DMS Student Journal, Issue 1 July 2021

STUDENT JOURNAL

Issue 01| July 2021

note from editors

We are proud to present the inaugural DMS Student Journal! As part of our initiative to connect aspiring medical students, we set out to produce a publication that demonstrates student's literary work in fields of medicine they are passionate about. We recognise and encourage independent enrichment and research, and this journal is a proud display of students' independent exploration of controversial medical topics and the science behind diseases.

Thank you to all the students who put forward an article for the journal - it is truly amazing to see aspiring medics from schools across Dubai come together and be a part of this project. From the many submissions, the judges chose 3 winning articles and 6 highly commended articles to be featured in the journal.

From a review article of Hutchinson Gilford Progeria to a thoughtful discussion of Genetic Engineering and the rise 'Designer babies', this journal explores an array of medical disciplines. We hope you find yourself challenged, informed and moved whilst reading these student crafted essays.

Happy reading!

- Hiba Khan, Omar Farouk, Annabelle O'Keefe Richardson

winners

We are excited to announce the winners of the article competition! The winning articles took a passionate and thoughtful take on their topic of interest, communicating with clarity, using accurate grammar and punctuation, and making effective and comprehensive use of external sources.

Well done to the following students for their outstanding articles:

First Place: 'Cystic Fibrosis: The Salty Child Syndrome' by Marina Kostopoulou

Second Place: 'Hutchinson Gilford Progeria' by Mishaal Faisal and Keya Nanavati

Third Place: 'Trauma: The Pandemic of the Mind' by Anjli Garg, Diya Marwah, Mariam Usmani, Zoya Asim

A special thank you to Mr A Khan and the JC science department for judging the article submissions!

04 | Cystic Fibrosis: The Salty Child Syndrome - Marina Kostopoulou

07 | Hutchinson Gilford Progeria (HGPS) - Mishaal Faisal, Keya Nanavati

10 | Trauma: The Pandemic of the Mind - Anjli Garg, Diya Marwah, Mariam Usmani, Zoya Asim 14 | Ethics in Medicine - Ananya Gupta 16 | Health Effects of Caffeine - Anoush Nathwani

19 | Eating Disorders, the obsession that haunts our youth - Dalia Petric

22 | Should we make attempts to change the human genome? - Shaz Raja

25 | 'Designer babies' a medical breathrough or a horror awaiting to happen? - Foteini Kalamatianou

28 | The Illusion of Battery Power Nicotine - Nour Mahmoud 31 | Bibliographies

Cystic Fibrosis: The Salty Child Syndrome

Marina Kostopoulou

“Life is not measured by the number of breaths we take, but by the moments that take our breath away.” -Maya Angelou.

This is a quote Cystic Fibrosis patients live by and cherish every day. If you breathe through a straw for 60 seconds, at first it may seem alright. But as you keep breathing, your head will start to ache, you will start feeling pressure in your lungs, and your palms will start to swell. When you’ve had enough, you can easily stop and start breathing normally again- but Cystic Fibrosis patients can’t.

Cystic Fibrosis, also known as CF, is a genetic disorder that affects more than 70,000 people worldwide It mostly affects the lungs, but patients can also have trouble with their liver, kidneys, pancreas, and intestines The body produces thick and sticky mucus that blocks the tubes designed to transfer the digestive enzymes created by the pancreas to the small intestine, this can damage the absorption of fats and proteins and cause vitamin deficiency and malnutrition. The mucus also restricts patients from breathing properly by filling the lungs up and blocking the trachea, this is the main cause of death in Cystic Fibrosis patients. No cure has been found for this disease yet, but there have been ways found to battle the

main symptoms patients have to struggle with in their sometimes short, daily life. There is no specific life expectancy for CF patients as it would be inaccurate because the life expectancy of people with CF broadly depends on the complications that each person develops These complications could include infections caused by Staphylococcus Aureus, malnutrition, pancreatic insufficiency, diabetes, and other respiratory infections that cause low lung function The life expectancy of each patient further depends on which country they’re from. Patients from developing countries, such as El Salvador and India, have a life expectancy of under 15 years. Whereas patients from developed countries, such as the US and UK have a life expectancy of 30 years or older. This is due to the fact that developing countries have a very limited number of doctors who are specialized in this disorder and lack a lot of necessities CF patients require to survive, such as medication and different therapy methods including oxygen therapy and airway clearance therapy

Cystic Fibrosis was first explored in 1938 when pathologist Dorothy Andersen was able to write a modern description of the disease. Previously it was known as ‘mucoviscidosis’, named after one of the most common symptoms - the

thickening of the mucus. The disease was also referred to as “salty child syndrome” as people with Cystic Fibrosis often have two to five times the normal amount of salt in their body, this symptom helped doctors and parents spot CF in young children before they had researched and explored the disease

In the 1940s, doctors started looking for antibiotics for the disease They started using Nebulized Penicillin and Sulphadiazine drugs for the chronic coughs, but they were later found to be ineffective. Four decades later, doctors started successfully using the antibiotics gentamicin and tobramycin to fight and prevent infections by a germ called Staphylococcus aureus. After a few years, in the 1990s, The Antibiotics Group of the UK CF Trust recommended doctors to give an antibiotic called flucloxacillin continuously for the first two years after birth for all CF patients. With this order, doctors and scientists also created a new formulation of tobramycin that could be inhaled, for easier use in younger patients

As mentioned before, one of the most common CF symptoms patients have to struggle with is increased amount of mucus, which blocks their airways and results in struggling for breath. Initially, in the early 90’s, doctors had been using massaging and physiotherapy to get mucus out of the lungs but they were deemed

inefficient and hard to do. In 2015, Mobile Airway Clearance Therapy was invented and companies, such as AffloVest, started producing vests with Patented Direct Dynamic Oscillation technology which made the process of clearing up the lungs easier and more efficient. The vibrating motors in the vests create waves that help lungs clear up their airways by breaking up the mucus that is blocking them and makes breathing more comfortable for the patients. AffloVests are easy to use and come in a wide range of sizes, but they sometimes are hard to find and very expensive This high cost offers a great issue to CF patients; due to their symptoms, most of them are unable to work full-time and don’t have the economic accessibility needed to purchase Mobile Airway Clearance Therapy.

In 2019, the U.S. Food and Drug Administration approved a new way of therapy including a new drug called Elexacaftor-tezacaftor-ivacaftor that mainly targets the dominant defect of the disease. The drug can be given to patients above the ages of 12, but doctors are looking into ways that this treatment could be offered to younger ages as early intervention could offer an increased chance in long-term benefits.

In December of 2020, the Cystic Fibrosis Foundation announced that new research has started being conducted regarding the exploration of treatments for the underlying cause of Cystic Fibrosis for all people with CF, regardless of their mutations With the help of seven academic institutions and two companies, they were able to fund nine research agreements to support focused research into a cure This announcement gave a lot of hope to the CF community and is a big step towards the right direction. The Cystic Fibrosis Foundation is also encouraging people to submit suggestions for new treatments and research, as well as raise more awareness about the disease in the hope that more doctors and scientists will help them

in their search for a cure Cystic fibrosis awareness has increased over the last few years after a romantic-drama starring 2 cystic fibrosis patients and their struggles with the disease called Five Feet Apart made a debut in 2019. The movie had a large impact on the Cystic Fibrosis community as it raised awareness for a lot of people as well as the younger demographic, and helped patients speak out about their stories and feel included.

Celebrities such as Miley Cyrus, Selena Gomez, Tony Hawk, Zac Efron, and many more have also helped raise awareness about the disease by donating to charities such as the Cystic Fibrosis Foundation, and the Australian Cystic Fibrosis Research Trust that help financially struggling Cystic Fibrosis patients get treatment and help raise money for research into a cure.

