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VIROTHERAPY: THE ETHICS AND FUTURE
Bradley Gobin ([email protected])
INTRODUCTION: ETHICS AND
TREATMENT
Naming someone who has been impacted by cancer is far
too easy a task for any person to do. Cancer is possibly the
most dangerous and deadly medical condition that faces the
world today. With 12.7 million people diagnosed with cancer
every year and 7.6 million deaths it is safe to say that it is very
large medical and engineering problem [1]. In the United
States alone the National Cancer Institute spends over $4.9
billion every year on just research for a cure, or improvements
in the treatment of cancer [2]. Even with this huge amount of
money spent on cancer treatment, the treatments have not
been making large and greatly effective advancements. This
is why I believe that oncolytic viruses and the use of
virotherapy is one of the keys to unlocking a future cancer
treatment that is much more effective that the methods used
currently. This type of treatment is important to me because
this is what I plan to research later in life and I greatly support
this method. I think that it is not very well known and needs
to be focused on more as a legitimate cure for cancer.
Virotherapy has to be done in an ethical way according to the
set engineering standards so that it can be both effective and
safe. The ethics of research is almost as important as the
research itself.
With any medical or engineering research there are very
strict guidelines to follow to keep the procedure ethical. These
guidelines or canons for this particular topic are set by the
National Society of Professional Engineers (NSPE) and the
Biomedical Engineering Society (BMES). These canons are
set to uphold the integrity and morality of all professional
engineers. If these canons were not in place, then the
engineers would not be held to any standard of ethics. This
scenario would then allow them to cut corners in order to
maximize profit even if it was at the expense of the welfare of
someone or something else. An example that will be
discussed in greater detail would be a case where a company
is trying to get a new virotherapy treatment out onto the
market quickly to cut cost of production and maximize its
profits. This might be done by cutting corners and not
analyzing information completely. This may also cause the
company to modify its data and make it appear that this
treatment is better and more complete than it actually is.
The canons that tie to this specific example of research
from the NSPE are “Engineers shall hold paramount the
safety, health, and welfare of the public. If engineers'
judgment is overruled under circumstances that endanger life
or property, they shall notify their employer or client and such
other authority as may be appropriate.” And “Engineers shall
University of Pittsburgh, Swanson School of Engineering
2013-10-29
be objective and truthful in professional reports, statements,
or testimony. They shall include all relevant and pertinent
information in such reports, statements, or testimony, which
should bear the date indicating when it was current. [3]” The
first canon requires that all engineers keep the safety and
health of the public as the main guideline of what they are
trying to accomplish, and to use their own judgment as to
when something is not safe or the best option for the welfare
of the public. The second canon indicates with that the
information that is reported should be kept truthful and not
altered in an attempt to better the image of the research.
The BMES canon that applies to this specific case is very
similar to the NSPE canons stated previously. The BMES
canon is “Biomedical engineers involved in research shall
comply fully with legal, ethical, institutional, governmental,
and other applicable research guidelines, respecting the rights
of and exercising the responsibilities to colleagues, human
and animal subjects, and the scientific and general public. [4]”
This canon deals with the engineer being held responsible for
his actions dealing with his research and subjects, and to be
certain that choices are ethical and right and ensure the highest
quality of care. As said by the world health organization “The
critical role of ethical practices in health care and research is
not only well recognized to ensure equity in health care and
research, but also is important to protect individuals and
communities from unnecessary risks and harm. [5]”
These are just a few of the canons of ethical engineering
that are applicable to the case mentioned earlier with a
business trying to get a new virotherapy treatment out on the
market as fast as possible by trying to cut corners. Engineers
and we who plan to become engineers need to be aware of
these canons and how they apply to what we do.
WHY IS VIROTHERAPY EVEN
IMPORTANT
Now before we go into any more of the ethical issues of
oncolytic viruses and virotherapy we need to point out why it
is important to be worrying about being ethical to begin with.
HOW VIROTHERAPY WORKS
First off what is virotherapy and oncolytic viruses?
Virotherapy is the use of engineered oncolytic viruses to treat
cancer. This is done by taking normal viruses that occur
naturally and changing them to do what the engineer wants
them to do. A normal virus infects the body and goes
throughout the body finding cells that have a specific genetic
make-up that matches that on the virus. Once a virus finds the
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cell with this make-up, it injects a new genetic code that
causes the cell basically to turn into a virus factory. This in
turn destroys the cell, but the process makes large amounts of
viruses that can then go out and find a new cell to infect, and
start the cycle over again. The engineered oncolytic viruses
do this exact same thing, but they only target and replicate in
the cancerous tumor cells [6]. This destroys only the
cancerous cells, while leaving all the normal body cells
completely unharmed.
Since these oncolytic viruses do not cause any harm to the
healthy cells, the body then does not filter the oncolytic
viruses as it would for normal viruses. This and because the
tumors have no immune system allows the viruses to function
with little interruption [7]. Since no oncolytic viruses are
being removed, they are able to grow exponentially, and
destroy more cancer cells as time goes on [8]. When there is
a high concentration of the oncolytic viruses in one spot, they
then spread out through the person and search for any
cancerous cells that may have metastasized to other parts of
the body.
