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Archive for December, 2015


Student_BlogScientific endeavors can be described as nothing short of the proverbial term-‘Playing with fire’. Like fire, it is great potential and hazard rolled into one. But the one strong resemblance that leads me to this comparison is how we learn from it. A child would know not to get too close to his birthday candle once he burns himself. True, we get numerous warnings from our ever-watchful parents but nothing teaches us what the flame does like our first burn. It is true that experiences in the lab help us to learn from our mistakes but how do we avoid such ‘mistakes’? Most of the scientific guidelines we have today are a result of experiences (unfortunately most of them unpleasant ones) from the past. As we work presently under what we may think are ethical practices, we may be unbeknownst to us, writing a chapter about what not to do for the future generations to read and learn from. Simply put, we do not notice our pitfalls till the damage is done. So in science where the stakes are high and there is so much to lose, it does not make sense to sit and wait for the next mistake to happen or for someone to give us a slap on the wrist to learn our lessons. I am not implying that we should develop a God like ability to predict everything that can go wrong overnight. But in the grand scheme of things where we work with methods passed down to us from generations of study and practice, it is very easy to lose one’s voice and sense of right and wrong with the only explanation being ‘um, that’s how its always done and it works so…’.

When we thumb through cases of scientific exploitations or disasters, we often come across people who initially recognized ethical misgivings but failed to bring about changes till it was too late. So what is it that drives the ability to detect AND correct potential ethical issues? I can almost hear everyone that works in a lab go “Ain’t nobody got time for that!” collectively after having read this (At least that’s what I said to myself). Coming back to my question, what is it that is stopping us from going that extra mile to make sure what we are doing is ethically sound and safe? The answer according to me is-Apathy.
Apathy not only distances us away from the cause we are trying to contribute to but also from the ethical foundation from which we started building our study. When names become numbers and subjects become nothing but data points on a graph, ethical issues fade into a dusty old manual nobody looks at anymore. Because numbers are incapable of feelings, right? For example, we are aware of many heart-wrenching problems that we read about in the news, where ‘n’ number of people were left homeless, we sympathize with them and continue on with our morning coffee. But if something similar happens to just one person we personally interact with say a roommate or sibling, we act on the sympathy we feel. A man who has known hunger will be more willing to share his meal. It is an undeniable fact that we act more readily towards causes that are closer to home. Most of us, especially people who work in life sciences are trained to be desensitized to emotional aspects of our study, say pain or distress of our subjects in order to properly carry out our study. It may range from obtaining samples, performing surgery, subjecting them to stress etc. In fact this kind of distancing one’s self from such emotional properties makes sense because I wouldn’t want to get operated on by a sobbing and shaking surgeon.
So where do we stop? Where do we draw the line? What should we question and what should we simply accept? The line between being strong and being completely apathetic is very thin and is a tightrope that scientists constantly attempt to walk on. It is important to keep in mind that being immune to emotional triggers does not necessarily mean being blind to them. We have to be able to relate and feel every emotion that our research may involve. Yes, feel the pain that the mouse or rat or cat or monkey or human in your study is feeling. But do not let that pain make you weak and balk from scientific endeavors. In turn, let that pain make you strong enough to make sure that participation in science is not in vain. Let the pain drive you to do everything that you can to contribute to the cause you work on. Let that pain leave no room for careless mistakes. Let the pain give you courage to stand up and take the lead if you so much as even feel that some may be unethical. Let the pain be the catalyst that takes you from thought to action.

Easy to write about but very hard to practice right? It is the idea that one person cannot bring about change or solve ‘big problems’ that often discourages us from even attempting to even think about bringing about a change in an established system. But like all things that matter, action starts at home. The only way to at least make a dent in solving these monster problems is to start with, what may seem to you, a small effort. “We know only too well that what we are doing is nothing more than a drop in the ocean. But if the drop were not there, the ocean would be missing something” said Mother Teresa. If we believe that apathy causes lack of action then can we not believe that our action can maybe stir empathy in someone else? All great reforms were a chain reaction that at some point of time were just one voice saying ‘this is not right’. So always remember that no action of ours ever goes unanswered (good or bad). Once we lose sight of why we do what we do, it doesn’t matter how good we are or what we do anymore. Keeping this in mind, we learn, we listen, we write, we skip lunches, we speculate, we imagine, we overdose on caffeine, we treat failure as the wisest friend, we feast on every significant p value, we burn the midnight oil and wake up again the next day and gladly do it all over again because we love what we do! Not only shall we try to walk that tightrope but we shall waltz across it my friend!