You can too support Cystic Fibrosis and contribute into the efforts of finding a cure by donating to charities that focus on the research and exploration of the disease, or by volunteering at one of your local CF organizations

“Make CF Stand for “Cure Found””- Cystic Fibrosis Foundation

Hutchinson Gilford Progeria (HGPS)

Mishaal Faisal, Keya Nanavati

Affecting 1 in 20 million people, Hutchinson Gilford Progeria (also known as Benjamin Button disease) is a rare progressive genetic disorder that occurs in children These children begin to age rapidly, yet seem perfectly normal at birth, making this disorder very hard to diagnose. During the first year of a child’s life with this disorder, symptoms such as slow growth and hair loss begin The average life expectancy is approximately 13 years, and there’s no cure. Children die at such a young age because of cardiovascular complications, such as atherosclerotic heart disease- which refers to the build-up of fats and cholesterol in your arteries. Such conditions normally happen at an older age, suggesting how children at a young age with progeria are prone to suffer

Surprisingly, only one gene is responsible for this complex disease: LMNA, located on chromosome 1. LMNA codes for the lamin A protein that fabricates structural proteins that holds the nucleus together and keeps the genome intact. Lamin A is a key component of the membrane of the cell’s nucleus. A mutated or defected version of this protein, known as progerin, causes the nucleus to become unstable and causes DNA damage. This misspelling on the lamin A gene causes the premature ageing that we associate with progeria.

Normally, the lamin A protein has a farnesyl group (lipids which act as protein anchors) added to the c-terminus (end of an amino acid chain) by farnesyltransferase (an enzyme).

In progeria, the farnesyl group at the end of the lamin A protein cannot be removed. The protein is fixed to the nuclear rim instead of being part of the nuclear envelope. This means that the nuclear envelope doesn’t have support to remain in its original state and may die prematurely

Progerin can cause many cell nuclei anomalies in addition to disturbances in the organisation of heterochromatin, mitosis and gene transcription. Progerin also damages DNA by hindering replication. The stress is sensed by proteins such as cGAS and STING which activate an immune response (STAT1) that leads to cellular decline. The immune response, though seems to be an interferon-like response, is not actually conducted through the release of inflammatory molecules, such as interferon. Interferons are signalling proteins released in the presence of viruses and trigger the immune system. This indicates that the ageing effects of progeria are cell-intrinsic and not external factors to the cell.

While the exact reason as to why premature ageing occurs is not fully understood, research suggests that this is due to the cumulative cellular damage from ongoing chemical processes (metabolic) within cells. The theory implies that compounds called free radicals are produced during chemical reactions in the body and these free radicals eventually accumulate in body tissues, causing damage to cells and impairing their functions.

This causes rapid ageing. Some enzymes, called antioxidant enzymes, are tasked with eliminating damaging free radicals As enzymes speed up chemical reactions, researchers believe that reduced activity of these enzymes may cause the rapid ageing of HGPS. One study compared the fibroblasts (skin cells) of a person with HGPS with healthy skin cells and found that the activity levels of some primary oxidant enzymes were much lower than those present in healthy fibroblasts. This could highly support the theory from before, assigning the ageing effects of progeria to a decline in the activity of enzymes.

Though it is a genetic disease, progeria does not pass down in families. Other types of progeroid syndromes do tend to be passed down much easier though HGPS is considered to be a sporadic autosomal dominant mutation due to two factors: dominant due to the fact only one copy of the gene needs to be changed in order to be passed down, and sporadic as it is a new change in the family. It is considered to be caused by a random accident during cell division, not a hereditary disease

Evidence is shown to suggest that parents having a child who already suffers from progeria may have a higher chance (around 23%) of having another child with the same condition. This is because of a condition called mosaicism, where a parent has the genetic mutations required for progeria in some of their cells but fails to have the actual disease.

Children with this condition can have complications related to atherosclerosis, which is when arteries harden The walls of the arteries that carry oxygen and nutrients from the heart to the rest of the body stiffen and become thick, often restricting proper blood flow. This is why children characterised by this

condition result in having heart attacks and congestive heart failure due to inadequate blood supply Other health issues such as strokes also occur, because of problems with the blood vessels that supply the brain These are also known as cerebrovascular problems.

In the first few years, distinct appearances and health issues become evident, but motor development and intelligence remain normal. Some appearance-focused symptoms include a narrower face, head disproportion, prominent eyes and incomplete closure of eyelids, wrinkled skin, visible veins, and a high-pitched voice. In parallel, health issues such as cardiovascular disease, delayed and abnormal tooth formation, hearing loss, skeletal abnormalities, insulin resistance, and hip dislocation coincide Skeletal defects are also evident, with a thin ‘dome’ portion of the skull as an example.

The prominence of the effects of HGPS develops throughout the lifespan of a patient While patients are still newborn, they might display instances of shiny, hardened skin over numerous areas in the body Bluish discolouration of the skin is also common during these times in addition to various other symptoms, though, growth delay is displayed only around 24 months. By 2 years old, patients display underdeveloped cases of bone, with the jaw and facial bones as examples. Here is where most indicators come into play such as loss of scalp hair and the aforementioned symptoms.

A doctor suspects progeria if a child is experiencing such characteristics of the syndrome. From there, a genetic test for LMNA mutations can confirm the diagnosis of progeria The test requires a blood sample from which doctors can deduce if the child has progeria. Other physical examinations help identify this syndrome since a physical appearance plays a large role in recognising this disease

Lonafarnib, sold under Zokinvy is a medication used to reduce the risk of death from HGPS This is the first-ever treatment the FDA approved in order to cure this disease Lonafarnib inhibits farnesyltransferase, an enzyme that hosts the production of progerin. This farnesyltransferase inhibitor (FTI) has demonstrated extended survival with children who have this since it prevents the protein from absorbing the cellular wall. The cellular wall is where most of the damage happens. Preventing this would mean reversing the instability of the structure. The capsules are known to treat certain processing-deficient progeroid laminopathies in patients older than a year old.

Calcitriol, a type of Vitamin D, rescues the cells that experience glitches in DNA replication from progerin This shows how significant of a role Calcitriol plays when it comes to DNA damage

Research on this medicine has been done in 30 countries, and Brown University along with other research centres have tracked more than 250 children, demonstrating an evident link between using this medicine and having prolonged survival. Upon using Lonafarnib, which was a failed pediatric brain cancer drug, researchers found a moderate weight gain and a reduction in artery hardening, as well as improved nuclear shape These positive results have led to this drug being used universally since copious amounts of evidence gathered indicates its success. Before this treatment, the only options available were supportive care and therapies directed towards the complications of this progressive disease.

In conclusion, while progeria does have a high number of risk factors, the medical procedures involved in treating this disease have proven successful. With decades of research on this topic, the data gathered has effectively helped treat this and evidenced to have an optimistic lead on eradication. Hopefully, our research has aided readers to see the dire situation of patients with Hutchinson Gilford Progeria and bring more importance and attention to the subject.

An organisation that aims to carry out effective research on Hutchinson Gilford Progeria Syndrome is progeriaresearch.org

You can donate to show your support towards distributing treatment to patients with HGPS

Trauma: The Pandemic of the Mind

Anjli Garg, Diya Marwah, Mariam Usmani, Zoya Asim

“Through the words of Gilbert Parker, the once prominent novelist and politician, “Memory is man’s greatest friend and worst enemy” From a statistical perspective, 60% of men and 50% of women experience trauma Trauma is common; it is the psychological injury and consequence of experiencing one or more distressing incidents. But how does our trauma affect us, our brain and our memory?

