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LS M5 (Ch3 (3.1 new model of factors for spreading diseases (concealment,…

- - - - gov conceal the information of the outbreak
        
        affect
        
        foreign trade
        
        career of gov officials
        
        failed to prevent disease
      - ineffective reporting mechanisum
      - e.g. SARS, MERS
      - exaggerate the situation
        
        ask for more financial assistance
      - unable to know the accurate information
      - because
        
        may cause chaos
        
        hinder economy
    - - source of infection in the marine ecosystem
        
        ship load goods, discharge sewage
      - aeroplane travel
        
        carry patients
    - - poor hygiene
      - repeated use of needles
      - mass migrations of refugees
      - low vaccination coverage
      - typhus, cholera, hepatitis
    - - urbanization, land dev, industrialization
        
        natural env changes
        
        e.g. paddy fields => breeding ground for mosquitoes
      - global warming
        
        climate warmer and more humid
        
        dengue fever,cholera can spread more easily
    - - tech may become breeding grounds for microorganisms
        
        e.g. air-conditioning systems => legionnaires' disease
      - abuse of antibiotics
        
        bacteria become drug-resistant
    - - high population density, ppl's frequent contacts
      - no. of old ppl increasing
        
        may easily be infected
    - - they can adapt to new host and new environment quickly
        
        influenza virus
  - - - improvement on sanitation
        
        water quality
        
        1982 polio-virus in Taiwan
        
        keep hk clean campaign since 1972 & more emphasis in 2003
        
        street cleansing team, striict food hygiene patrol, immediate summons of spitting
      - public education
        
        public education for AIDS
        
        avoid risky behaviors such as needle sharing and unsafe sex
    - - vaccination for public
        
        2006 influenza vaccination for 5 high risk groups
      - surveillance of infectious diseases
        
        early warning system to predict mosquito breeding accurately
      - intercept the media spreading the diseases
        
        1997 hk slaughtered 1.5m chickens to remove the source for bird flu
        
        cow disease, EU prohibited the import of British beef until 1999
      - inspection and reporting for import and export
        
        SARS, hk, port control measures
        
        implementation for the health declaration during entry and temperature check
      - quarantine to prevent exposure to infection
        
        1995, Ebola, military blocked all roads to outside and did not allow any person to leave
        
        2003,SARS, residents in Block E of Amoy Gardens were admitted to quarantine camp
    - - contingency planning
        
        HK gov three-level response(see ppt)
      - research of vaccines and antiviral drugs
        
        research & development
        
        human swine influenza vaccine
        
        US launched vaccine for cervical cancer
      - establishment of a global warming mechanism
        
        establishment of the pandemic alert level(4 warning level see ppt)
    - - (strategies see ppt 43-45)
  - - - HK gov
      - chinese gov
      - docters
        
        private
        
        public
      - general public
      - mass media
      - community & NGOs(non-profit organization)
    - - long term
      - short term
      - direct impact
      - side-effect
    - - oppose
        
        violates the right of individuals
        
        freedom is infringed by being detained
        
        the quarantined ppl's health is at risk
        
        disease would spread amoung those ppl by cross infection
        
        values
        
        personal interest
        
        human right/ individual right
        
        hinder reputation of hk
        
        hinder tourism
        
        economic loss for the hotel staff
      - support
        
        gov should prevent spread of disease
        
        reduce the risk of public getting the flu
        
        the severity of virus is unknown
        
        gov should deal with it seriously
        
        gov's swift action can promote the reputation of hk
        
        values
        
        sacrifice personal interest
        
        community/ public interest
        
        social responsibility
    - - swine flu vaccination program for injection to a total of two million people in five high-risk groups to free
      - risks
        
