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| HEALTH TRIBUNE | Wednesday, June 13, 2001, Chandigarh, India |
| Ethics
in the age of the Gene Prof Jens Reich THE deciphering of the human genome brings with it a wealth of new insights into both the origins and future of the human species. By comparing the gene sequences of primates and early humans, we can learn more about our place in biological and cultural evolution: such evidence provides information which is as precise as that of authenticated written sources. HEALTH BULLETIN No teeth,
no job! Yes, it's true Surgery of
heart and brain
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Ethics in the age of the Gene
THE deciphering of the human genome brings with it a wealth of new insights into both the origins and future of the human species. By comparing the gene sequences of primates and early humans, we can learn more about our place in biological and cultural evolution: such evidence provides information which is as precise as that of authenticated written sources. Initial results indicate that all human beings originate from Africa and that their genetic affinity is so close that there is no further scientific justification for retaining the concept of race in human biology. Our understanding of the evolution and functioning of the human body will also increase. We will be in a much better position to understand the laws that govern inheritance and the nature of acquired individual characteristics, insofar as these have a genetic base. Such new biological insights will perhaps draw a line under many an ideological debate, but they will scarcely provide fuel for new controversy. Controversy will most certainly arise, however, over investigation into the genetic make-up of the individual. Of great significance here is the diagnosis of hereditary dispositions and the concomitant possibility actually severely limited for the most part of predicting an individual's future life. An especially explosive issue is the greater potential for genetic testing during pregnancy; so long as it is limited to suggesting abortion as the only effective therapy, this will be of little help to those concerned. A very pressing question is what diagnostic procedures should be allowed before pregnancy, on embryos at an early stage of development, and in cases of artificial insemination if such diagnoses allow the selection of desirable and the prevention of undesirable offspring. It is an open question as to whether laws aimed at ensuring that decisions based on such diagnoses are made on strictly medical grounds can really prevent an insidious broadening of the criteria applied. We must also regulate the use of genetic testing to diagnose future risks of illness whereby a straightforward ban on such testing will not solve the problem, since such diagnoses are in many cases extremely desirable. The deciphering and diagnosis of the human genome will not immediately, but in the long term also allow us to intervene in the development of the human organism. It will be possible to create a genetically identical twin from a mature individual, as well as a twin with deliberately improved characteristics even though pursuing such goals will probably lead to unforeseeable mishaps. But the prospects opened up for medical therapy could also create ethical conflicts when, for instance, it turns out that research into and production of transplantable replacement cells and tissue necessitate the use of valuable donor material and even of human embryos. I believe that making such material available for research is not on the agenda at the moment, because insufficient research has been conducted on animals to allow the objectives of similar research on humans to be precisely defined. In addition the necessary political discussion has not progressed for enough. It is astonishing what a strong impetus the new science of genetic biology has given to the biologisation of our concept of the human being, both among those who applaud these developments and see them as grounds for optimism, and to an even greater extent among those who view such developments with concern but who use the crudest materialistic arguments to present their case, portraying genome researchers as modern-day Frankensteins who have taken over control of the human genome and thus of the fate of humanity. Such fears are based on a completely exaggerated mechanistic concept of how the human organism
functions. yet the question still remains as to how in the future we are to define what is human and concomitantly what is human dignity, what are human rights, and what is involved in protecting human life both before and after birth. It is clear that long-term political and legal solutions to the problems raised by genome research can be found only when we are sure of finding answers to these basic questions. And it is also clear that ethics cannot be based purely on biological facts. A precise knowledge of the role our genes play in our existence is a precondition but not a sufficient basis for a normative morality. The neurotic assertion that we are only automatons at the mercy of our genes and can thus be manipulated at will simply complements the anticipatory spirit of resignation that declares all moral decision-making to be powerless in the face of the twin threats of cultural and economic globalisation. A capacity for reason and self-determination is not a sufficient precondition for that human dignity which we wish to defend, since many people ( such as babies and the mentally challenged) do not possess these qualifications to a sufficient degree yet they still clearly possess human rights that merit protection. Still less does the mere material fact of human existence justify these basic rights. I am convinced that human rights should be premised on the fact that we human beings are creatures who lead a communal existence together. A primarily metaphysical conviction that the rationale behind human existence consists of more than its simple duration could also help define this basic ethical position. I can only hope that any future discussion of the limits of human biology will be characterised by more composure, more self-awareness, and a more measured consideration of the consequences of such research and how to control them than is evident at the moment. Prof Jens Reich is a molecular biologist and former GDR civil rights activist.