Acute trauma is a result of suffering from a single traumatic event occurring, such as an accident, being a victim of a crime, or even due to a natural disaster However, if the trauma is repeated and prolonged for more than six months, for example relapsed traumatic episodes of highly stressful events, it can be classed as chronic trauma. Chronic trauma often emerges when the perpetrator is a known individual to the victim, and the event exhibits a behavioural pattern. Living with chronic trauma tends to be overwhelming and enervating; in a report published by Paper Dolls Research Group, survivors were seen to liken the feeling to “bruises,” “walls,” “bullets,” “a nightmare” and “the inability to see” - with the word “pain”

arising frequently. It often has lasting effects on both a person’s physical and mental health, and on one’s sense of identity. Due to the erosive and long-term nature of chronic trauma, where survivors perceive things to be getting worse before they get better, survivors may not recognise the full extent of the abuse that occurred and may also face isolation and a lack of support from others.

Acute trauma can cause permanent brain damage by affecting your ability to process and store information, a fundamental function of memory (the inability to do so could ultimately lead to memory loss). Additionally, it has been scientifically evident that patients with a history of trauma, depression, or even stress are more likely to form false memories - fabricated memories of events that did not take place Traumatic incidents negatively impact your psyche and daily life, however, resolving trauma is not an easy task and if left ‘ignored’ it can do more harm than good. Over time, our memory works to delete information, and as a result we lose certain memories, forget details of those we do retain, and alter aspects of other memories as the result of our constant retrievalsnumerically, 15% to 38% of known trauma survivors fail to recall their experiences. Memories of trauma have important characteristics that make them appear different from normal, everyday memories. After experiencing a traumatizing event,

several studies have shown that it may be remembered forever and this is an adaptive outcome as the brain responds by clutching onto the memory in hopes of confronting it later

The brain has been able to learn that “this is important, remember this because it could later save your life.” However, the more the trauma is ignored, the more your body will hold onto it; it needs to be processed consciously and in a professional manner in order for the trauma to be overcome

Complex trauma is when a lifetime of distressing and shocking events accumulate over a long-term period. It is the result of exposure to multiple traumatic events that often leaves many individuals to believe life is nothing more than their trauma. This arises from situations like an unsolved kidnapping or children who are given a lack of warmth and praise in their childhood A notable example of complex trauma is Post-Traumatic Stress Disorder, which can be developed after an individual experiences or witnesses a shocking or distressing incident and its aftermath, such as natural disasters, war or combat, etc. Covid19 has brought about huge numbers of distressing incidents around the world, most obviously, death and prolonged illness of loved ones. Others have witnessed friends and close relatives being made unemployed and forced to relocate with their survival being under threat. Covid-19 has and is still creating unknown levels of complex trauma with potentially permanent effects on the generations of people involved. Complex trauma can lead to significant effects like constant stress and negative thoughts, emotions and beliefs about yourself or the world Complex traumas can disrupt healthy development and increase the risk of many .

other mental health issues. This is unlimited to depression, anxiety, eating disorders, suicidal thoughts, as well as drug and alcohol abuse, although time may have passed from the occurrence of the event - this does not bode well for people in the years following Covid19. If the trauma is not overcome, it can often lead to shame and disappointment that only worsens the condition. Overall, there are many long-term effects that can cause significant deteriorations in the day-to-day lives of those struggling with the disorder.

It has been proven that complex traumas can often lead to structural changes in the brain including the enlargement of the amygdala (the alarm center of the brain) and the shrinkage of the hippocampus (the part critical to remembering the event that happened) These structural changes can lead to altered brain activity such as an increase in stress hormones; this can ultimately result in other psychiatric disorders. The shrinkage of the hippocampus impairs an individual's ability to experience and regulate a healthy range of emotions and prevents the consolidation of memories that allow an individual to move on from the trauma. The amygdala contains implicit and fragile memories of the trauma, and this ability is heightened and therefore triggers often lead to the arousal of fragmented memories of a traumatic event

.

This can be seen in Ehlers’ and Clark’s cognitive model of Post-Traumatic Stress Disorder where the nature of traumatic memory is depicted to be “fragmented, readily primed and triggered, and poorly contextualized into memory.” As a result, memories of traumatic events, for example an instance of sexual assault, can be disjointed and difficult to recollect in a complete or linear way. Nevertheless, the effect on memory differs from person to person, as some are able to recall the traumatic incident clearly (depicted through flashbulb memories), whilst others suffer from amnesia with regards to major parts of their memories

Trauma survivors might be in a constant state of stress and fear; they perceive life for all its negativity and may not recognise the full extent of their abuse Since your body holds on to your trauma in hopes of addressing it in the future, if left untreated, it can result in a psychological chain reaction of illnesses like depression Therapy is usually the first response for treatment, possibly in the form of somatic experiencing and psychotherapy. Somatic experiencing therapy utilises mind and body exercises to release repressed trauma from the victim’s subconscious and conscious self. Aside from that, psychotherapy, or talk therapy, helps people achieve a deeper understanding of what triggers their symptoms by encouraging them to open up and explore their thoughts Overall, therapy allows victims to identify safer coping mechanisms to confront their trauma and progress onwards from their psychological distress. Considering this and our desire to recover from our current, trauma-inducing time period, we should as a society make therapy more readily available for those who are suffering

While therapy is usually effective for most, individuals may need to resort to medications.

Trauma patients respond to ‘threat’ differently and their ‘fight or flight’ response is easily triggered; they have an abnormal release of neurotransmitters in the brain and may be easily susceptible to depression and anxiety. Hence, medications like Selective Serotonin Reuptake Inhibitors (SSRI) and SerotoninNorepinephrine Reuptake Inhibitors (SNRI) are used SSRIs include Fluoxetine, Paroxetine and Sertraline; these drugs increase levels of serotonin by preventing its re-absorption into neurons. SNRIs include Venlafaxine, these medications regulate the balance of serotonin and norepinephrine Both SSRI and SNRI drugs improve mood stabilisation, feelings of wellbeing, happiness and the ability to cope.

Trauma can take control of a person’s entire mind and body; it can change your brain’s structural features, which results in incoherent and implicative memories. These memories aren’t perfectly recalled, can be reconstructed and forgotten. For example, many victims suffer from amnesia and forget major parts of their trauma; in a study investigating the memories of adult survivors of sexual abuse, psychologists found that 31% of participants reported no memories of their abuse and were unable to recall the incidents. However, in some cases

trauma can augment memories as ‘flashbulb memories’ - they are extremely vivid and comprehensive memories of shocking or traumatic events that are retained for a lifetime and continue to trigger emotions and feelings Therefore, different victims remember their traumas differentlymemories can be fragmented and forgotten or remembered as graphically as a screenshot. Ultimately, this may even affect how an individual copes and approaches their traumatic experiences. Nevertheless, as Peter A. Levine remarks, “Trauma is a fact of life. It does not, however, have to be a life sentence”.

Ethics in Medicine

Ananya Gupta

“Ethics” as a general term is concerned with the studying and build up of a coherent set of “rules” or principles by which people should live. It is the social value which binds the society by uniform opinion/consideration and enables the society to decide what is wrong and what is right. It is the science of morale concerning principle of human duty in the society.

Ethics in medicine often refers to examining a medical problem, and providing a solution through either facts and logic, or the patient’s or doctor’s values Medical ethics differs from morality. Ethics is based on values and reasoning, and it uses persuasion to get its message across, whereas morality involves adhering to a specific belief system or code of conduct There are constant changes in what is deemed to be ethical, which is why there is never a single right answer, and the best course of clinical action may be subjective. There are four pillars of medical ethics: beneficence, non-maleficence, autonomy, and justice

Beneficence (to do good) is the idea that a medical practitioner has the moral duty to carry out treatment that would factually be in the patient’s best interest It is mainly concerned with the circumstances, and the patient’s preference or expectations (known as patient-centric care) This specialized focus on the individual is important, as it often leads to the best care

Non-maleficence (to do no harm) states the of a medical practitioner having the duty to do no harm or allow harm to be caused to a patient

due to neglect Although it may seem similar to beneficence, it has two major differences. Firstly, it has the understanding that if a treatment causes more harm than good, then it shall not be considered. This opposes beneficence, where all treatments are considered, and then decided by patient preference. Secondly, non-maleficence is an uninterrupted clinical practice and a duty that should be constantly carried out, in contrast to beneficence, which is individual-based, specialized treatment.