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Student_BlogMariam-Webster dictionary defines ‘cognition’ as ‘conscious mental activities: the activities of thinking, understanding, learning, and remembering’. So, we can say that it is related to memory and attention. Most of us take tea, coffee to keep ourselves active and working. Coffee is regarded as one of the most consumed drinks all over the world and the most popular reason is that it keeps you alert as it contains caffeine which is a stimulant. What if there was something which was better in keeping you alert and increasing your cognition? To what extent would you compromise to get it? Do you think that you should be allowed to enhance your cognition by taking that “something”? Should everybody else be allowed? These are not simple questions to answer.

Few months back I came to know about these ‘cognition enhancing drugs’ through an article. I quickly read about them and came to know that nowadays there are several drug companies that manufacture these drugs and many people take these drugs in a regular basis as a part of supplements in their diet. I read all the reviews people had written about these drugs and was quiet curious to feel the effects on myself, so I could not resist from ordering the free trial from one of the companies. I started using the pills last week and now I’ve started to feel the change as well. Did I do a right thing by using those ‘cognition enhancing drugs’?

People having attention problems like attention deficit hyperactive disorder (ADHD), memory problems like Alzheimer’s and others having similar problems are the original targets for these drugs but because of unclear and lenient law for drugs like these normal people also take these drugs to enhance their cognitive ability. These drugs act on the nerves and the neuro-transmitters. Based on the type of drug, can increase memory, increase attention or keep alert. Some of the commonly used pharmacological cognitive enhancers are: Donepegil, Provigil (modafinil), Ritalin (methylphenidate) etc.

There are studies (Teter CJ et al, McCabSE et al) which show that more than 8.5% of all the US population has at least tried these drugs once in their lifetime and among the students the figure rises to more than 25%. Not only students, studies have shown that large number people from other areas also take these drugs to keep themselves going. The number of people taking these drugs is only going to increase in the days to come when competition will be tougher than what it is now. Some people support the availability of these drugs to the normal people and some oppose. Both of these kinds of people have their own arguments. The people who oppose the use of these drugs believe that it is against the law of the nature. They consider this as a cheating and argue that one should always respect other’s talent and ability and try not to level off everyone’s cognition which they describe as devaluation of knowledge. But, the people who

support the use of these drugs have different opinions. They argue that discovering new things and implementing them for our own benefit can’t be against nature. Moving forward, making discoveries and using them for some more discoveries to make lives easier are in fact nature’s law. They believe that professionals like doctors, engineers and militants would work more efficiently and effectively and would we not want that? The opposing group mentions that treatment is different than enhancement and we should only limit the usage of these drugs to treatment and not as enhancers. But, the supporters of these drugs have a different opinion; they compare these drugs with the vaccines which are also not used as a part of treatment but are a type of enhancer.

Having said that, what we should know is that these enhancers are drugs and like all the other drugs they also have side-effects. These drugs also require favorable conditions to work. We should think about the dose, age of the person using the drug and long term consequences as well. These drugs have different pharmacokinetics and pharmacodynamics than caffeine, so we cannot directly compare these with coffee sipping. Well, this is my thought. You may have a different opinion.

No doubt, there are benefits of using these drugs but there are still no any proofs that these drugs are very safe and can be made available to all the people. Jonsen et al have formed a model to analyze the factors that a physician must consider while prescribing these drugs to the normal. The model is known as the “four box model” and the four factors considered are: medical indications, quality of life / beneficence, patient preferences, and contextual factors. The balanced view according to most of the intellectuals is that these drugs should be made available to people with some restrictions for now. There are studies (Sahakian & Morein-Zamir, 2010) that have shown that the cognition can even worsen because of these drugs, so until and unless these drugs are declared safe they should only be made available for the needy and not for all the general public. There should be a separate regulating body to overview the issues related to these drugs, be it FDA or some other organizations. Later on, when we know enough about the effects, side-effects, long term effects and everything else about these drugs then I think we should leave the decision to individuals whether to take the drugs or not.

