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Henrietta Lacks is immortal. Or, more accurately, her genome is. The HeLa (short for Henrietta Lacks) cell line is one of the most important scientific tools of the past century. They all originate from the original sample taken from the cancerous cervical tumor of an African American woman in the 1950s. Prior to their discovery in 1951, scientists had never been able to preserve the life of human cells outside the body for a significant amount of time, something crucial to many research questions. Now, labs all around the world can grow HeLa cells, and many do.

Since, HeLa cells have contributed to numerous scientific discoveries that have revolutionized medicine and molecular biology. HeLa cells were crucial in the development of the polio vaccine, in vitro fertilization, the discovery of human telomerase, and most recently the development of the vaccine for COVID-19.

While there is no arguing that HeLa cells are an excellent discovery in science, they also bring with them important concerns about the state of research ethics and genetic privacy.


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Lacks’ cells were sampled without her knowledge at Johns Hopkins Hospital in Baltimore, Maryland during a treatment for her cervical cancer. Scientists had been trying with no success to isolate a human cell line, so when they were taken no one considered that it might work, though at that time they would not have needed permission even if they did. Lacks’ cells were being used in labs all around the world all without her family’s knowledge.

When the Lacks family first learned about the existence of HeLa cells, they were rightfully angry and confused. The Lacks had little to no understanding of what it meant that their family member’s cells were still alive; they did not know if Henritta’s legacy was being mistreated or if they were at risk because of its existence.

The collection and commercialization of the HeLa line has raised a lot of questions and concerns about consent and compensation in genomic research. Informed consent was simply not an ethical concern at the time Lacks’ cells were taken without her knowledge. Lacks’ story is just one example in biomedical research’s long history of experimenting nonconsensually or with misinformation, particularly on at-risk groups such as minority groups or children.

The acquisition of Lacks’ cells, while acceptable at the time, raised further concerns about the importance of permission for use of someone else’s biological samples in research. Much of this concern, particularly in genomic research, comes from the personal nature of one’s genome. In 2013, a German research team published a paper containing the sequence, a genomic analysis, and the RNA profile of the HeLa cell. The Lacks family responded instantly with concerns about such information being publicly available, because as her descendents, they share a significant portion of their genome with Henrietta’s cells. Despites their concerns, the paper remained publicly available until another lab proved that it was possible to gain information about the genetics of family members from data like what was published about HeLa.

Since then, the Lacks family has agreed to the publication of the HeLa genome and the re-release of some of the data, under the condition that the information is in a database for which researchers must request access. The cells are only permitted to be used for biomedical research and the family is not to be contacted. The panel that helps approve access to the database holds one of Lacks’ family members.

The NIH has also been updating guidelines on informed consent and the storing of genetic information in part due to cases like Lacks’. On the bright side, the research community has put in place and continues to update strict policies on what is considered ethical and consensual research as they move forward in collecting samples. But the general consensus indicates that the research community is unwilling to retroactively construct these ethical frameworks for similarly used nonconsensual samples, as such a feat would halt many current projects.

The use of HeLa cells also raises questions about compensation in research. Lacks’ cells led to many lucrative scientific discoveries, but her family remained poor despite the success of these developments. They still are not compensated for work done on HeLa cells. In 1990, the Supreme Court of California ruled in Moore v. Regents of the University of California that cells discarded from a person are not that person's property anymore. At least legally, this suggests that the HeLa cell line is not the property of the Lacks family and they are therefore not entitled to financial compensation.

HeLa cells are arguably some of the most important cells in scientific history. They have helped revolutionize medicine in countless ways. However, they are unfortunately part of medicine’s long history of exploiting under-informed, underrepresented groups. The Lacks family’s work and advocacy has helped drive changes to existing ethical frameworks, making progress in biomedical research more ethical, but it is important that these policies are continuously reviewed and updated so that privacy can continue to be respected as research continues.


Note: If you’re interested in learning more about Henrietta Lacks, I recommend The Immortal Life of Henrietta Lacks by Rebecca Skloot.


Edited by: Eric Lee

Graphic Designed by: Olivia Fu


References


 
 
 

Cleft lip and/or palate (CL/P), where the upper lip is divided at birth and can continue into the hard palate, is one of the most common congenital abnormalities worldwide. This condition affects one in 700 live births globally and is most common in Asia with 1 in 500 live births. Untreated, CL/P can lead to difficulties feeding, breathing, speaking, and hearing, but CL/P can be treated successfully through reparative surgery. Unfortunately, increased cleft lip risk has been found to disproportionately impact those with indicators of lower socioeconomic status, including lack of prenatal care and lower maternal education, and those living in low-resource areas face geographic and economic barriers to quality care access.


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Stigma compounded with a lack of access to the resources needed to care for an infant with CL/P contributes to the number of infants who become orphaned due to their anomaly, particularly in underserved regions. This is in part driven by a lack of available knowledge on the etiology of the condition, especially since cultural beliefs and myths surrounding CL/P continue to persist in Asian and African countries. A study conducted in Kenya on social stigma associated with CL/P found that 19.4% of surveyed individuals believed that CL/P was a result of “evil spirits,” while 46.1% reported not knowing the cause of the cleft. These beliefs were found to contribute to increased prejudice, social exclusion by mothers, and decreased social support from other community members.