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HEALTH BULLETIN USED
medicinally in Ayurveda, ginger is a very important herb to be acquainted with. It was mentioned in Charak Samhita, the most respected treatise of Indian medicine, and was called Vishvabhaishajam universal medicine. Ginger was brought to the West through trade with India much later. Now, when we understand many of the chemical constituents responsible for ginger's remarkable medicinal properties, its use in Ayurveda continues as much as it did 5,000 years ago. The medicinal use of ginger involves the utilisation of the rhizome, in fresh form called ardraka or in the dried form referred to as shunthi or nagar in Sanskrit. It has been described as katu and tikta (pungent and bitter) in taste and light, unctuous and hot in effect. While pacifying vata and kapha, it is known to aggravate pitta. Ginger contains a yellowish volatile oil, a bitter substance known as gingeroil and an oily resinous substance ginger in which is its main active principle. Besides this, from time to time, one usually comes across various research reports originating from different parts of the globe regarding the benefits of ginger which only validate the assessment of ancient Ayurvedic acharyas. Ginger is carminative, digestive, sialagogue (which produces saliva), blood purifier and anti-colic. It also has cardiac stimulant, aphrodisiac and anti-rheumatic properties. It has been described as one of the best ama-pachaka, meaning a substance helping to nullify toxins produced in the body by improper digestion. Nowadays many multinational drug companies are working to come up with different derivatives of ginger which have been successfully tried as anti-emetic agents during the course of chemotherapy in cancer patients. However, some of the common uses of ginger are as under - Digestion: Ginger aids in digestion from the beginning to the end. It has traditionally been used for setting right an upset stomach, gas trouble and nausea. It also helps in the digestion of proteins because of the overwhelming presence of an enzyme called protease. In Ayurveda it is the drug of choice for controlling the mucous coming with stool. Cold and flu: Ginger is a diaphoretic; it brings heat into the body, increases perspiration and stimulates the circulatory system. Therefore, it is good for chill and cold. It also has cough-suppressing qualities. It soothes sore throat and relieves congestion and sinusitis. The use of ginger tea is common, in such conditions. Rheumatism and migraine: The use of the famous Panchkol Churna, which contains ginger along with four other ingredients, is the first step according to Ayurveda in the treatment of rheumatoid arthritis in its flare-up phase. Ginger can also incite delayed menstruation, relieve menstrual cramps and lessen the intensity of migraine. There are various classic Ayurvedic preparations in which ginger is used as an important constituent. To name a few, Trikatu Churna (for indigestion and sinusitis) Vyoshadi Ghrit and Churna (for cough and allergies) and Saubhagya Shunthi Pak (a general tonic and metabolic corrector) are in practice. The dose of the fresh juice of ginger varies from 2 to 5 ml and of its tried powder from 1 to 2 gm. However, patients having gall-bladder stones, severe acidity and ulcers are advised to consult their physicians before using ginger as a single drug. Dr Vatsyayan is based at the Sanjivani Ayurvedic Centre at Ludhiana. Phones - 0161-423500, 431500;
E-mail-sanjivni@satyam.net.in |
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No teeth, no job! Yes, it's true Developing countries place a premium on the state of women's teeth. In Chile, for instance, President Pinochet's reforms made dental care prohibitive for the poor, causing a general decay. Women with poor teeth found they had less chance of getting a good job. So a cheap dental care programme launched about 10 months ago is attracting thousands of women who believe new teeth offer a new chance in life. The Indian scenario is far better though! *
* * Santiago: Almost anywhere in the world, the state of one's teeth is a very personal matter. Not so in Chile. In this South American state, the state of a woman's teeth can determine her status in life. Unless in possession of a set of teeth fit for an advertisement for toothpaste, women have to set their ambitions low. For in Chile, no teeth means no job. Unless, of course, the pinnacle of a woman's aspirations is to be domestic helper. In a country where racial discrimination and lack of equal opportunity are hardly uncommon, women with poor or no teeth have little chance in life. So a campaign is underway to provide thousands of the country's less privileged women with new sets of teeth. "Women are always the hardest hit by poverty and losing their teeth is just one more deprivation for them," explains Maria Christina Yanez, spokeswoman for the national Foundation for the Promotion and Developing of Women (Prodemu), the campaign organisers. "But it's really a tough one because we live in a society where women without a nice smile are really discriminated against," she confesses. It all started when Luisa Duran, wife of President Ricardo Lagos, hit the campaign trail