        Guillain-barre syndrome
        
        affecting the peripheral nervous system
        
        paralysis
        
        cause life-threatening complications
        
        just a rare side-effect
        
        rate of 1 per million vaccines
        
        weakness begins in limbs
        
        miscarriage
      - ppl refuse to get injected
        
        medical staff do not support the vaccination
        
        the no. of injections at clinics fell
        
        dropped from 17000 to >5000 per day
      - numbers
        
        the chance of dying is a few hundred thiusandths
        
        only about a millionth of the world will have allergic reaction
        
        rate of dying of local pregnant woman due to swine flu w/out 0.016% vs miscarriage is 0.12% to 0.14%
      - high risk group is...
        
        children
        
        ppl with chronical illness
        
        medical staff
        
        pregnant woman
        
        workers who deal with poultry
  - - - a diease require(epidemiological triangle)
        
        host
        
        mosquitoes
        
        mouse
        
        isolate them
        
        environment
        
        pathogen
        
        the bacteria
        
        from moquito bite
        
        vaccine
        
        steriolizing env
      - e.g. MERS(in south korea)
        
        what measure did the HK gov take
        
        must wear mask
        
        flu quarantine areas in hospitals
        
        tourist sign health deceration
        
        conduct health evaluation of visitors who have fever
        
        what was the problem in south korea in dealing with it
        
        not enough transparency
        
        did not disclose the pateins' hospital
        
        HK gov cannot trace whether the tourist come form that hospitalization
        
        poor venilation in hospital
        
        spread within hospital
        
        allow pateins to transfer to leave south korea
        
        poor aboard control
        
        a nurse ignonred the carrier's symtom
        
        allow patients to go to other hospitals
      - infectious diseases
        
        AIDS, Ebola,SARS,Bird flu
      - non-infectious diseases
        
        Cardiovascular diseases,diabetes
  - - - they are expensive and difficult to produce
        
        less susceptible to imitation
      - those with patent guarantee a huge profit
        
        can monopolize the market
      - Wyeth's pneumococcal vaccine Prevnar made profit up to 300 billion US every year
      - cervical cancer vaccine $1200-$1800
      - problems
        
        95.98% of pharmaceutical patent are accounted by dev-ed countries
        
        LDC cannot afford the vaccine
        
        more disease
        
        generic drugs
        
        +ve
        
        patients in LDC can fford the genetic drugs
        
        gov can spend less on subsidizing the patient
        
        1 more item...
        
        encourage medical research in LDC
        
        1 more item...
        
        doctors without borders also use generic drugs
        
        -ve
        
        if no guaranteed revenue, might stop pharmaceutical research and dev of new drugs
        
        LDC might face litigation
        
        1 more item...
        
        quality of generic drugs may be lower(contaminated)
        
        3 more items...
        
        solutiions
        
        non-selfish scientist
        
        research on reducing the production step of Tamiflu
        
        do not plan to patent the resaerch
        
        self-reliant of poor/ weak countries
        
        independent research
        
        lower price
        
        TRIPS, 2001
        
        member states can have flexible provision according to their need on public health response
        
        compulsory licensing
        
        the gov allows to produce a patented product without consent of the patent owner
        
        ppl applying has tried to negotiate a voluntary license with the patent holder: but failed then can issue c.l.
        
        the patent owner has to receive payment"adequate remuneration"
        
        no need to try v.l. for 'national emergencies', 'other circumstances of extreme urgency', 'public non-commercial use'
      - "evergreening"
        
        make minor modification to the product
        
        extend the (20year) patent
        
        hinder the production of affordable generic drugs
- - - - its easier to prevent than cure
    - - can cover mental health
        
        stress, emotion managment
      - cost effective, so can use in large variety
- - - - a finding: cervical cancer is an infectious disease/ sexually transmitted
        
        preventing diseases
        
        health promotion
        
        medical and nursing service
    - - vaccines
      - antibotic
- - - - kidney
      - heart
      - intestinal
      - lung
      - pancreas
      - skin grafts
      - islet cell
      - hematopoietic stem cell
    - - The number of organs for transplant is far less than the number of patients awaiting the transplants
        
        shortage of organ donation
        
        over 2000 patients in HK waiting for organ
        
        5.2 reasons for shortage
        
        Regulations of organ donation in Hong Kong set that no removal of organ is allowed as long as the family members refuse.
        
