examples

Question 1

examples of treatments that are effective but not yet explainable

Answer 1

• traditional eastern medicines (e.g. acupuncture, tai chi/meditation)
• deep brain stimulation is currently the best treatment for Parkinson’s Disease, most effective at improving motor symptoms e.g. tremor
• placebo effect

Question 2

public health act 1988

Answer 2

• legislation for England and Wales which requires physicians to notify appropriate authorities of any person deemed to be suffering from a notifiable disease
• notifiable disease examples: MMR, tuberculosis, meningitis
• this law was used as the legal basis for the regulations that put into force the stay at home order for COVID-19

Question 3

example of when passion and bias has blinded scientists to what has been objectively proven

Answer 3

Sir Fred Hoyle who rejected Hawking’s presentation of the Big Bang theory until his death despite overwhelming evidence (cosmic microwave background)

Question 4

assumptions made by the argument that it is unfair rich people can buy better healthcare than poorer people

Answer 4

• that private healthcare provides better treatment than public healthcare: waiting times may be shorter, but most private doctors also work in NHS, and all use the same scientific knowledge
• that only the rich use private healthcare: health insurance is now widely available with the insurance companies e.g. BUPA and is included with many jobs
• the presence of both systems is actually beneficial to all as it helps NHS with patient demands and waiting times, those who receive private care still pay taxes to fund the NHS, so free up resources for those who are dependent

Question 5

examples of technology that have ethical objections

Answer 5

• use of embryonic stem cells
• genetic editing with CRISPR-Cas9
• use of pig/cow valves for heart valve disease
• blood transfusion

Question 6

examples of technological developments to reduce ethical issues

Answer 6

• induced pluripotent stem cells, doesn’t involve destroying an embryo
• metallic heart valve instead of pig/cow valve
• cell saver devices instead of blood transfusion, collects the blood lost during surgery, cleans it and returns it, disadvantage: lower % of RBCs are recovered than in transfusion

Question 7

examples of creativity in science

Answer 7

• creativity is exploring the original and unusual with imagination and curiosity, straying from the normal way of thinking to solve complex problems
• e.g. Doudna and Charpentier’s discovery of the innovative gene technology of CRISPR-Cas9 taken from the natural mechanism that bacteria uses to fight off viral infections
• e.g. Alexander Fleming’s discovery highlights that scientists have to be flexible and creative. If he hadn’t noticed that the mould contaminating his Petri dish had inhibited the growth of the staphylococcal bacteria, and interpreted this even though it was not part of the initial plan, the life-changing discovery of penicillin would not have come about

Question 8

examples of when doctors withholding information may be acceptable

Answer 8

• withholding bad news from a patient who may not be able to cope with the truth, doctors may feel it is in the patient’s best interests as telling them would only burden them more or lead to psychological damage
• not telling a patient participating in a randomised, blinded clinical trial that they are receiving placebo instead of the drug (although the patient has consented to be in the trial so has technically consented to receiving the placebo)
• being completely honest with relatives would breach the confidentiality of a patient

Question 9

penicillin discovery - example of luck in discoveries

Answer 9

1. a fellow scientist was in the lab below happened to be working with this rare strain of fungi which happened to produce large amounts of penicillin
2. Before going on holiday, Fleming left his dish of bacteria out on the lab bench instead of putting it the incubator
3. While Fleming was away, there was an exceptionally cool 9-day period, which favoured the growth of penicillium mould, after which the temperature rose, stimulating the growth of staphylococcus

Question 10

example of moving from paternalism to patient-centred care

Answer 10

• Bolam test which asks whether a doctor’s conduct would be supported by a responsible body of medical opinion
• no longer applies to the issue of consent in 2015 following the judgement in the Montgomery case
• mentality has moved from doctor focussed to patient focussed
• the patient now decides what they want to know and should be told all relevant risks however small unless patients expresses a wish not to be told

Question 11

example of things that are said to be true but have no physical evidence

Answer 11

• religion, has no material evidence that can be replicated and documented in a scientific fashion,
• the existence of God has not been positively proven (however it could be argued that just because humans haven’t found hard evidence yet, doesn’t mean it is not the truth)
• a person’s testimony - often held as the truth without any material evidence

Question 12

Terrorism Act 2000

Answer 12

-doctors must report to the police any information that might be relevant in preventing an act of terrorism

Question 13

Tuskegee Syphilis Study

Answer 13

• ran from 1932 to 1972
• after being recruited by the promise of free medical care, 600 African American men in Alabama were enrolled in the project
• the men were not given penicillin to treat their syphilis to satisfy the scientific enquiry of the long-term effects of syphilis on the human body
• to track the disease’s full progression, researchers provided no effective care as the men died, went blind, insane or experienced other severe health problems due to their untreated syphilis

Question 14

Evidence based medicine

Answer 14

• the process of systematically reviewing and appraising clinical research findings to aid the delivery of optimum care for patients
• highlights the importance of rigorous, unbiased and well-conducted research
• alternative medicine is not evidence based as there is insufficient proof with regards to its effects
• However, it could be argued that the positivist nature of EBM limits its applicability as it focusses on objectivity and social/subjective factors may be missed

Question 15

changing science

Answer 15

• In medieval times, it was though that imbalances of thefour humours: phlegm, blood, yellow bile and black bile, caused illness: we have now proved this wrong and know that illness can be caused by many factors including pathogens, genetics and lifestyle
• Thalidomide, many doctors prescribed it for morning sickness but after finding out its detrimental effects on babies, it is no longer widely prescribed

Question 16

breaching confidentiality

Answer 16

FOR: -if patient has a notifiable disease

• disclosing information for the greater good of the society (e.g. terrorism)
• disclosing info for good of patient (e.g. suicide)

AGAINST: -goes against patient autonomy and subsequently can cause them harm (violation of non-maleficence)
-can result in loss of patient trust in their doctor and the whole healthcare system which can be detrimental for their health as they may not disclose important info on their own medical problems