with her husband in the run up to the elections in March 2000. "I came up close to a lot of people and I noticed that this was a real problem. They would lower their heads and avoid making eye-contact while talking. You could tell their toothlessness limited their chances of work and lowered their self-esteem," Duran said. In the early 1980s, General Augusto Pinochet's military regime brought in reforms that put health and dental care beyond the reach of most ordinary people. The unemployed and those without money were issued with cards that gave them free access to health care. But dental care was available to them only in emergencies. In a country where average earnings are around $5,000 a year, replacing a tooth at the going rate of $1,160 was not an option available to any but the richest. Inevitably millions of Chileans have never been to a dentist in their lives. Three million people live on less than $2 a day while many more are living on the legal minimum wage of $175 a month. Even a toothbrush is a luxury for women in this bracket who lose most of their teeth by the time they reach 40, if not before, due to previous neglect and malnutrition. So Prodemu teamed up with Chile's College of Dental Surgeons and the Chilean State Bank to offer women new teeth at prices they could afford. Sophie Arie is the former Editor of Out There and is a correspondent for AFP. (To be concluded) |
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Surgery
of heart and brain TARA Singh (70), who belongs to Ferozepur, was recently admitted with the complaint of chest pain and dizziness at BBC Heart Care, Jalandhar. He had other discomforts too. On investigation, he was found to have blockages in all the three main supply arteries of the heart and more than 90% blockage in both arteries in the brain. This was a critical situation which carried the risk of a stroke and a heart attack, thus endangering his life. The team of surgeons comprising Dr Sunil Sarin, Dr Devapriya Marik, Dr Sarju Ralhan and the anaesthetist, Dr Rajesh Arora, performed a two-stage operation on this patient. In the first stage, the left-side carotid artery supplying the brain was operated upon. The obstructing block was removed and the artery was repaired with the help of a vein from the lower leg. After this, the patient was conscious and there was no damage either to the brain or to the heart. The second stage of the operation was done three days later. It was a combined operation of the arteries of the brain and the heart whereby the blockage in the right carotid artery was removed and the artery was repaired in a similar fashion. Concomitantly, the blockage in the artery supplying the heart was bypassed by a new technique of beating heart surgery commonly called OPCAB. Tara Singh has fully recovered and is moving around. This rare combined operation on the arteries of the brain and the heart reduced the risk of a stroke and a heart attack. By using the technique of beating heart surgery, the blood requirement and the ventilation requirement were decreased. The patient's recovery was fast without any post-operative complication. Dr Sunil Sarin, senior cardiac Surgeon at the institution, said that the combined blockage of arteries making supplies to the heart and both arteries of the brain present the biggest challenge with no set guidelines regarding the management of such patients. It was imperative to repair one artery of the brain at the first stage to protect the brain so that in the second stage the brain and the heart could be operated upon in the same sitting. This combined operation using the new technique of beating heart surgery can be done safely with the reduced risk of neurologic complications and the risk of a heart attack. According to Dr Sarju Ralhan, the stroke is the third most common cause of death following heart disease and cancer. It most commonly happens due to a block in the arteries supplying the brain with its requirements. It has been demonstrated that coronary artery bypass grafting, in association with a significant blockage of the arteries supplying the brain carries 6.7% risk of a stroke. This risk is increased to 15% if both arteries supplying the brain are blocked. To reduce the risk of a stroke in a patient having a blockage of both carotid and coronary arteries, many surgeons have advocated carotid endarterectomy before or simultaneously with bypass surgery. According to Dr Rajesh Arora, cardiac anaesthetist, such patients have to be anaesthetised very carefully so that the heart and the brain are protected. According to Dr Devapriya Marik, the potential reduction in blood pressure during bypass surgery using the heart-lung machine may influence the incidence of neurological events. This may be reduced by beating heart surgery. Multiple procedures such as simultaneous repair, staged repair and reversed-staged repair have been now carefully described. The patients having bilateral carotid artery disease with coronary artery disease, as Tara Singh has, present the biggest challenge of its kind. It is satisfying to note that Tara Singh is doing well. Dr C.S. Pruthi, the Managing Director of BBC Heart Care calls it "an uneventful recovery." Best of luck to the sturdy old Punjabi villager!