Once enough of the cancerous cells die off the body is then
able to combat the tumor itself. The body can detect the
remains of the cancer cells, and then is able to produce cells
in the immune system that are better able to combat the
current cancer and cancer that may form later on in the
person’s life [9].
radiation. The healthy body cells do not develop this
resistance, and are killed at a faster and faster rate.
BACK TO THE ETHICS
Now that there is a basic understanding of what
virotherapy is, how does this tie into the ethics mentioned
earlier?
Say that a company is researching a new way to produce
these oncolytic viruses and wants to get it onto the market as
fast as possible. In order to do this they speed up the process
which may causes them to skip or maybe not go as deep into
a part of the research. This could be putting the safety of the
people using this treatment in jeopardy due to unforeseen
flaws or complications.
This violates all of the ethical canons mentioned earlier.
The first canon from the NSPE are “Engineers shall hold
paramount the safety, health, and welfare of the public. If
engineers' judgment is overruled under circumstances that
endanger life or property, they shall notify their employer or
client and such other authority as may be appropriate. [3]” An
example of using professional judgment of ethics comes from
the recent NSA information leak and Edward Snowden, a
computer engineer working for the NSA. In this case
Snowden used his judgment that what he was doing was
morally wrong, so he let the world know what was going on
in order to hold the government responsible. [10] That point
is more difficult than it sounds when it comes to medical
fields, since nearly all medical treatments are weighing
potential risks and benefits. The people that are given the
treatment may view the potential benefits to outweigh the
risks so they will want to go forward with the treatment. What
can a doctor do when they think a treatment is a bad idea, but
the person receiving the treatment wants it? [11] This means
that the engineer’s main responsibility is to make sure that
whatever they are making is, to the best of their knowledge,
safe to the public. If the engineer feels that it is not safe, he or
she should then notify whomever the product or in this case
treatment, is intended for that research may not be completed
and continued research is needed.
The next canon that would be violated in this situation is
the NSPE canon of “Engineers shall be objective and truthful
in professional reports, statements, or testimony. They shall
include all relevant and pertinent information in such reports,
statements, or testimony, which should bear the date
indicating when it was current. [3]” This applies because all
too often medical reports are biased to make it seem that a
new type of treatment is a perfect solution and does not have
many negatives. This would happen in the situation of a
company trying to get the new virotherapy treatment out on
the market because they may not understand all of the possible
negatives, and may hide some of the known negatives so that
it appears to be much better than it is so more people will use
it over other options. Most people would see the side effects
VIROTHERAPY COMPARED TO OTHER
TREATMENTS
Why should a person even bother with this treatment when
there are many other treatments out there that are much more
popular?
Most people that are diagnosed with cancer are put on
regimens of chemotherapy and radiation therapy. Ask anyone
that has been put through these treatments and they will tell
you that it one of the worst things that a person can imagine.
They sometimes even end up in worse condition after the
treatment than before the treatment.
These treatments use the same things that cause cancer to
try to cure it. Chemotherapy uses highly toxic chemicals to
try to kill the cancer cells and it has been proven that cancer
is caused by unnatural and harmful chemicals. Radiation
therapy uses focused radiation to try to kill the cancer cells,
and radiation has been shown to cause all types of cancer.
Using the same things to cure cancer that can cause cancer has
been shown to possibly cause new cancer to form in the
person.
Neither chemo nor radiation therapy can distinguish
between healthy body cells and cancerous cells, which results
in losing just as many healthy cells as the cancerous cells. This
leaves the person very weak and unable to fight the cancer or
any other diseases that they encounter.
The cancerous cells have also been shown to develop a
resistance to the treatments, which means that each new tumor
growth requires stronger and stronger regimens of chemo or
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that are published by the company and expect that those were
all of the side effects and none were being covered up.
It seems like medical companies would have learned by
now not do this in modern times, but it actually happens all
too often. A recent case was in 2010 when a mumps vaccine
that was used for a short period of time had a 97% infection
rate [12]. This means that 97% of the people that were given
the vaccine then developed full strength mumps. The
company that made the vaccine later admitted to not fully
following guidelines and simply trying to fill the demand.
They also admitted to hiding possible side effects and
problems with the vaccine. There was little thought about the
safety of the people that the vaccine was intended for.
The canon that deals with this situation the best is the one
that is set by the Biomedical Engineering Society, which
states “Biomedical engineers involved in research shall:
Comply fully with legal, ethical, institutional, governmental,
and other applicable research guidelines, respecting the rights
of and exercising the responsibilities to colleagues, human
and animal subjects, and the scientific and general public. [4]”
This ethical canon is very similar to the first one stated by the
NSPE but it adds the part of respecting the rights of the human
subjects. It would be a violation of human rights to give
patients a treatment about which not everything is known, and
essentially having the person be the unwilling test subject for
the treatment.
It would be hard to say what could be done in the situation
above. One thing would be simply to slow things down and
try to go more in-depth to fully understand the situation of the
research. The person running the research may not want to,
but it is what is needed. Yes, this would mean that the
company may not get the virotherapy treatment out as quickly
as they want to and they may lose out on some money in the
short term. These are the things that need to be done in order
to keep the patients safe and make sure that the engineers
follow the standard of ethics that all engineers have to follow.