Autonomy (to give the patient freedom where able) means that the patient is given the responsibility to make their own decision for their treatment or outcome. Along with this comes the idea that a medical practitioner must not impose treatment on an individual no matter their professional opinion, except in cases where the patient is deemed unable to make their own ‘autonomous’ decision. Despite this, people often defer their treatment decision to the doctor, however at times it is important that the patient is actively involved. An interesting idea of autonomy is voluntary active euthanasia being ethically justifiable. Technically if a patient is competent, they should have the right to choose if, when and how they will die.

In medical ethics, justice (to ensure fairness) is the principle that when making a decision whether a certain path is ethical or not, it is important to consider its compatibility with the law, the patient’s rights, and whether or not it’s fair and balanced This also means that no one shall be unfairly disadvantaged when it comes

to healthcare. Just like autonomy, justice can also support euthanasia, as it asserts that it is unjust to deny patients the opportunity to end their pain.

Although these are the main pillars, ethical values are not limited to just these four principals There are other important aspects to consider, for example honesty, transparency, and showing respect for the patient as well as their own values

A medical ethics concept to consider is consequentialism. It is an ideology that states the morality of an action is dependent purely on its consequences Basically, if the action has an overall benefit, then the action itself does not matter. The two key components of consequentialism are the probability of an outcome occurring, and the value of that specific outcome Although consequentialism is a broad ethical theory, there are many forms of it, for example welfare consequentialism (or welfarism). This maintains the idea that the right act is the act that maximises well-being. An example of welfarism is utilitarianism This moral theory that focuses on the overall balance of positive and negative effects of a healthcare professional's actions All actions are considered on the basis of consequences, not on the basis of fundamental moral rules and principles or with regard to the action’s traits. In short, it instructs a person to choose the action which maximises utility ‘utility’ in this circumstance has traditionally been defined in terms of happiness or the patient’ preference satisfaction.

Just like consequentialism, deontology is another medical ethics concept, however there is an important contrast. Deontology states that the correct course of action depends on what the medical professional’s duties and obligations are. This supports the idea that the morality of an action is based on whether or not one follows

the rules, rather than what the consequence of following them.

To compare these concepts, studies have shown the association of deontological inclinations with empathy, religiosity, and perspective-taking, while moral concern and reduction in the cognitive load being associated with utilitarian inclinations. Although they may provide completely different outcomes, utilitarian and deontological perspectives have their own importance in medical ethics This is why a balance between these two ideologies would improve the overall ‘ethical’ viewpoint of any certain medical practice

In conclusion, medical ethics is not just a thought process. It also involves people skills, such as gathering the facts needed to make a decision as well as the addition of other principles. The world of medical ethics continues to see a conflict between what could pass as the ‘best’ idea. The prime example of euthanasia in medical ethics presents the dilemma of granting a person’s wish to die, as opposed to prolonging their life with medical treatment. A conflict like this may never be overcome, no matter the action of the ‘right’ objective view. A physician’s job is to carry out all possible medical treatments in attempt to prolong a person’s life, however these treatments may be deemed unethical due to the patient’s suffering, as well as the ignorance of their own opinion of their body. This is just a single example of the complications of ethical theory in medicine.

Health Effects of Caffeine

Anoush Nathwani

Introduction1.

Many of us drink caffeine everyday, sometimes without even realising it This is because consuming caffeine has become a habitual routine that we are accustomed to We believe that it would be beneficial to investigate the true effects of caffeine so that you can build a better understanding of the harms and benefits This essay shall analyse the health effects of caffeine on the human body.

2. Sleep Deprivation

One of the most common things that you will have heard since a young age, is that you should not drink coffee because it will keep you awake at night. To what extent is this true, or is it a complete misconception? This section of the essay will cover the effects of caffeine on our sleep, and the links to insomnia.

According to PubMed Central, caffeine is commonly consumed to help offset fatigue, however, it can have several negative effects on sleep quality and quantity. For example, in a study conducted in the University of South Australia (Watson, Coates, Kohler and Banks, n d ), participants who reported poor sleep (PSQI global score ≥ 5) consumed 192.1 ± 122.5 mg of caffeine which was significantly more than those who reported good sleep quality. The data suggests that shorter sleep is associated with greater caffeine consumption, and that consumption is greater in adults with reduced sleep quality. So, higher caffeine intake appears to increase the amount of time it takes to fall asleep. It may also decrease total sleeping time, particularly for those who are older. It is clear that caffeine can worsen

not only the quality of our sleep, but also the quantity.

On the other hand, some data suggests quite the opposite. It has been made clear that caffeine blocks the effects of Adenosine, according to Amerisleep (Limen, 2020). When you drink coffee, your stomach and small intestine absorbs the caffeine and redistributes it through your bloodstream to multiple parts of your body, such as your brain. After the caffeine reaches your brain, it sticks to your adenosine receptors. Adenosine helps you feel sleepy and controls your sleepwake cycle. When caffeine binds to your adenosine receptors, your brain isn’t processing its adenosine, however that doesn’t necessarily mean it stops producing it. Once the caffeine wears off, there’s a build-up of adenosine that will bind to your brain’s receptors, making you feel tired

3. Dependency

As the above diagram shows, 44% of Americans drink 2 to 3 cups of coffee a day. Studies have demonstrated that people take in a minimum of 100 mg of caffeine per day (Wikipedia Contributors, 2021). This means that 44% of Americans consume approximately 200-300mg of caffeine in a day. Caffeine dependency is soaring as more people rely on caffeinated drinks to heighten alertness and reduce headaches. Caffeine dependency may also be increasing due to the increase in mainstream consumption among teenagers and young adults. Some symptoms

of increased caffeine dependency are dizziness, feeling shaky, headaches, increased blood pressure, heartbeat abnormalities and sleep issues (verywell, 2021). Work addiction works in tandem with caffeine addiction because many rely on this stimulant’s energising effects to increase their performance at their job (ibid). Consuming caffeine causes chemical changes in the brain that lead to the alertness that people crave and have difficulty withdrawing from (Addiction Center, 2020) While caffeine dependency is not categorized as a substance abuse disorder like drug abuse, caffeine withdrawal comes with a multitude of symptoms such as fatigue, decreased alertness, irritability and general discontent (Chaunie Brusie, 2017)

(Statcdn.com, 2021)

As the above diagram shows, 44% of Americans drink 2 to 3 cups of coffee a day Studies have demonstrated that people take in a minimum of 100 mg of caffeine per day (Wikipedia Contributors, 2021) This means that 44% of Americans consume approximately 200-300mg of caffeine in a day. Caffeine dependency is soaring as more people rely on caffeinated drinks to heighten alertness and reduce headaches. Caffeine dependency may also be increasing due to the increase in mainstream consumption among teenagers and young adults. Some symptoms of increased caffeine dependency are dizziness,

feeling shaky, headaches, increased blood pressure, heartbeat abnormalities and sleep issues (verywell, 2021) Work addiction works in tandem with caffeine addiction because many rely on this stimulant’s energising effects to increase their performance at their job (ibid). Consuming caffeine causes chemical changes in the brain that lead to the alertness that people crave and have difficulty withdrawing from (Addiction Center, 2020) While caffeine dependency is not categorized as a substance abuse disorder like drug abuse, caffeine withdrawal comes with a multitude of symptoms such as fatigue, decreased alertness, irritability and general discontent (Chaunie Brusie, 2017).

4. Effects of caffeine on the central nervous system

80% of the adults of the US population consume caffeine on a daily basis, yet what many may not know is that it is a central nervous system stimulant - as well as the most widely consumed - which has countless affects on your body (Natalie Olsen, 2018) Contrasted with the widely believed myth that it’s sole purpose is to keep you awake, the diagram below outlines some of its symptoms as well as long-term effects.

