Miles Anderson, Bryce Colón, Nolan Isaacs, Thao Nguyen

P H R M 4 8 5 : G R O U P 2

Biological International Health Issues

Miles Anderson (Professional Student), Bryce Colón (BSPS Candidate), Nolan Isaacs (BSPS Candidate), Thao Nguyen (BSPS Candidate), Renee Wayner (Professional Student)

Source: https://grants.nih.gov/ngri.htm

SUMMARY OF TOPICS DISCUSSED

International health issues related to advancements in biology and medicine are broad, ranging from issues with provider and patient education to international tourism to seek unregulated treatments. Presented here are five issues: genetic education, biosurveillance, issues related to longevity, stem cell tourism, and fetal testing methods to prevent diseases. The issues affect a wide range of people and raise a number of ethical considerations upon which each author will provide commentary.

GENETIC EDUCATION

By Miles Anderson

Background: Genetic education is a means for individuals to obtain information about their potential risk of getting a genetic disorder or disease. Genetic education can also be used to better educate healthcare professionals. Genetics has provided great benefits to human health such as the identification and treatment of diseases linked to single-gene mutations. Genetics can also be utilized to enhance the health of humans by altering the genome. Genetic services include: Genetic counseling (i.e. obtaining, interpreting, and/or assessing genetic information and relaying this information back to the patient clearly and in the form of an action plan if one is necessary), a genetic test, and genetic education. Global issue: This is a global issue because it can affect poor people no matter the country or region. A certain region may have a lower or higher incidence of poorer people so there may or may not be less access to genetic education and services that are provided. Who/what is affected: Poor people in low income parts of the globe are impacted negatively by having less access to genetic education and services. What efforts/solutions have been made? (or should/could be done?): Make genetic programs a service paid for through the government or foreign government support, or make the services a free service offered by the healthcare system for those most in need.

Opinion: Genetic education, information, and services should be available for the improvement or maintenance of an individual's health no matter someone's economic status or location in the world. Genetic education should also be applied to help healthcare providers all around the globe improve knowledge and improve confidence in making decisions. -M. Anderson

Background: So what is biosurveillance? It is the systematic process of detecting, reporting, and responding to pandemic potential pathogens before they become outbreaks. There are programs that have been implemented in the United States (BioWatch), Canada (National Enteric Surveillance Program, NESP), Germany, and other countries. Who/what is affected: Everyone is affected by the potential outcomes of these programs because of their goal of reducing the threat of infectious diseases by promoting global health security. The goal of these programs is to enable early detection of a threat and mounting of an integrated response. These programs are important because emerging and re-emerging infectious diseases are a major challenge for public health and economic security worldwide. What efforts/solutions have been made? (or should/could be done?): The way biosurveillance systems work is by gathering data from various sources like hospitals, pharmacies, and veterinarians and putting it into a database. Then that data is analyzed to see if there are any patterns or anomalies and those cases are flagged for potential outbreaks. From there, the system alerts public health officials and they can make the decision of what to do moving forward. During this time, all these different biosurveillance programs will be sharing their data and this promotes global health security.

Opinion: These programs will be beneficial because they will give awareness to the infected countries and allow them to plan accordingly instead of in a rush. When the COVID-19 pandemic occurred, almost every nation was unprepared and which lead to mass panic, but that urged leaders to allocate resources to these programs. -T. Nguyen

Source: https://www.sciencedir ect.com/topics/medicineand-dentistry/ biosurveillance

LONGEVITY By Nolan Isaacs

Background: The study of longevity genes is a developing science that is translating to a very developing industry. The study of longevity is finding ways to increase the lifespan within individuals, whether this is through decreasing neurodegeneration, newer medicines, healthier lifestyles, or cleaner environments.

Global issue: The current global issue with longevity is finding the technology to develop the biologics and then finding ways for the globe to sustain the effects of people being able to live longer. This is an issue because the common assumption is that most people would prefer to live longer, but finding ways to create these newer medicines while finding ways to not affect the economy and usage of resources is relatively impossible.

Who/what is affected: The main thing getting affected by increasing lifespan and longevity would be the economy and the structure of the way things work.

Increasing the lifespan of people means a larger population with resources that will be more used. Another huge thing getting affected is the future of medicine. Finding ways to enhance gene therapies to increase longevity opens up a whole other branch of medicine. What efforts/solutions have been made? (or should/could be done?): The current efforts being made consist mainly of new research facilities across the globe at various universities and various companies. The first to make a breakthrough in developing such biologics would see great success with financial backing and certified awards. Other solutions to mask the effects that come with increasing the population would be to increase food production and increasing ways to create technology advancements with renewable resources instead of nonrenewable.

Opinion: In my personal opinion, I believe longevity biologics and medicines should be increased in terms of funding and research. The benefits it could have across the globe with people being able to live longer and produce more could lead to a higher working economy and more successful living. I think the economy would adjust to the slow improvement of longevity just as it adjusts to other things that occur in the world. -N. Isaacs.