 

References:

Substance abuse and mental health services administration (SAMHSA), Results from the 2008 National Survey on Drug Use and Health: National Findings (HHS Publication No. SMA 09-4434), 2009.

Teter CJ, McCabe SE, LaGrange K, et al. (2006) Illicit use of specific prescription stimulants among college students: prevalence, motives, and routes of administration. Pharmacotherapy 26: 1501-1510.

Rose, S.P.R. (2002). “Smart Drugs”: do they work? Are they ethical? Will they be legal? Nature Reviews Neuroscience, 3, 975-979.

Hall, S. S. (2003). The quest for a smart pill. Scientific American, 289(3), 54-65.

Greely H, Sahakian B, Harris J, et al. (2008) Towards responsible use of cognitive-enhancing drugs by the healthy. Nature 456: 702-705.

DeSantis AD, Webb EM, Noar SM (2008) Illicit use of prescription ADHD medications on a college campus: a multimethodological approach. J Am Coll Health 57: 315-24.

Jonsen A, Siegler M, Winslade W (2010) Clinical Ethics: a practical approach to ethical decisions in clinical medicine, 7th eds. New York: McGraw-Hill, 2002.

Wilens TE, Adler LA, Adams J, et al. (2008) Misuse and Diversion of Stimulants Prescribed for ADHD : A Systematic Review of the Literature. J Am Acad Child Adolesc Psychiatry 47: 21-31.

Thomas LM, Mccabe SE, Cranford JA, et al. (2011) Misuse of Prescribed Stimulant Medication for ADHD and Associated Patterns of Substance Use : Preliminary Analysis Among College Students. J Pharm Pract 24: 551-560.

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It is not uncommon if we ask any grown up in this part of the world “why is fluoride important” and get the answer that it is essential for tooth health, more stress being laid upon the prevention of dental caries with its use. So again it is not surprising to see people apt for fluoridated toothpaste when it comes to a routine procedure of brushing the teeth. It is not even surprising to see dentists advocate different toothpastes hailing the amount of fluoride they contain or how fluoridated toothpaste helps prevent tooth decay. However, what is surprising is the fact that most of the drinking water supplied by the government to the common households in the form of tap water is fluoridated. Are we able to choose whether to use fluoridated toothpaste or not? We sure are. But are we free enough to opt for non-fluoridated water in the taps in our households? Hardly is the case so. Why would we even want to opt for non-fluoridated water when the water supply is trying to make sure we consume this metal in one way or the other? What is the truth? Is fluoride necessary? Or on the other side, is it dangerous? My aim is not to raise a controversy but to bring forth little insight that I have gained through some of the recent studies done in this area. While the proponents of fluoridation claim that water fluoridation in recommended dose aids in reduction of dental caries, opponents argue that not only is water fluoridation a violation of individual freedom, but is totally unnecessary, risky and accompanied by several health hazards backed up by numerous epidemiological and lab studies.

Firstly let’s address the cause of the issue. According to the handbook ‘Clinical Toxicology of Commercial Products’, fluoride is more poisonous than lead and just slightly less poisonous than arsenic. Fluoride is a toxic drug, the dangers of which far outweigh any benefit it might have to one’s teeth. In fact, any anti-cavity benefit one may reap from fluoride comes from topical application. The labeling in the toothpaste says “dangerous if swallowed” because of the toxic effects of fluoride. The practice of fluoridation of drinking water began in 1950 when the U.S. Public Health Service first endorsed fluoridation to reduce the occurrence of dental caries in the communities. It is one of the longest running debates in the history of public health. But is fluoride really dangerous?