Caffeine is considered to be a psychostimulant, which can lead to serious health issues if consumption is not monitored regularly, as it has proven to have the same central effects as cocaine and amphetamine; classical psychostimulants. A psychostimulant addiction is a recurring brain disease in which compulsive drug-seeking and drug-taking behaviors persist despite serious negative consequences. (J.-X. Li, 2017) According to research done by Sergi Ferre since the early 1990s on the mechanism of action of caffeine on the central nervous

system, caffeine increases motor activity and although its reinforcing effects are not as strong as those of the classical psychostimulants, it has both arousal and reinforcing effects, however its mechanism of action is different.

5. Effects of caffeine on the cardiovascular system

Studies have shown that caffeine has a visible effect on the cardiovascular system. The stimulatory effects of caffeine intake may cause the heart to beat faster, increase blood pressure or lead to the development of arrhythmia (problems with the heart rhythm) Research has clearly indicated that the physiological effects of caffeine in relation to the cardiovascular system are a result of its ability to stimulate the nervous system, according to Gonzaga et al (2017). Caffeine is known for its structural similarity to adenosine receptors, acting as an antagonistic blocker. When caffeine blockades these adenosine receptors, autonomous nervous system activity is increased, inducing tachycardia and increased blood pressure.

According to Turnbull et al (2017), existing literature suggests that moderate caffeine intake (400-600 mg per day) is not associated with increased risks of heart conditions such as cardiovascular disease and arrhythmia. Populations who are at risk for hypertension may be more sensitive to some effects of caffeine. It is not possible to identify the point at which caffeine intake may cause harm to the cardiovascular system however, as data on the effects of daily intakes greater than 600mg is currently limited Caffeine seemingly blocks a hormone produced by the body to keep the arteries wide open, narrowing blood vessels and raising blood pressure. Caffeine intake could cause blood vessels supplying blood to the brain to narrow by as much as 27%, impairing mental ability.

6. Conclusion

To conclude, this essay has explored both the positive and negative effects of caffeine on the human body and mind, ranging from sleep deprivation, addiction and its effects on the central nervous system alongside the cardiovascular system

Eating Disorders, the obsession that haunts our youth

Dalia Petric

An eating disorder is defined as ‘any of several psychological disorders (such as anorexia nervosa or bulimia) characterized by serious disturbances of eating behavior’ ( Merriam-Webster, 2021) The surge in eating disorders in the past decades has unfortunately targeted adolescents, the 17- to 18-year-old age group had the highest prevalence (3%) (Journal of the American Academy of Child and Adolescent Psychiatry, 2010) This is due to the hyper-admiration of social media’s influencer’s, through marketing ploys, endorsements and advertisements that result as a form of sponsorship. The single pattern that continues throughout these influencers, is their idolized conventionally attractive features that fit into western norms. Young adolescents already experience ‘developmental challenges’ which include ‘dealing with the physical and psychological changes in puberty; moving toward increased psychological and physical autonomy’ (Attie, Brooks-Gunn & Petersen 1990; Smolak & Levine 1996) Due to the increased sense of self and independence adolescents should begin to understand their passions and independent aspirations that are not as a result of peer or parental influence. Alongside, as a result of the thriving age of social media, the ‘identity crisis’ in teenagers has increased dramatically, as “Social media creates an environment where disordered thoughts and behaviors really thrive,” The Dove Self-Esteem Project says. This identity crisis relying primarily on body image today, when reflecting on Erikson’s stages of psychosocial

development, stage 5 ‘Identity vs Role confusion’, teenagers are so enamoured today in what their ‘role’ is meant to be from even more accessible influencing on social media by ‘influencers’.

Due to these delicate stages during puberty, it is vital for adolescents to be nourished with optimal nutritional needs, as the body begins to form into the final structure that it sustains throughout adulthood. Both physically, emotionally and socially. As most importantly your body needs the gonadotropin-releasing hormone (GnRH) to be released from the hypothalamus that happens at the primary stage of puberty and adolescence. Teenagers who become deficient in GnRhH and do not complete puberty results in a lack of sexual development and infertility

Firstly, anorexia nervosa is an emotional disorder characterized by an obsessive desire to lose weight by refusing to eat, defined by Oxford Languages The ‘glorification of thinness’ by ‘ fear of fat that leads to dieting is a primary risk factor for eating disorders, which are the third most chronic illness among American adolescent females (Fisher, Golden & Katzman 1995). The most prominent disorder is anorexia nervosa, which includes restricting calorie count and reducing body weight to adhere to the 'glorification of thinness’. The dangers of anorexia, bulimia and

other malnutrition causing disorders is that they damage the: Cardiovascular system, Gastrointestinal system, Neurological system, Endocrine system and potentially result in fatalities When the body consumes fewer calories than needed, your body proceeds to break down its own tissue to use for energy. Muscles are the first organs to break down, most dangerously breaking down the cardiac muscle of the heart This is why blood pressure begins to drop as the heart has less energy to contract strongly with to pump blood around the body, as well as fewer mitochondrial muscle cells to sustain a strong pumping heartbeat. As a cause of this, people with malnutrition disorders are at a higher risk of heart failure and strokes due to blood pressure levels decrease. Their heart becomes malnourished first, consequently by the blood being the primary supplier of energy by oxygen, the rest of the person’s organs and organ systems begin to deteriorate as well due to the lack of energy (fuel).

Patients with bulimia, ‘an emotional disorder characterized by a distorted body image and an obsessive desire to lose weight, in which bouts of extreme overeating are followed by fasting or self-induced vomiting or purging’, defined by Oxford Languages, suffer from electrolyte loss as well. Due to purging, the electrolyte potassium is depleted, its role is to help the heartbeat and muscles to contract, however without it, the heart begins to lose its strength and ability to pump blood around the body. Excessive electrolyte imbalance can lead to arrhythmia, heart failure and death

Secondly, the gastrointestinal system goes into a state of heavily slowed down digestion known as gastroparesis. This is due to the lack of food and vomiting that harms the stomach’s ability to excrete food through the stomach and falter the digestive system’s ability to absorb nutrients.

This diagnosis usually leads to, large amounts of stomach pain and bloating, nausea and vomiting due to the inability to keep food down as it is foreign to the body, weakened intestine muscles that prevent the ability to propel digested food out of the body. In extreme cases, laxative abuse can create a dependency, so that the body needs them to create bowel movements. Another risk is the development of pancreatitis, inflammation of the pancreas, which causes nausea and vomiting. Overall, plenty of other infections and diseases can result as a cause of damaging the gastrointestinal system, many being fatal if left untreated

The neurological system, being one of the most essential body systems, is severely defected by malnutrition as well. Your brain’s neurons need electrolytes, (potassium, chloride, calcium, sodium) to send electrical and chemical signals to the brain and body. Severe dehydration and an electrolyte imbalance can lead to seizures and muscle cramping. Meaning if the brain and blood vessels can’t push enough blood to the brain, it causes dizziness and fainting. Additionally, the brain consumes one-fifth of the body’s calories, self-starvation and erratic eating results in the brain not getting enough energy, causing it to obsess over food and developing an inability to concentrate. This also can develop into everybody dysmorphia and insomnia, where the body cannot fall asleep due to being extremely hungry and always thinking about food

Finally the endocrine system, due to the decrease in fat and healthy cholesterol the body needs, levels of hormones fall. Especially dangerous in adolescents as in females, lowered sex hormones means menstruation begins to decrease, become irregular or fail completely

causing amenorrhea. Not only does this cause potential non-reversible infertility, but also osteoporosis, increasing the likelihood of fractures and stressed bones.