Background: Medical tourism is a phenomenon wherein people travel abroad to receive some sort of medical care that is unavailable or not affordable in their country of residence. Upwards of 1 million Americans make these medical journeys annually, but most involve cosmetic procedures and dentistry. Global issue: Stem cell tourism is a type of medical tourism that involves crossing international borders to receive stem cell treatment (see graphic on next page). It is attractive because it promises to treat desperate patients with chronic, debilitating conditions. Although some may travel to receive scientifically-backed and ethically investigative stem cell treatments (such as those in approved clinical trials), many patients travel to clinics that do not have the proper scientific backing or credentials to administer such treatments. Because much of the industry operates covertly and is not subject to regulatory scrutiny, it is difficult to estimate the number of patients traveling abroad for this type of medical procedure. It is also difficult to estimate the economic cost associated with this travel, although it is likely a multi-million dollar industry (7). Who/what is affected: The industry operates mainly through the Internet, with websites that advertise directly to the consumer. These websites are often shared in forums/groups for people with chronic diseases, but they rarely highlight the inherent risks that come alongside receiving a therapy not backed by mainstream science. Many of these websites use scientific nomenclature to attain the veneer of scientific legitimacy, but oftentimes they advertise therapies that they do not even perform. What efforts/solutions have been made?: Stem cell tourism is hard to address because regulatory laws only operate within nations. Many clinics have been accused of using cells not fit for intrathecal or intravenous injection. Or, if they harvest stem cells autologously, they may not properly treat and enrich the stem cells prior to injection.

Most of these clinics are located in the United States, but other countries with multiple stem cell clinics in operation include China, India, and Thailand. Stem cell tourism to countries like China is particularly difficult to control because China is not likely to abide by regulatory harmonization laws. Although the United States has updated regulatory laws that left loopholes (i.e. the minimal manipulation and homologous use clauses), low-to-middle income countries often lack the government apparatuses to enforce these kinds of laws. Although much of the literature suggests that healthcare professionals and nations have the obligation to protect patients by restricting their access to unproven stem cell therapies, others argue that patient choice is paramount. Indeed, some healthcare professionals argue that terminally and chronically ill patients should have the freedom to seek corrective medical care, regardless of the scientific veracity of the treatment. Some believe that stem cell counseling may be needed in order to guide patients through the dense and confusing information surrounding the stem cell boon, especially since many of the patients are emotional and hopeful about stem cells (8). These researchers believe that one way to prevent patients from being hurt by untested cell products is to provide better information that is accessible to laypeople, as well as train physicians on how to interact with patients should they consider seeking stem cell treatment.

Opinion: The medical community and the international community have an obligation to protect patients, especially those who are medically fragile and vulnerable to outlandish "miracle cures"; nations should clamp down on unproven stem cell treatments. Choice is important, but only if the options are thoroughly vetted and scientifically sound. -B. Colón

HEREDITARY DISEASE PREVENTION & GENETIC TESTING ON FETUSES By Renee Wayner

Background: The anticipation of knowing characteristic about an unborn fetus is something many people look forward to. However, under some circumstances it is important to know this information for medical purposes. There are two common forms of genetic testing for fetuses: amniocentesis and chorionic villi (CVS). Amniocentesis is the process of extracting fluid from the amniotic sack. CVS extracts fluid from the blood in the placenta. Procedures such as amniocentesis and CVS detect serious conditions such as Rh factor that can negatively affect the woman and fetus. Global issue: Women’s access to reproductive and natal health is important worldwide. Across the globe, it is typically an expensive procedure or unknown as an option. In the US, the cost can range from $1000-7000 or more. It is not typically covered by insurance. The procedure can also concern mothers, as it is an injection into the stomach to extract the specimen. However, it is commonly unpainful due to anesthesia. Who/what is affected: Both women and fetuses are affected by these procedures. Women have the procedure before 14 weeks in the case abortion is considered. The chances of complications from these procedures are low (0.1-0.3% risk). What efforts/solutions have been made? (or should/could be done?): Further education within pregnancy care clinics is currently a growing process. What should be considered is making more affordable access to resources such as amniocentesis and CVS that could detect future health risks for both the fetus and the mother.

Opinion: Education on options such as amniocentesis and CVS should be more common in women's health clinics. These measures can save the life of both the women and the fetus. The cost of treatment for detecting these lifealtering conditions is expensive. Knowing the results of these tests and women having knowledge of their impact can help multiple lives. -R. Wayner

Map showing the prevalence of unregulated stem cell clinics across the world. Source: .https://link.springer.com/article/10.1007/s13770-013-1116-7

References

1. Prenatal diagnosis: Amniocentesis and CVS. familydoctor.org. (2020, April 1). Retrieved February 22, 2022, from https://familydoctor.org/prenatal-diagnosis-amniocentesis-and-cvs/

2. Chandrasekharan, S., Minear, M. A., Hung, A., & Allyse, M. (2014, April 9). Noninvasive prenatal testing goes global. Science translational medicine. Retrieved March 29, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4112725/

3. Pang, Tikki. “The Impact of Genomics on Global Health.” American Journal of Public Health, © American Journal of Public Health 2002, July 2002, www.ncbi.nlm.nih.gov/pmc/articles/PMC1447192/.

4. Abrew, Ashwini de, et al. “Challenges in Global Genomics Education.” Applied & Translational Genomics, Elsevier, 8 Nov. 2014, www.sciencedirect.com/science/article/pii/S2212066114000416.

5. Bartlow AW, Middlebrook EA, Romero AT, Fair JM. How Cooperative Engagement Programs Strengthen Sequencing Capabilities for Biosurveillance and Outbreak Response. Frontiers in Public Health. 2021;9. doi:10.3389/fpubh.2021.648424

6. What is Global Health Security? www.cdc.gov. Published October 12, 2021. Accessed March 16, 2022. https://www.cdc.gov/globalhealth/security/what.htm

7. Gharaibeh B, Anderson JE, Deasy BM. Combating the threat of stem cell tourism through patient education an: IEH. https://www.dovepress.com/combating-the-threat-of-stem-cell-tourism-through-patient-education-an-peer-reviewedfulltext-article-IEH. Published January 27, 2016. Accessed March 25, 2022.

8. Murray IR, Chahla J, Frank RM, et al. Rogue Stem Cell Clinics. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7002842/. Published February 2020. Accessed March 25, 2022.