REFERENCES
[1] (2013). “World Cancer Day” Center for Disease Control
and
Prevention.
(Online
Article).
http://www.cdc.gov/cancer/dcpc/resources/features/WorldCa
ncerDay/
[2] (2013). “Cancer Research Funding”. National Cancer
Institute.
(Online
Article).
http://www.cancer.gov/cancertopics/factsheet/NCI/researchfunding
[3] (1993) “NSPE Code of Ethics for Engineers” National
Society for Professional Engineers. (Online Article).
http://www.nspe.org/Ethics/CodeofEthics/index.html
[4] (2004). “Biomedical Engineering Society Code of Ethics”
Biomedical Engineering Society. (online article).
http://bmes.org/files/2004%20Approved%20%20Code%20o
f%20Ethics(2).pdf
[5] (2011). “Bioethics” Eastern Mediterranean Health
Journal.
(Online
Article).
http://go.galegroup.com/ps/i.do?action=interpret&id=GALE
%7CA271883780&v=2.1&u=upitt_main&it=r&p=AONE&
sw=w&authCount=1
[6] M. Zeyaulla. (2012) “Oncolytic Viruses in the Treatment
of Cancer: A Review of Current Strategies” Pathology and
Oncology
Research.
(Online
Article).
http://link.springer.com/article/10.1007%2Fs12253-0129548-2
[7] A. Katsnelson. (2011) “Engineered Viruses Selectively
Kill Cancer Cells” MIT Technology Review. (Online Article).
http://www.technologyreview.com/news/425293/engineered
-viruses-selectively-kill-cancer-cells/
[8] R. Auer. (2012) “Oncolytic Viruses: Smart Therapeutic
for Smart Cancers”. Future Oncology. (Online Report).
http://go.galegroup.com/ps/i.do?id=GALE%7CA284022433
&v=2.1&u=upitt_main&it=r&p=AONE&sw=w
[9] N. Seppa. (2013). “Virus Used as Cancer Killer:
Treatment Triggers Immune System to Kill Malignancies”
Science
News.
(Online
Article).
http://go.galegroup.com/ps/i.do?id=GALE%7CA323973723
&v=2.1&u=upitt_main&it=r&p=AONE&sw=w
[10] G. Greenwald. (2013). “Edward Snowden: The
Whistleblower behind the NSA Surveillance Revelations”
The
Guardian.
(Online
Article).
http://www.theguardian.com/world/2013/jun/09/edwardsnowden-nsa-whistleblower-surveillance
[11] P. Heift. (2012) “Am I Obligated to Give Therapy
Against my Better Judgment” UBM Medica. (Online Article)
http://rt4rf9qn2y.search.serialssolutions.com/?ctx_ver=Z39.
88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF8&rfr_id=info:sid/summon.serialssolutions.com&rft_val_fm
t=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=
Consultations+IN+Ethics&rft.jtitle=Oncology&rft.au=Paul+
R+Helft&rft.date=2012-1001&rft.pub=United+Business+Media+LLC&rft.issn=0890-
WHY ETHICAL STANDARDS ARE NEEDED
Just say there were no set standard of ethics to follow for
engineers. What would happen? Well one thing is that there
would be no way to keep the engineers that are making things
in check. This means that whatever they make, may not be as
safe or as good as it could be. Purchasing a product or having
a treatment done would just be on the faith that the one
engineer had an ethical approach to his or her work.
ETHICS FOR THE FUTURE
Ethics need to be taught to all engineers and future
engineers. The world needs engineers and people to invent
new things, but only if the things that they are making and the
process by which they are made, are held to high ethical
standards. All of us who plan to be engineers need to
understand that the approach for our research needs to be done
keeping the welfare of others as the number one goal.
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Bradley Gobin
9091&rft.volume=26&rft.issue=10&rft.spage=995&rft.exter
nalDocID=2793990541&paramdict=en-US
[12] J. Auferheide. (2013) “17 Examples of Admitted
Vaccine
Failures”
VacTruth.
(Online
Article).
http://vactruth.com/2013/02/23/17-examples-ofvaccine-failure/
ADDITIONAL SOURCES
D. Tolmach. (2013) “Chemotherapy” The Journal of the
American
Medical
Association.
(Online
Article).
http://rt4rf9qn2y.search.serialssolutions.com/?ctx_ver=Z39.
88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF8&rfr_id=info:sid/summon.serialssolutions.com&rft_val_fm
t=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=
Chemotherapy&rft.jtitle=JAMA&rft.au=Deborah+Tolmach
+Sugerman&rft.date=2013-0710&rft.pub=American+Medical+Association&rft.issn=0098
-7484&rft.eissn=15383598&rft.volume=310&rft.issue=2&rft.spage=218&rft.exter
nalDocID=3025220201&paramdict=en-US
ACKNOWLEDGEMENTS
I would like to thank the other members of my engineering
group, Eric Rizzo and Ami Hirata for helping with this essay
and keeping me motivated.
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