Final Exam, Bio 4, 00W

Rules:

In compliance with the Dartmouth honor principle, all the work you hand in on this exam is to be your own.

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. With the increasing number of genes that have been identified comes an increased responsibility to use genetic information responsibly. Privacy of one’s genetic profile is important, yet there might be instances in which the genetic information about a particular individual can be used for greater public good. Here is a hypothetical case for you to consider. Let’s assume that a gene is discovered that gives an individual carrying that gene a very high risk of having a severe stroke. A proposal is made to institute a law specifying that all people having positions where the safety of others is involved must be tested for this “gene”. For example, airline pilots who hold the lives of all passengers in their hands, would have to be tested.

Discuss the issues surrounding this kind of decision. Is it right to demand testing if the lives of others are at risk? Where can a line be drawn in determining what professions should be tested? Is it never correct to demand testing?

B. When patients are treated with drugs, the drugs work correctly in the vast majority of cases. However, in a small minority of cases the drug fails to work or, even worse, introduce serious new complications for the patient. An example is the drug Prozac which is used for patients suffering from stress related disorders. In a very small minority of the cases, Prozac actually builds up to toxic levels in the body and does not do the job expected of it. Recent research indicates that this difference in response to drugs might be the result of differences in the genetic makeup of the patients. Some patients metabolize the drug “normally” allowing the drug to perform appropriately, while other patients might metabolize the drug differently, causing the drug to have no effect or even an adverse effect. Because of this recent research, pharmaceutical companies are considering the development of special genetic tests to evaluate which patients will respond appropriately to various drug treatments. This is of particular importance for chemotherapy treatments in which a patient might stay alive long enough for a single treatment - how can it be decided which of several alternative chemotherapy treatments will be most effective in treating this individual patient?

Should pharmaceutical companies be forced to develop these tests (it costs lots of money to do so)? What are the ethical and legal ramifications of this new field of “pharmacogenomics”? Should patients ALWAYS have these tests done before receiving ANY drug treatment? What is the doctor’s responsibility in prescribing the tests? What if the tests are very expensive to perform - how can one decide which are the appropriate circumstances under which testing should be performed?