---> Due Tuesday, June 1, in class <---
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 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.
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. 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?
B. It has been recognized for some time that some patients respond better to certain drugs than others. This has been a mystery and a source of frustration to those who are trying to provide care. We now know that those individuals who fail to respond to certain drugs (e.g. chemotherapy drugs or Prozac) have certain alleles of specific genes that prevents them from responding. This realization raises a number of issues regarding testing and treatment. Determining the best drug to be used in chemotherapy might be facilitated by knowing ahead of time which drug has the best chance of success based on the patient's genetic profile, perhaps as determined through microarray experiments. Similar testing might determine which anti-allergy drug is best or which antidepressant is best.
Should these kinds of tests be required before any drug treatment is undertaken? What if the tests are very expensive? Should the same considerations apply to testing chemotherapy drugs as to less serious situations, such as drugs designed for treatment of allergies or depression? What happens 5-10 years from now when there may be tests available for almost any drug treatment? How does one decide when it is appropriate to test and when not? Are there legal responsibilities? What role (if any) should insurance companies play in this process? Discuss this issue using some (or all) of the questions raised here. Think about the implications of your answer/ideas carefully in trying to decide what should be done and what should not be done.