The study by Bassin E.B. found association between fluoride exposure in drinking water during childhood and the incidence of osteosarcoma among males.[1] A number of other cancer studies have found link between exposure to fluoride through drinking water and incidence of cancers like osteosarcoma and carcinogen induced cell transformation.[2],[3],[4],[5] Several other studies linked increased

incidence of hip fractures to fluoridation of water.[6],[7] Yet other studies have pointed out the deficiency of iodine resulting in hypothyroidism and/or hyperthyroidism in consumers of fluoridated water/environment. In experimental rats, fluoride exposure via drinking water was found to cause neurotoxicity and intelligence impairment.[8],[9] They found adverse effect of high fluoride exposure on children’s neurodevelopment as well as sex- and dose-specific behavioral deficits with a common pattern in rats. Advocates of fluoridation counter that these animal studies are invalid because high doses of fluoride were used. However, it takes 5-20 times more fluoride to reach the same plasma levels in rats as in humans (Sawan 2010). After reviewing 27 different human IQ studies, a team of Harvard scientists concluded that fluoride’s effect on the young brain should now be a ‘high research priority’ (Choi, et al, 2012). While the American Dental Association claims the overall reduction in the incidence of dental caries in the last few decades due to water fluoridation, similar reduction in dental caries have been observed in countries and areas where there is no water fluoridation.[10],[11],[12] The dramatic decline in dental caries witnessed in different parts of the world has occurred without the dental profession being fully able to explain the relative role of fluoride in this process and it is not surprising taking into account the fact that dental caries is not the result of fluoride deficiency.[13] Thus, in addition to the well documented toxic effects of fluoride to the human body, very small concentration (1 ppm), usually found in artificially fluoridated water, can inhibit enzyme systems, damage the immune system, contribute to calcification of soft tissues, worsen arthritis and also cause dental fluorosis in children. The evidence is there to support the claim that fluoridation of water has no role in preventing dental caries.

I was reminded of the case of lead presented in the ethics class. Voices are being raised against water fluoridation as well incorporation of fluoride in other products but the industry is very powerful. What makes the case of water fluoridation so distinguished and different from lead or any other toxic chemical introduced to the human community is that there is not even consent in part of the consumer. It looks like it is being force fed through our very basic need and right of clean drinking water. Although there are a number of different sources through which fluoride gets into our body (smoking, fluoridated toothpaste, shower with fluoridated water especially warm shower, canned foods, mechanically deboned meat), fluoridated (both tap and mineral) drinking water remains the major source. We as consumer have right to proper and unbiased information in any product that we consume. Whatever be the controversy and whatever level it be at, we need to feel safe in our own day to day environment. If there is even as little as a speck of truth in the findings of all those studies, consumers need the right to fluoride free life.

 

 

 

1 Age-specific fluoride exposure in drinking water and osteosarcoma (United States);Cancer Causes Control 2006 May;17(4):421-8.

2 Carcinogenesis, Vol. 9, pp. 2279-2284 (1988)

3 Fluoride Vol. 26, pp. 83-96 (1992) Fluoride is an equivocal carcinogen

4 A Brief Report on the Association of Drinking Water Fluoridation and the Incidence of Osteosarcoma among Young Males, New Jersey Department of Health, November 1992

5 Blakey K, Feltbower RG, Parslow RC, et al. Is fluoride a risk factor for bone cancer? Small area analysis of osteosarcoma and Ewing sarcoma diagnosed among 0-49-year-olds in Great Britain, 1980-2005. Int J Epidemiol. 2014;43:224–234.

6 Danielson C, Lyon IL, Egger M, and Goodenough GK. Hip fractures and fluoridation in Utah’s elderly population. JAMA Vol. 268, pp. 746-748 (1992)

7 Fluoride in drinking water and risk of hip fracture in the UK: a case-control study. Lancet 2000 Jan 22;355(9200):265-9.

8 Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis

9 Neurotoxicity of sodium fluoride in rats;Neurotoxicology and Teratology Volume 17, Issue 2, March–April 1995, Pages 169–177

10 Cheng KK et al. (2007) Adding fluoride to water supplies. British Medical Journal 335 (7622): 6999-702

11 Pizzo G, et al. (2007). Community water fluoridation and caries prevention: a critical review. Clinical Oral Investigations 11(3): 189-93 12 Neurath C. (2005). Tooth decay trends for

12 year olds in nonfluoridated and fluoridated countries. Fluoride 38: 324-325

13 Aoba T, Fejerskov O. (2002). Dental Fluorosis: chemistry and biology. Critical Review of Oral Biology and Medicine 13: 155-70

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