For males infertility can also occur as a result of lowered testosterone levels, preventing the maturity of the reproductive system. In both sexes, the thyroid hormones also fall, reducing your metabolic rate by your body trying to reserve energy. This can completely disrupt your body’s rate of reaction and become cemented into a stagnant state of being unable to provide energy to your whole body, as it is consistently trying to reserve it This deteriorates the body’s function and results in extreme fatigue and inability to cope with daily life activities.

Overall, we must raise awareness for our youth to engage in consistent activities of self-love. We cannot allow adolescents to spiral into a fatal cycle of obsession with body image, by the influence of social media and its highly unrealistic standards of beauty. As young people between the ages of 15 and 24 with anorexia have 10 times the risk of dying compared to their same-aged peers (Smirk et al. 2012). Adolescents in society will be at the forefront of the working force eventually, they must comprise of strong emotionally and physically capable soldiers to adhere to the world’s ever changing combats and needs of brighter minds and innovative ideas.

Should we make attempts to change the human genome?

Shaz Raja

During a pandemic, it has been asserted that we, as a species, have encountered many hurdles – as well as overcome just as many difficulties. Thus, as we enter a new a recuperating age with vaccine distributions beginning, we must reflect on what has enabled us to come this far. Since the era of the plague, society has made many scientific advancements in technology and medicine, and had it not been for such developments, it is unlikely that any of us would even be reading this article. Hence, I pose a question, the next logical step in human advancement and one that has seen reluctance and scepticism: “Should we make attempts to change the human genome?”.

The notion of “making attempts to change the human genome” leeches onto the fundamental doctrine of recommendation and/or obligation such that an action ‘should’ be done if there is a perceived benefit, whereas it ‘should’ not be done in the reverse scenario. The answer, therefore, lies in the evaluation of ‘benefit’ and ‘disadvantage’ –corresponding to a ‘good’ and ‘bad’ As this scenario exists in the realm of biological advancement and medical applications, the foundational pillars underpinning evaluation will be that of bioethics: beneficence, nonmaleficence, justice, and autonomy; upon which further considerations may be noted. The motivations for changing the human genome fall broadly into two categories: gene therapy, and gene enhancement. Whereby gene therapy constitutes an “introduction of exogenous genes into cells with the goal of ameliorating a disease condition" (with some adding the prospects of

prevention) gene enhancement may be inclusive of that which “improves bodily condition or function beyond what is needed to restore or sustain health”

However, with these distinctions, there remains room for discourse on what constitutes a “disease condition”, or “function beyond what is needed to restore or sustain health”. For the sake of this piece, however, these nuances as well as those on ‘normality’ and ‘disability’ cannot be covered. Furthermore, the means of changing the human genome can take place in two strata of cells: somatic cells (nonheritable) and germline (heritable) cells. In contrast to germline cells, changing the human genome in somatic cells creates effects biologically constrained to the individual in which such edits take place and this is already being clinically trialled. However, changing the human genome in germline cells carries on such changes in the progeny of such individuals – requiring greater consideration

Therefore, in the case of genomic modification in somatic cells (SCGM), it may be argued that gene therapy in these cells is comparable to any other type of medication or treatment Offering treatment that may reverse a harmful genetic allele to one that is not, gene therapy, under the ethical pillar of beneficence could even be seen as an obligation to provide gene therapy to persons for whom it is the best, or only, course of treatment – persons who would otherwise have their health compromised.

However, such a procedure may not conform to the remaining pillars such as in the premise of autonomy and SCGM in foetuses. The debate of ‘personhood’ (when a foetus is considered to have rights) is outside the scope of this piece and thus, following the English law, one can state that a foetus, is not considered a ‘person’ prior to 24 weeks, and thus, the issue of autonomy and informed consent is waived (as SCGM in foetuses would take place in the earlier stages of development). To follow, even if the foetus were to be considered a ‘person’, a foetus cannot be considered Gillick competent and so treatment, assessed under beneficence and non-maleficence, merely requires maternal consent (as in the case of foetal surgery).

Furthermore, when approaching germline cell genomic modification (GCGM), it may be used to prevent the transmission of inherited genetic diseases; however, an immediate objection to this is that alternatives exist e.g. not having children, adoption and using donated germ cells Nonetheless, this does not satisfy some parents’ desires to have genetically related children where IVF (in vitro fertilisation) with PGD (preimplantation genetic diagnosis) may be utilised instead However, some object to the discarding of unused embryos (as done in PGD) and PGD is not a viable option where all or a majority of embryos will be affected (e g Huntington’s disease); in such situations, GCGM may offer an alternative Likewise, GCGM is merely an extension of SCGM that allows the prevention of hereditary diseases that cannot be treated by SCGM (e g those prevalent multiple tissues like cystic fibrosis). In some cases, for genetic disorders that are fatal, it allows birthing children with longer predicted lifespans. Thus, under the pillar of beneficence, GCGM should take place if such a condition can be resolved and it is in interest of the foetus.

Despite the pillar of beneficence in SCGM and GCGM, conflict arises considering the ethical requirement of non-maleficence: SCGM has not been proven to be entirely safe accurate nor effective, and there has been associated deaths In addition, for GCGM, it cannot be said to be able to effectively treat conditions due to issues such as mosaicism. Hence, on one hand one can suggest that the human genome should not be edited, as it’s efficacy or toxicity cannot be proved; on the other hand, it can be asserted that further genome editing should occur in laboratories on human tissues and embryos to advance understanding. Despite so, although SCGM has not been proven to be entirely safe due to the prospects of off-target effects and side-effects resulting from limited accuracy –such errors in DNA replication occur naturally (e.g. the reason for many genetic conditions in the beginning) and it has been suggested that since the rise of CRISPR-Cas9 genome editing technology, it offers accuracy that is increasingly similar to, or more accurate, than natural replication. Mosaicism, on the other hand, may be overcome by carrying out such genome editing in the genomes of gametes directly before fertilisation.

Moreover, although GCGM may alleviate potential financial/emotional burdens on individual families (an incentive under the pillar of beneficence), a continuation of a lack of research (as identified above) leads to possible effects on the human gene pool if certain alleles are removed which may be a factor in natural selection (e g positive selection of sickle-cell anaemia and protection). However, were GCGM carried out, it would only be for the treatment of a few diseases such as Tay-Sachs as not enough genes have been directly identified as disease-inducing: thus, not having an effect on the human gene pool.

Correspondingly, it may even be considered unjust to reject GCGM under parental autonomy as they already determine the genetic makeup of the child (by selecting mates). However, socially it may present risks of alienation and anguish as children are seen as ‘constructed products’ that are naturally ‘not enough’ – possibly even leading to a greater compromise in psychological and social health (e.g. depression, anxiety). Another thought exists that GCGM may be utilised under the pillar of justice to provide equality to those whose ascendent traits put their progeny at a disadvantage

Furthermore, objections to gene therapy exist due to the probability of leading to gene enhancement; occurring as such editing could be considered ‘unnatural’; however, this argues on the fallacy that natural is superior (e.g. diseases themselves are natural). In fact, some transhumanists hold it to be an extension of evolution such that humans are defective in their requirements and cognitive ability – it is ‘natural’ to improve them (e.g. caffeine). Likewise, objections to gene enhancement suggest the demarcation of social advantages (e.g. plastic surgery) as it may start to be considered ‘unfair’ to those without such modification Further objections relay the prospects of eugenics and an intolerance of disability; however, these are probabilistic thoughts and ignore the precedence that strict regulations and sanctions in place may prevent such results

Be that as it may, the concept of ‘engineering’ children is distasteful and as political theorist Michael Sandel once wrote, “to appreciate children as gifts is to accept them as they come, not as objects of our design or products of our will or instruments of our ambition. Parental love is not contingent on the talents and attributes a child happens to have”.

Thus. this concurs that although such potentials exist, parents should still limit modifications to that which is ‘therapy’, and not ‘enhancement’ – as doing so may lead to a cumulative culture that

views humans differently.