        Education and publication of Organ donation are insufficient.
        
        Traditional Chinese belief (Confucianism: Filial piety) advocates the protection of the whole body after death for reincarnation
        
        Misconceptions about organ donation hinder the people from donating.
        
        determination of brain death is done by 2 senior eligible doctors with no relations with organ transplant services to carry out 2 seperate tests
        
        donation will not disfigure the body
        
        There were organ donors died due to illness. Some organs are not suitable for donation (e.g. cancer). Brain death only accounts for less than 1% of total death.
        
        so...
        
        the no. of organe donations remains small
        
        relatively low deceased donation rate compared with UK,US and Spain
        
        waiting list > 2600
        
        5.3 ways to deal with shortage
        
        voluntary donation (opt-in)
        
        the gov may consider one time registration for all ppl
        
        no of organ is limited
        
        culture of donation cannot be established
        
        education is needed but not effective
        
        family can object the patient's intention after death
        
        due to negative emotion facing death
        
        does not pose any intention to others
        
        everyone can make the decision in a clam situation
        
        UK,US,Australia,Taiwan, Japan and HK
        
        presumed consent (opt-out)
        
        Singapore, Brazil, some European countries
        
        if individuals never expressed intention of not donating, the authorities can assume they are willing
        
        the no of organ can be maintained
        
        the culture of organ donation can be established
        
        when implementing this policy ppl will discuss about it
        
        1 more item...
        
        all the citizens are registered and their detail are recorded
        
        implementation costs time and money
        
        ppl's right might be infringed
        
        ppl are not asked permission to be added in the scheme
        
        HK 51.9% ppl agree
        
        forced donation
        
        no countries do this
        
        all ppl possess no ownership of their body; the authorities can decide how to handle the dead body
        
        the number of organ available can be maintained
        
        casas of family refusal after death can be reduced
        
        lack of consent for the people
        
        human right are infringed
        
        ppl cannot control the destination of their organs(e.g. trading of organ)
        
        all the citizens are registered and their detail are recorded
        
        implementation costs time and money
        
        sale of organs
        
        legal in Philippine and Iran
        
        illegal trade of organs
        
        reasons
        
        4 more items...
        
        no. of organ can be maintained
        
        ppl have more incentive for organ donation
        
        increased incentive
        
        cases of family refusal after death can be reduced
        
        sources of organ are unknown
        
        e.g. from criminal, intended murder etc.
        
        the rich have priority to get the organs(poor cannot afford)
        
        the value of contribution with organ donation is distorted with money-oriented purpose
        
        quality of organs is hard to be controlled
        
        artificial organs
        
        but cant last long, just to extend their life to wait for donation
        
        most recipients died within a year
        
        artificial heart has flaws, may give rise to blood clots, stroke in some patients
        
        xenograft or xenotransplant
        
        pigs reproduce fast
        
        structure, use similar to human
        
        although have anti-rejection drugs, there is still a serious rejection
        
        animal viruses(e.g.swine flu) may infect humans
        
        may be unknown hidden virus which will spread in human community
        
        moral
        
        these medical experiments put risk not only the patients but also on all human species
        
        it will harm human dignity
        
        we cannot control the life and right of the animals for the exchange of human survival
        
        hk' policy
        
        opt-in
        
        centralized organ donation register
        
        1 more item...
        
        adopt opt-out?
        
        hk donation rate is very low
        
        1 more item...
        
