desire” of the virus, which is to replicate itself. The weaponized virus serves a perverse human “desire,” the creation of a lethal pandemic.
So, after you graduate, you go to work at an institute or a university or a drug company, and they put you to work on a project with perhaps less than laudable goals. Or worse, they put you to work on a dangerous project. Or even worse, you are working on a dangerous project without proper precautions. Or they ask you to manipulate data or lose data or hide data. What do you do? What are your ethical considerations?
This week, the American College of Physicians Ethics, Professionalism, and Human Rights Committee published the sixth edition of their Ethics Manual.
Each new edition is a response to the fact that medicine, law, and social values are not static and that over time, ethical considerations need to be reevaluated. The new manual expands or modifies topics as the technical and social environment changes.
The 2012 edition offers advice on relevant innovations in medicine like managing confidentiality in the age of electronic health records, guidance on participating in social media and online sites, the uses and abuses of genetic testing, taking care of very important persons (VIPs), the appropriateness of pay-for-performance and professionalism, physician–industry relations, the use of human biological materials and research, and appropriate placebo controls in clinical trials. The manual is available without subscription at the following link:
The editorial by Ezekiel J. Emanuel, MD, PhD, Head of the Department of Bioethics at The Clinical Center of the National Institutes of Health, is very enlightening.
An appendix contains a case based method for making ethical determinations in clinical situations, but with some manipulation and modification (non genetic), may be useful to all life sciences students and teachers.
Back to my husband’s question about our recent household pandemic. I told him what our family doctor used to tell us when we became sick in the winter: “There is a lot of that going around.” No conspiracy, no evil scientists, no weapons of mass destruction. You’re sick. You’ll get over it.
And he did.