In conclusion, one cannot deny the notion that we should make attempts to change the genome, however, there may objections in how we change the genome. Attempts to change the human genome in laboratory settings should be allowed as it may increase the efficacy and toxicity of treatments of disease that may benefit the population However, the question of modifying the genome in clinical settings rests on identifying at which point the maleficence outweighs the beneficence and how carefully it may monitored for its intended purposes under the ethical consideration of justice (e.g. therapy).

'Designer babies' a medical breakthrough or a horror awaiting to happen?

Foteini Kalamatianou

Introduction

Advancements in technology have allowed scientists to combat many issues in the world of medicine over the course of the past few decades Genetic engineering and ‘designer babies’ have successfully been used to address problems such as disease inheritance and harmful genome mutations. However, as time and technologies progress, gene altering and characteristic selection will inevitably raise the question as to where the limit to the pursuit of human perfection should be placed As fascinating as this technology might sound, there can be a dark side to it. One thing is for sure: stepping into the world of genetic engineering is like cracking the door ajar to a Pandora’s box and a single mistake can irreversibly affect the entire gene pool of humanity.

1. The Human Genome and Gene Editing

The human genome is incredibly complex. Our biological traits are a result of many genes intertwining and creating the organism as we know it. Alleles are different types of the same gene which contribute to an individual’s genotype and phenotype, meaning its genetic makeup and physical features Different alleles predetermine each organism’s characteristics; however, they vary from human to human creating genetic diversity Genes, however, can also cause diseases, specifically in terms of inherited alleles from previous generations

These diseases can range from genetic disorders such as haemophilia and cystic fibrosis, to communicable ones such as HIV. Scientists have tried to use the concept of genetic engineering as a response to dealing with these disorders and develop technologies that can remove ‘faulty’ alleles and DNA sequences from the body Designer babies are, by definition, babies that are genetically engineered in vitro (IVF) for specially selected traits. Essentially, it can be described as a form of selective breeding in humans Genetic engineering via designer babies in our current time is predominantly seen as a tool to eradicate medical disorders.

However, genes also determine our visible characteristics, such as eye colour, height and the shade of our skin, which are regulated by the alleles inherited when individuals are born. By developing the field of gene editing, many experts believe that science will steer away from treating disease and, instead, focus on assembling a superhuman being possessing all traits deemed to be desirable by society.

2. Current technology

Most methods being used by researchers at the moment do not actually involve editing the genome, but rather selecting the best choice of embryo for the parents to use due to medical necessity. The common ground between all these methods is that they are carried out through screening or manipulating embryos through IVF.

Preimplantation Genetic Diagnosis (PGD) is a popular and simple method which does not require gene altering. PGD has been used as treatment in instances of gene-specific inherited conditions or sex-linked disorders in the past During IVF, early-stage embryos are screened for indications of the genetic condition and the most suitable one is selected and transferred to the womb for fertilisation.

Another emergent technology is that of “Threeparent babies”, where the mitochondrial DNA of the original fertilised egg is replaced by that of a donor, ultimately preventing issues such as muscular dystrophy and certain heart diseases, giving the baby three genetic parents.

The most controversial procedure currently being developed is CRISPR Cas-9 (Clustered Regularly Interspaced Short Palindromic Repeats), a process discovered in the sequence of bacterial DNA after researchers studied the behaviour of bacteria under attack from phages, where they stored viral genes in a location called CRISPR and used Cas-9 proteins to cut out dangerous DNA. It is a clean and cheap technique that allows precise edits to any gene by altering DNA sequence CRISPR is regarded as a scientific breakthrough. In PGD cases, the embryos that are available for selection have a specific range in the quantity of genes provided, as there are limitations to the types of alleles parents carry. With CRISPR, scientists can theoretically insert and replace any gene into the organism. This opens up the possibilities of gene manipulation to much more than disease prevention or the phenotype of a baby.

Although the above technologies can create countless possibilities for science, further understanding of the human genome is vital before they can safely be used.

3. Concerns and regulations

Genetic enhancement has been described as the first stride towards disease eradication, that would provide collective benefit within society and would potentially contribute to the end of human suffering. Supporters of genetic engineering argue for a world with less diseases and disabilities, higher lifespan, a better quality of life, and less discrimination within society. In essence, it is argued that it would give everyone a fair chance in life. However, what if the opposite takes place? Genetically modified humans would alter the genome of the entire species, and hence creating one baby would cause an impurity to be passed on to the entirety of the human gene pool. Everyone will be affected regardless of their stance on the field

In addition, as gene editing technologies progress and become accepted by society, the notion of handpicking characteristics (from gender selection and enhanced intelligence to specific physical features and abilities) could lead to the point where it might be considered as unethical to refrain from using such technologies, as it would condemn children to preventable suffering Temptation to use genetic enhancement would increase significantly and many have predicted a ‘turning point’ where moving past it would lead to a world where non-perfect humans will be rejected based on their lack of characteristics or traits. Hence, segregation and inequality will increase, putting those without the financial means to acquire these characteristics at an immense disadvantage regarding jobs, education, and social interactions. However, it can be argued that the hierarchy in modern society is already largely structured based on peoples’ prejudices predominantly regarding sex, colour, race and religion. For this reason, many believe that any discrimination created by

genetic enhancement would merely add to an already unjust system.

As for the rejection of ‘natural’ humans, this is already happening to an extent when it comes to childbirth and deciding pregnancy. In Europe, 92% of pregnancies where down syndrome (the most popular genetic malfunction) has been detected, have led to an abortion.

At the moment, genome editing for human reproduction purposes is illegal in most countries. For decades, the ban on genome editing has been considered a red line that scientists should not cross The world was shocked upon announcement of the first gene-edited babies being created by Dr. He Jiankui, a Chinese doctor, in November 2015 when he reported the birth of twin girls Lulu and Nana with man-made Cas5 protein mutations, claiming to have achieved HIV immunity for the children. The scientific community received the news with great scepticism and scientists around the world called for a five-year moratorium on gene-editing.

Fairly recently, certain countries, including the UK, have permitted scientists to genetically edit human embryos for purely research purposes and for a maximum of 14 days after which all embryos must be destroyed. In the UK, the Nuffield Council on Bioethics recently concluded that the potential use of genome editing could be ethically acceptable in some circumstances if the welfare of the person who may be born is secured and does not increase disadvantage, discrimination or division in society Could the above actions be showing a shift of perspectives regarding the debate on gene editing overall? Forming a conclusion in relation to the control measures that need to be placed on genome editing will be largely dependent on society’s stance regarding the ethical perspective of the debate. As is the case with most subjects charged

with ethical dilemmas, all arguments, either in favour or against, are based on mere hypotheticals, making it difficult to determine the “right” answer.

Conclusion

The prospect of genetic engineering is developing alarmingly fast Technology should not be seen as ‘per se’ problematic. It is up to humans to create strict, collective regulations on an international level, binding for all, that clearly draw the line on the procedures to be allowed At the moment, a sensible action would be to place a moratorium on most technologies. Limitations caused by the uncertainty of the safety of technology should be a top priority amongst researchers. Spreading awareness to the public to be able to fully realise what is at stake is imperative. Considering a bottom-up approach and factoring the opinions of society is vital in making decisions, as governments should strive towards collective benefit rather than positional growth that would inevitably be created in certain scenarios (due to gaps in class, wealth and education) On the other hand, banning all actions connected to genome manipulation would cause secretive and reckless behaviour from scientists that are keen on developing the field. Instead, research should be allowed, strictly following predefined regulations, which would provide a sense of openness and transparency, allowing the government and researchers worldwide to form suitable and intelligent decisions.