K.P.S. |
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Q&A Q What is blood and what are its components? A
Blood is the red fluid which circulates in our body. A normal adult male has about five litres of blood and a female about 4.5 litres. It consists of liquid plasma and the solid cellular part. The cellular component is made up of red blood cells which contain haemoglobin that carries oxygen to the different tissues of the body. White blood cells act as the body's defence force to fight against germs and the platelets repair injury to vessel walls, thus controlling bleeding. Plasma carries nutrition to all tissues in the body. It also contains blood-clotting factors, immunoglobulins and albumin. Q
Why should we donate blood? A Although our body produces enough blood for our requirements, there are situations when blood is not sufficiently available in the body to cope with. This may be in acute conditions of blood loss such as accident, trauma, surgery or in disease states where the body is not producing enough to fulfil the requirements such as anaemias and leukaemias. In these situations, when extra blood is required for the suffering individual, one cannot walk into a shop and buy blood because blood is neither manufactured nor can it be obtained from an animal source for human use. Hence it has to be received as a gift from fellow human beings. Q
Who can donate blood? A Any person more than 17 years of age and less than 65 years of age can donate blood. A male should weigh a minimum of 110 lbs and a female 90lbs. A male donor should have Hb-13.5 gm% or more and a female donor 12.5 gm% or more. All donors must pass the physical and health history examination given prior to blood donation. Q
What precautions are taken during the donation? A A complete aseptic set up is used. Disposable needles and tubes are needed. Q
How much time does donation take? A The actual donation time is just about 10 to 15 minutes. Some more time is required for registration, physical tests and health information. Q
Is the blood donation procedure painful? A It is an absolutely painless procedure. The only time you feel a little pain is when the needle is inserted into your vein. The use of a spray of local anaesthesia can be used at the site of the needle prick. Q
How much blood can one donate at one time? A A male donor can donate around 500 ml and a female donor around 450 ml. Q
How long does it take to build up the blood you have donated? A
The donated volume of blood is replenished within 24 hours and the red blood cells are normal in a few weeks. Q
What happens to the blood you have donated? A Blood is tested and typed for blood groups and also for any unexpected red cell antibodies that may cause problems in the recipient. Screening tests are also performed for the possible evidence of donor infection with the hepatitis virus B and C the human immunodeficiency viruses (HIV) I and II (for AIDS) and syphilis. some labs also look for human T-lymphotropic viruses (HTLV) I and II. Q
What are blood groups and their importance in blood transfusion? A
Blood groups are characters present on the red cells which make them specific. The commonest varieties used are
A, B, AB and O groups and Rh groups. Because of specificity of these blood groups, only compatibly matched blood can be transfused. Q
How is blood stored? A Each unit of blood is normally separated into its components such as plasma, red cells, platelets etc. Red blood cells may be stored under refrigeration for a maximum of 42 days or kept frozen for upto 10 years. Platelets are stored at room temperature and may be kept for a maximum of five days. Fresh plasma is usually kept in a frozen state for up to one year. Cryoprecipitate (the anti-anemophilic factor) is usually made from fresh frozen plasma and may be stored frozen for up to one year. While blood cells, when separated, must be transfused within 24 hours. Q
How is blood used? A Whole blood is mostly used in exchange transfusions for new borns in cases of Rh incompatibility. Packed red cells are used in acute blood loss following accidents trauma or surgery and in cases of chronic anaemia of any origin where sufficient blood is not produced by the body. Platelets are generally used in the patients who bleed from platelet deficiencies as in leukaemias and other forms of cancer. Fresh frozen plasma is used as blood volume expander for the control of bleeding due to the deficiency of clotting factors, for plasma exchange to remove unwanted antibodies, etc. Cryoprecipitate is used for haemophilia cases and granulocytes are used to fight infections. Q
How frequently can one donate blood? A One can donate one unit of blood every three months. Dr Sumitra Dash is Additional Professor of Haematology at the PGI, Chandigarh. She worked as a consultant in haematology and was in charge of the Central Blood Bank at the Salmanya Hospital, Bahrain, from 1991-99. (To be concluded) |