Symbolic stigma—the passing of negative moral judgment tied to a chronic health condition—towards children with CL/P and their families was commonly seen in studies among populations in China, Kenya, and Nigeria. Stigma often acts as a barrier to healthcare, and symbolic stigma has been previously studied and tackled in chronic conditions such as HIV/AIDS and epilepsy. Stigma for a health condition is frequently present at a number of levels and settings: institutional, interpersonal, community, and intrapersonal, all of which require targeted approaches for mitigation.


Stigmatized health conditions need to be disassociated from the negative moral valence misattributed to them. Common sources of stigma towards health conditions exist, particularly in underserved regions; thus interventions for health-related stigma have broad applications. Internalized stigma manifesting in feelings of guilt or shame can act as a barrier to healthcare. Stigma on the community level often takes the form of blame and social isolation, which can continue through institutional employment disadvantage. Successful prior interventions in low-resource areas include utilizing community healthcare workers to bring awareness to the existence of stigmatizing attitudes. These individuals can additionally provide families with needed healthcare resources and emotional support, and provide the community with knowledge on CL/P and options for care. Such interactions with community-based workers also decrease social isolation and trends of social exclusion.


The mitigation of stigma needs to take place concurrently with a sustainable increase to access to care. Making stigma reduction a priority is a critical step towards global health equity, which many fail to recognize.


Edited by: Sanjana Anand

Graphic Designed by: Libby Gough


References

  1. Chung, Karen Y, et al. “The Impact of Social Stigma for Children with Cleft Lip and/or Palate in Low-Resource Areas: A Systematic Review.” Plastic and Reconstructive Surgery. Global Open, Wolters Kluwer Health, 28 Oct. 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6846294/#:~:text=There%20are%20still%20children%20with,exacerbated%20by%20barriers%20to%20care.

  2. Kimotho, Stephen Gichuhi, and Fiona Nduta Macharia. “Social Stigma and Cultural Beliefs Associated with Cleft Lip and/or Palate: Parental Perceptions of Their Experience in Kenya.” Nature News, Nature Publishing Group, 15 Dec. 2020, https://www.nature.com/articles/s41599-020-00677-7.

  3. Pulerwitz, Julie, et al. “Reducing HIV-Related Stigma: Lessons Learned from Horizons Research and Programs.” Public Health Reports (Washington, D.C. : 1974), Association of Schools of Public Health, 2010, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2821857/.

  4. “Tools to Survive: Cleft Palate in China.” Journal - Nutrition - Tools to Survive: Cleft Palate in China | Mead Johnson Nutrition, https://www.meadjohnson.com/journal/tools-survive-cleft-palate-china.

 
 
 

Our eyes, an essential part of our sensory organs, allow us to perceive the rich and diverse world around us – but they are more powerful than we think. These mighty machines have the ability to alert us when there is a problem with an organ's function and even signify the onset of diabetes!


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The development of less life-threatening eye conditions, such as cataracts or glaucoma, is a sign of aging. If care isn’t taken, these conditions can progress to blindness. Fortunately, early identification, diagnosis, and treatment can prevent vision loss. In cases where the cataract or glaucoma is severe, a simple surgical procedure can allow the patient to regain sight and confidence in performing their day-to-day tasks. Yet, it is clear there are higher rates of preventable blindness, in marginalized communities, where access to healthcare is poor and there exists an overwhelming lack of resources. The correlation between marginalized communities and high poverty rates suggests that even if such resources were available, many patients would be unable to provide monetary provisions due to a lack of funding.

Fortunately, efforts to address this inequity in ocular health have been greatly aided by the use of telemedicine as an efficient means for patients to acquire service in a low-cost fashion. Engineers from Konyang University in South Korea programmed an application that allows users to track their ocular health with only a smartphone. They devised a means to prognosticate circulatory system diseases by imaging the eye fundus and monitoring the behavior of eye blood vessels. The procedure just requires an adapter that can be installed on the smartphone’s rear camera, which allows the patient to capture the eye fundus and also “align the light source axis of the smartphone and camera at a certain distance." The result is an examination similar to a fundus exam at a doctor’s office.

When the disease-detecting algorithm is run and produces a prognosis, a physician, likely an ophthalmologist, confirms the results. The physician can then validate the results and take further measures if necessary.

This program is still in the stages of being developed. The ultimate goal is to use oculi images fed to AI algorithmic deep learning systems to detect other diseases, including diabetic retinopathy, macular degeneration, and glaucoma. With the hope to revolutionize ocular health, engineers are using technology to invent new ways of diagnosing and treating disease.


Edited by: Eric Wang

Graphic Designed by: Shaily Pal


References


 
 
 

DMEJ

   Duke Medical Ethics Journal   

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