The Illusion of Battery Powered Nicotine

Nour Mahmoud

Its chemicals invaded everything they were, from a sickly yellow film over their skin to the air in their lungs. Its recent discovery provides an enigma surrounding its dangers and long term effects acting as a safety blanket for those reckless and naive enough to place their body, mind and health second. Vaping and E-cigarettes. What are they? What are their effects? Are they less harmful than traditional cigarettes? Who is the target audience for the cause of the rapid outbreak of vaping and e-cigarettes? You might be wondering why I chose to explore this topic rather than so many other seemingly more interesting medical topics and the answer is simple. I cannot deny that I have a strong passion for medicine, not only because it is immensely satisfying to know that the concept of working a medical problem would ultimately lead to the better health of individuals but also because of the constant and rapid change in medical research and discoveries. Insights provided by medical research everyday continue to unravel the molecular workings that underpin disease leading to significant headway in constantly advancing medical knowledge. However, my love for medicine aside, I chose to bring vaping and ecigarettes to your attention due to its rapid rise among teenagers and young adults. Therefore as a teen who knows many that resort to the usage of vaping as a coping mechanism or as a way to fit in or be socially compatible/accepted into a group, this topic resonated deeply with me and I felt compelled to inform and educate and increase awareness. Knowledge is power, as the saying goes

As our nation strays away from traditional smoking as we come to terms with its negative impact and its link to increased health effects from heart disease to problems with the immune system [CDC,2017], we’ve come to find new and modern ways to ease the transition from traditional cigarettes to not smoking at all such as the invention of vapes and e-cigarettes The e-cigarette as we know it today didn’t show up until a chinese smoker and pharmacist named Hon Lik invented it in 2003 [Brueck, 2019] Around 2006, ecigarettes were introduced to Europe and it wasn’t long before they spread nation-wide However, medically the World Health Organization stated in 2008 that “no rigorous, peer-reviewed studies have been conducted showing that the electronic cigarette is safe and effective in nicotine replacement therapy”. Nevertheless, this hasn’t stopped people from experimenting and trying this mix of propylene glycol and/or vegetable glycerin (called PGVG), which vaporizes and delivers drugs, along with any chosen flavors which is evident in that at least a quarter of teens in the US today say they’ve tried vaping, while 6% of high schoolers vape regularly [Brueck, 2019] Moreover, due to the largely unregulated ecigarettes industry, it’s difficult to know what exactly is in a single vape with many experts suggesting that there could be the presence of dangerous chemicals lurking in some vapes Due to the experimental aspect of vaping, medical research is still scant however some initial studies suggest that there may be serious and life-threatening consequences to vaping. [Vaping Rises Among Teens, 2019].

CDC, the U.S. Food and Drug Administration (FDA), state and health departments, and other clinical and public health partners are investigating a national outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI).[CDC,2019]. Although there are many unknowns about vaping including how they affect mental and physical health in the long term, emerging data suggests link to chronic lung disease, asthma and cardiovascular disease [Blaha, 2015]. As of February 18th 2020, a total of 2,807 seemingly healthy patients other than their use of ecigarettes have been hospitalized and 68 dead with 15% of patients under the age of 18 [CDC, 2019]. Published case reports have detailed a range of specifically severe pulmonary illnesses among those who have reported use of nicotine or cannabis extracts in e-cigarettes [Layden et al ,2019] Those who have been diagnosed with vape-related lung injury experience symptoms including rapid onset of coughing (85%),breathing difficulties,weight loss, nausea (66%) and vomiting (61%) and diarrhea(44%) attributed to a buildup of oil and/or white blood cells in the lungs. [Northwestern Medicine Staff, 2019] [Layden et al ,2019] Moreover, vape-related lung injury caused common intensive care unit admission for respiratory failure and 26% of all patients underwent intubation and mechanical ventilation.A lthough the definitive cause or causes of lung injury remain unknown, the severity of the illness and the recent and rapid increase in the incidence of this clinical syndrome indicate that these cases represent a new or newly recognized and worrisome cluster of lung injury related to vaping [Layden et al.,2019].

Furthermore, the health dangers of the use of vapes and e-cigarettes goes beyond pulmonary or lung-related illnesses or diseases it has also been linked to cardiovascular disease.

Research has demonstrated that e-cigarettes raise blood pressure and heart rate, change the artery walls so that they become stiffer and less elastic, and inhibit the function of blood vessels by damaging their lining. Each of these four effects are risk factors for blood clots and fat build-up inside artery walls which can cause severe heart attacks.[www.escardio.org, 2020] In fact, a 2017 survey found that the odds of a heart attack increase by 42 percent and odds of suffering from a stroke by 30 percent among ecigarette users compared to non-smokers [www.pennmedicine.org, 2020]. Additionally, coronary artery disease and circulatory problems, including blood clots, were also much higher among those who vape 10 percent and 44 percent higher, respectively. Furthermore, the health dangers of the use of vapes and e-cigarettes goes beyond pulmonary or lung-related illnesses or diseases it has also been linked to cardiovascular disease.

Not only does vaping and e-cigarettes have detrimental effects on physical health, it also has negative side effects on a user’s mental health. Vaping with or without nicotine has been shown to impact impulse control, especially in young adults whose brains have not fully developed yet. Some of these risks include mood disorders and permanent damage to parts of the brain responsible for memory, emotion and critical thinking. [Change to Chill, 2019] Nicotine is a highly addictive substance that can have a grave impact on the underdeveloped brain of a middle school or high school student. The areas of the brain that deal with cognitive and emotional processing, mainly the prefrontal cortex, are at greatest risk of long-term damage from nicotine exposure“The prefrontal cortex is largely responsible for things like thinking through a decision, sustaining attention, evaluating consequences, and having the ability to control impulses,”says Hart Wylie, psychiatric nurse-practitioner

at Canopy’s Center for Excellence. “If this area of the brain is damaged, you may see several problematic behaviors, including difficulty sustaining attention and focus, making poor decisions, acting erratically, and personality changes.” [Canopy Children’s Solutions, 2020] Furthermore, the addictive nature of vapes and e-cigarettes cause physical and emotional consequences, due to the fact that nicotine is considered a gateway drug, when a teenager or young adult becomes addicted to a substance, that very substance remaps how their brain works. This, in turn, creates a vicious cycle of dependence which, depending on a child’s tolerance level, can start as early as the first couple of vaping pods used. Changes to the developing brain alters an individual’s threshold for addiction, making it much more likely that a teenager may experiment with cigarettes, alcohol, or harder drugs in the future.

Once again, a reiteration of how currently relevant and important this is to discuss is the use of vapes and e-cigarettes and its link to COVID. Teenagers and young adults who vape face a much higher risk of COVID-19 than their peers who do not vape, a new study has found. Vaping is linked to a substantially increased risk of COVID-19 among teenagers and young adults, according to a new study led by researchers at the Stanford University School of Medicine [digitale@stanford edu, n.d, 2020] Certainly we know that vaping itself can lead to inflammation and profound lung disease, as well as to a malfunction of the immune system in the lungs. Therefore we would expect that those who vape may be much more susceptible to pulmonary complications following a COVID-19 infection. [Outbreak, 2020] Not only does COVID impact a person who vapes and uses ecigarettes more severely but it also increases

the spread of COVID. If a person who smokes or vapes has COVID19, but does not show symptoms, they are more likely to spread the COVID-19 virus through coughing. Moreover, smoking and vaping involve hand-to-mouth contact. This makes it easier for the virus to spread from their mouth to their hands and onto other surfaces. [Massachusetts General Hospital, 2020].

In conclusion, we as a community need to curb the spread of this “vaping” epidemic and as a whole be ready and have the power to start this conversation. First and foremost is education for both teenagers and their parents Teenagers obtain most of their knowledge on e-cigarettes from social media and their peers. One in three adolescents in the U.S. still consider electronic cigarettes to be less harmful than traditional combustible cigarettes It is imperative and so important to combat this that teens are given accurate information on e-cigarettes. [Jones and Salzman, 2020] We cannot allow the illusion of battery powered nicotine to cloud our judgment or provide us with a deceptive appearance or impression.

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