Healthcare Controversies: Stem Cells & Genetic Testing

Controversy In Health Care

• Health care is always surrounded by controversial issues because people and their requirements are complex.
• Controversial issues often gain media attention, particularly during presidential elections or when new scientific discoveries are revealed.

Stem Cell Research

• Stem cell research was deemed quite controversial, specifically when using embryonic stem cells and public funding, but recent advancements in stem cell research have lessened the necessity for human embryos.
• Scientists discovered a method to stimulate an individual's cells to act like stem cells, which reduces the need for donated stem cells.

Genetic Testing and Engineering

• In 2003, the Human Genome Project successfully mapped the human DNA sequence.

DNA

• DNA, or deoxyribonucleic acid, is the small code found in all human cells, which determines our characteristics.
• Genetic testing allows scientists to complete for a variety of purposes such as medical, forensic and legal purposes.
• Genetic testing can determine the possibility of developing certain disorders and diseases.

Burlington Northern Santa Fe Railroad

• In 2001, Burlington Northern Santa Fe Railroad settled out of court by agreeing to stop secret genetic testing of its employees.
• The company began using blood samples to screen for predisposition to carpal tunnel syndrome.
• Having a predisposition for cancer does not mean a patient will actually develop that cancer.

BRCA

• BRCA is an acronym that stands for Breast Cancer susceptibility gene.
• Normally BRCA is suppose to prevent the development of cancer cells.
• Those with BRCA mutations are not able to suppress the development of tumors, which can lead to breast or ovarian cancer.

Genetic Information Nondiscrimination Act of 2008

• Employers are prohibited from using genetic information to discriminate against employees or applicants.
• Healthcare organizations cannot share genetic information to any third party without patient consent.

Eugenics

• Eugenics is the effort to improve the genetic makeup of a population.
• Nazi Germany used this philosophy to justify medical experimentation and even extermination of non-white and Jewish citizens.
• Laws requiring sterilization of patients classified as “mentally ill" existed in some states and were eventually overturned, but not before thousands of patients were sterilized.

Cloning

• Cloning is the copying of cells to create copies with similar genetic content and is generally acceptable for research purposes only.
• The concept of cloning life forms is deemed too controversial currently.

Organ Allocation

• The Uniform Anatomical Gift Act, passed in 1968, allows anyone 18 years of age or older to donate body parts for the purpose of transplantation after his or her death.
• The National Organ Transplant Act was passed in 1984 and created a network for registering and matching organ donor recipients.
• The Organ Procurement and Transplantation Network (OPTN) is a private, nonprofit organization that contracts with the federal government.
• The United Network for Organ Sharing (UNOS) was awarded the contract in 1986 and focuses on sharing organs from deceased donors in an efficient and equitable manner.

Organ Donation

• Donation of organs have come exclusively from deceased or living patients who donate the organs voluntarily without financial benefit.
• There are significantly more people waiting for donated organs than there are organs available.
• Singapore pays donors nearly $36,000 per organ, and Iran has eliminated its waiting list for kidney transplants by paying donors.
• In Israel, if you are not designated as an organ donor, you are placed at the bottom of the recipient list should you need one yourself. Some countries, such as Great Britain, operate under presumed consent.
• UNOS maintains a computer database of patients waiting for organ transplantation
• As of August 2017, 116,000 men, women, and children are on the national transplant waiting list.
• In 2016, 33,611 transplants were performed.
• 20 people die each day waiting for a transplant.
• 95% of U.S. adults support organ donation, but only 54% are signed up as donors.

The Conscience Clause

• The conscience clause, a federal regulatory law, protects healthcare professionals from discrimination if they refuse to participate in sterilization procedures or abortions, due to religious or personal objections.
• The Obama administration repealed the old law and replaced with new one in January 2012.
• The new law only protects healthcare professionals who wish to avoid assisting directly with sterilization and abortion procedures

Catherina Cenzon-DeCarlo

• In 2009, Catherina Cenzon-DeCarlo, a devout catholic working as an operating room nurse at Mount Sinai Hospital was asked to help with an abortion procedure.
• Original interpretation of the conscience clause allowed pharmacists to refuse to fill prescriptions used to prevent or terminate pregnancies.

Affordable Care Act (ACA)

• The ACA originally required all insurance policies to provide contraception to patients at low or zero cost.
• In King v. Burwell, the Supreme Court ruled that employers with a historical religious foundation could be exempt from certain requirements outlined in the ACA, including coverage of birth control and sterilization procedures.

Research

• According to the Patient Bill of Rights, patients have the right to decide whether or not to participate in research studies.

Henrietta Lacks

• Henrietta Lacks developed cervical cancer at 30 years of age. Tissue samples of her cancer were taken and eventually benefitted financially from their research finds.

Medical Marijuana

• Medical marijuana is a growing legal and ethical issue in healthcare.
• Marijuana is a controlled substance, which means that it is heavily regulated and illegal to take across state lines.
• Marijuana recommended for therapeutic use by some medical professionals and has been found to effectively reduce pain, controls nausea and vomiting, and is less addictive than other controlled substances, especially those containing opioids.

Other Public Health Issues

• Public health issues include, but are not limited to, obesity, gun control, and opioid addiction.
• Opioid addiction is currently considered a public health emergency. This designation allows funding to be shifted and utilized more easily under the Public Health Emergency Act.
• The U.S. Department of Health and Human Services is focusing its efforts on five major priorities which includes:
  • improving access to treatment and recovery services
  • promoting use of overdose-reversing drugs
  • strengthening our understanding of the epidemic through better public health surveillance
  • providing support for cutting-edge research on pain and addiction
  • advancing better practices for pain management
• The National Institutes of Health (NIH) is exploring formal partnerships with pharmaceutical companies and academic research centers to develop:
  • safe, effective, non-addictive strategies to manage chronic pain
  • new, innovative medication and technologies to treat opioid use disorders
  • improved overdose prevention and reversal interventions to save lives and support recovery