        only 9 organ transplant coordinators in hk
        
        cloning
        
        embryonic stem cells => clone them
        
        e.g. liver, heart
        
        can nurture or repair with no rejection
        
        extract stem cells from bone marrow of patients with sever heart attack and implanted in the dead left auricle
        
        significant improvement in myocardial function
        
        organ donation rate(2013, HK): 6.1 per million citizens
      - disputs
        
        must be over 18
        
        underage are under the protection of law
        
        doctor: the surgery post high stress on them
        
        surgeons will bear responsibility
        
        patient: dont want to risk the life of the donner
        
        bad example, blur the line of the law => create dispute
        
        should focus on promoting deceased donation
        
        fulfill the donner's wish
        
        increase the no. of organ donation
        
        increase the chance of patients to get cured
        
        familiy members => higher chance of matching of organ
        
        cannot name who i want to donate to
        
        No, the donation will become a organ trading
        
        the patient will be in dept of the donner
        
        reputation?
        
        should those who have more media exposure be prioritize?
        
        should depend on the urgency, how long they have waited
      - High cost of transplant surgery
        
        liver transplant, the surgery costs about 300,000-400,000. Patients still have to pay for the expensive anti-rejection drugs in the future
      - Post-transplant rejection
        
        There are many patients not able to live long due to the rejection after transplant
      - to donate or not donate (reason=>factors=>values)
        
        <slide 24>
    - - for the purpose of replacing the recipient's damaged or absent organ
    - - 1/1000 chance dying
      - big scar
      - 40%-60% of the liver is removed
      - ave hospital stay for donner and patient in 7 days
    - - can differentiate into diverse specialized cell types and can self-renew to produce more stem cells
      - allogenetic stem cell (embryo to patient)
        
        can be extracted form blastula => embryonic stem cells
        
        recover cartilage cells, then implanted in the damaged joints
        
        promote nerve regeneration in spinal cord
      - autologous stem cell(self stem cell to paitient)
        
        extract stem cells from bone marrow of patients with sever heart attack and implanted in the dead left auricle
        
        significant improvement in myocardial function
        
        for beauty
        
        stem skin regeneration tech => sells self repair
        
        anit-aging
        
        breast augmentation
      - test tube burger (from cows stem cells)
        
        more sustainable
        
        less environmentally harmful source of ffod
      - 5.5 controversy of embryonic stem cell research
        
        destroying life with e.s.c. research??
        
        sources of e.s.c.
        
        natural and artificial adortion of embryos
        
        remaining embryos artificial fertilization
        
        embryo from somatic cell nuclear transfer technique
        
        => embryos must be destroyed after extracting e.s.c.
        
        views on e.cs.c. research
        
        it can solve organ shortage and organ rejection
        
        collected from human embryos
        
        also a form of life
        
        the destruction of embryoss cannot br tolerated
        
        the e.s.c. cannot dev into an independent baby
        
        it is not embryos
        
        e.s.c. research does not violate ethics
        
        those remaining embryos after fertility treatment will be abandoned
        
        it is more desiradle to use them into scientific dev and human health
        
        can be applied in food production (e.g. test tube burger)
        
        decrease production of methane
        
        helps alleviate the problem of global warming
        
        the company will be funded in vitro fertilization and abortion to obtain extra embryo
        
        (may) more abortion
        
        e.s.c. can be obtained through buying and selling
        
        impacts on traditional ethics
        
        disparity between rich and poor
        
        man should not replace the role of god to create and dominate life
        
        will e.s.c. research be abused?? (a.k.a. for beauty)
        
        treatment is not for medication but replacement with better organ
        
        research is done for div-ing therapeutic cloning
        
        for AIDS, parkinson's disease, alzheimer's,diabetes
    - - no age limit
      - organ and tissues have adequate function
      - no severe / systemic infection for the deceased
      - no HIV infection for the deceased
    - - living organ transplantation
      - corpse organ transplantation
- - - - GMO
        
        genetically modified organisms
      - GM food
        
        why(benifit)
        
        create new spices
        
        quality of crops (bigger crops)
        
        aquabounty
        
        larger
        
        need less food
        
        grow faster
        
        reduce production cost
        
        increase productivity
        
        solve the problem of hunger and world population
        
        resistance
        
        reduce use of pesticide
        
        lower cost
        
        scorpion genes implanted into corn
        
        insect resistance
        
        herbicide tolerence
        
        only kill weed
        
        soyabean
        
        herbicide tolerence
        
        disease resistance
        
        drought resistance
        
        enhance the nutrient of food (mix diff species)
        
        process of genetic engineering
        
        refer to ppt
        
        problems
        
        producer don't disclose the effect on our health with long term consumption
        
        might cause cancer
        
        allergic reaction
        
        associated with the transfer of genes
        
        such as herbicide tolerance transfer to weeds, creating super weeds
        
        transferred to other species
        
        affect the quality of other crops
        
        change the make up of human digestive system
        
        may be antibiotic-resistant to...
        
