Final Exam, Bio 4, 98W

Rules:

In compliance with the Dartmouth honor principle, all the work you hand in on this exam is to be your own. Please remember to be precise in your wording -- scientific descriptions rely on accurate use of specific terms. Also, try to keep your answers concise. If you can say something briefly there is no need to create a lengthy answer just to fill up space.

For this exam, please choose one of the following questions. Do not answer more than one question. Your answer should be a maximum of 6 printed pages (this is a limit not a goal) -- anything beyond six pages will be ignored. A page is defined as an 8.5" x 11" sheet with one inch margins. The font should be 12 point Times and text should be double spaced. The bibliography (and any figures you might have) should be at the end of the paper and will not count towards the page limit. You can cite references in the body of the text using numbers.

This exam is open book. You can use your notes, the web, the library, newspapers, etc. You cannot talk to others about your answer, though -- the work you hand in must be entirely your own.

There is a defined format to be followed for the paper.

Good luck.

Questions (choose ONE):

Please be sure to state the question (A or B) you are answering and be sure to provide a title for your essay. You should address the general issues raised and not necessarily focus on answering the specific items that are mentioned (although you certainly can address them). They are provided to help you understand some of the issues that need to be addressed. The question you should address is in red.

A. Apolipoprotein E (APOE) tests may indicate that an individual with two copies of one form (allele e4) of the gene has a 5-30 times the average risk of developing Alzheimer disease. Managers of the Silver Years Retirement Community near Pines Bluff decide to require the test for entrance. They argue that people with Alzheimer disease not only cost the retirement community more in terms of nursing care (a cost that is spread among members through high entrance fees), but also have a demoralizing effect on the general atmosphere, thereby discouraging new entrants. In most states, retirement communities may set their own health standards for entrance. The APOE test, however, does not provide a certainty that someone will develop Alzheimer disease; many people with two APOE variants remain normal. Using the test will screen out many persons who are genetically unfortunate although they will never develop the disease, but will improve the community's risk pool. If most retirement communities institute testing, these people will be penalized for having the "wrong" genes. Even those who would actually develop Alzheimer disease may die of other causes before they show the first Alzheimer symptoms.

Ann and Carl Bradley of Pines Bluff, both nearing 70 years of age, had been planning to seek entrance into the Silver Years Retirement Community. They had been discussing this for some time with each other and with their friends at the local church. Both agree to take the apo E test. Ann's profile is acceptable (alleles 3/2) but Carl's indicates a poor prognosis (4/4), and they are informed that as a couple they would not be granted admission. Both are devastated, and strongly suspect that their friends will know the reason why they will not be carrying out their much-discussed plans. Carl has become severely depressed, and there are strong tensions developing in the marriage.

Is it right to exclude people on the basis of a genetic test, in the absence of symptoms or of certainty about whether, and when, they will develop the disease? On the other hand, is it right to make everyone in the community pay the high costs of nursing care for a few? Is it right that susceptibility tests such as these may be used with significant negative impacts on individuals and families, including their privacy? Discuss some of the moral, ethical, and regulatory issues raised by this kind of testing. What do you think is the right way to proceed? (this case study was from the National Human Genome research Institute)

B. Each year, 300-500 million people become ill with malaria and several million die. Most who die are children under five. 200-300 children die from malaria each hour. Pregnant women and non-immune adults are also severely affected. Families and communities suffer worldwide, as do national and global economies. Research is under way towards developing a malaria vaccine. Malaria often strikes people in remote areas of third world countries where it is difficult to receive proper medical care. It is often difficult to deliver vaccines that need to be refrigerated along with the sterile needles and other medical supplies. One approach being discussed is to create a transgenic fruit (bananas are often talked about) that contains a gene which would make a surface protein from the malaria parasite (i.e. - a malaria antigen). Individuals eating this transgenic banana would ingest the protein and would synthesize antibodies to the protein. In the future, when the individual is exposed to a malaria parasite, they would already have a built in immunity and not succumb to the disease. This approach eliminates the need for refrigeration and a meticulous sterile environment. However, it raises some other questions.

Disregarding the economic questions of generating the vaccine and delivering it, do developed countries have a moral obligation to provide the vaccine if they can? It is generally accepted practice for a doctor to discuss with a patient his or her medical condition and possible treatment options. How can this discussion be handled with individuals who probably have never heard of the concept of cloning (or in many cases of vaccination)? Finally, if the procedure is implemented and is successful, the populations will expand -- which might lead to serious starvation problems. Is it morally or ethically correct to save lives with a vaccine, only to create a situation in which many individuals will suffer starvation?