        human cells
        
        gut microflora
      - quality of
      - labeling policy
        
        voluntary labeling(HK)
        
        producer: no need to disclose information, not affect sales
        not significantly affect the cost of production
        
        gov:
        
        protect HK's reputation of 'small gov, big market, minimal intervention', freest economy
        
        consumer council advice food with more than 5%GM should be labeled
        
        labeling of designated products only
        
        gov: less opposing force
        
        small-medium enterprises(SMEs) will be affected the most
        
        pan labeling
        
        PMSAS
        
        a policy thats not passed in HK
        
        situation in HK
      - manipulation of an organisms genome
    - - genetic disease
        
        breast cancer
        
        lung cancer
        
        are caused by disease-causing genes
      - somatic cell gene therapy
        
        not pass on to next generation
        
        only change on part of the cells or tissue for the patients
        
        e.g. execrating modified gene from pigs and injecting it to human with hemophilia
      - germ cell gene therapy
        
        pass on to next generation, heritable
        
        germ cells(sperm, eggs) are modified or replaced by healthy and functional genes
      - positive
        
        econ
        
        ease long term financial burden of gov
        
        social
        
        burden of the families can be reduced
      - negative
        
        econ
        
        cost of curing all ppl may be huge for the gov at the beginning
        
        scientific
        
        hard to decide the level of normal or cured
        
        the organic talent may be altered or disrupted
        
        70-100 in definition are not patients
        
        the definition of intelligence has to be reset
        
        social
        
        patients may have difficulties in adapting the new life
        
        advocates the massage that "congenital intelligence" is more important than effort
        
        leads to endless competition(of intelligence)
        
        the rich can escape from the risk of having less intelligent children
        
        polarization between rich and the poor intensifies
      - derives...
        
        genetic enhancement
        
        gene eugenics
        
        to improve or impair the inborn qualities of human beings and of future generations
        
        to reduce the incidence of genetic disorder
        
        genetic screening
        
        selection of baby
        
        change of gene
        
        should society accept the tech?
        
        no
        
        immoral
        
        2 more items...
        
        unnatural
        
        1 more item...
        
        slippery slope effects
        
        3 more items...
        
        increase intergenerational conflict
        
        1 more item...
        
        social problems
        
        1 more item...
        
        abuse of technology
        
        1 more item...
        
        effectiveness and safety
        
        2 more items...
        
        devaluation of skills, experience and effort
        
        1 more item...
        
        yes
        
        can save life for the family
        
        1 more item...
        
        reduce chance of getting disease
        
        2 more items...
        
        improve the quality of human
        
        2 more items...
        
        can trigger more research on the potential usage of genetic engineering to improve mankind
        
        can design our next generation with less anti-social behavior(violent gene: MAOA) and more socially accepted behavior(altruism)
        
        1 more item...
        
        this tech can get rid of...
        
        2 more items...
        
        legislation and regulation
        
        1 more item...
        
        modify a person's non-pathological human traits
        
        well => better than well, not treat disease
        
        effect of enhancement & eugenics
        
        unfair competition
        
        society governed by a family with genetic enhancement
        
        evolved two races
        
        off spring of family with genetic enhancement would grow continuously
        
        some super humans would be formed
        
        1 more item...
        
        homogeneity of the human gene pool
        
        enhancement would be made towards the same ideal target gene
        
        the attack of a new disease can lead to extinct of mankind
        
        1 more item...