Tuskegee Study of Untreated Syphilis

From new developments in mRNA vaccinology to targeted cancer treatments, the United States has made many strides in the medical and research fields. However, these advancements come with a history of unethical trials and experiments, one of which being the Tuskegee study of Untreated Syphilis.

In the early 1900s, there was no known treatment for syphilis, a bacterial infection that can lead to death. In order to study the progression of syphilis, researchers from the U.S Public Health Service promised 600 African American men in Macon County, Alabama free medical care if they enrolled in the project in 1932. 399 of the men had latent syphilis, while the control group of 201 were free of syphilis. These men were told that they were being treated for “bad blood,” which was a common layman term used to generally describe different illnesses.

Penicillin, the recommended treatment for syphilis, became available 15 years into the study. Even with this advancement, the men with syphilis were only given placebos, and the researchers withheld it from the men. As a result, the men went blind, died, or experienced other severe health problems. Though concerns regarding those subjects were raised, the study continued with the ultimate goal being to track all of the participants until they died so their bodies could be analyzed to better understand syphilis progression.

Eventually, the story was leaked to the public and public outrage forced the study to be shut down in July of 1972. When the study finally ended, 28 men had passed away from their syphilis, 40 of the men’s spouses were diagnosed with syphilis, and 100 other participants passed away from complications.

As a result of the Tuskegee study, guidelines were issued to protect human subjects in future experimental research, but many African Americans developed a mistrust of public health officials due to the cruel mistreatment of the men affected. Today, informed consent has been carefully developed as a very important aspect of human subject research. Ensuring that those involved in a study understand its purpose and potential risks and benefits is ethically necessary.

Edited by: Sanjana Anand

Graphic Designed by: Shanzeh Sheikh

References

1. https://www.history.com/news/the-infamous-40-year-tuskegee-study

2. https://www.cdc.gov/tuskegee/timeline.htm

Precision Medicine: A Global Health Perspective

What is the best way to go about the biggest global health problems facing the modern world? Should we focus on the individual and make sure no one is left behind, just like the UN’s Sustainable Development Goals state, or should we try to focus on population health? This problem of efficiency and the methods of approach have been very prominent in global health since the inception of the field, but with the introduction of precision medicine, it makes the decisions for public health officials much more difficult.

Precision medicine focuses on individual patients and updating treatment based on individuals’ backgrounds and specific cases, which allows for a “custom-fit” treatment of the patient. This is great for hospitals and treating patients on a smaller scale, but when the task is preventing the spread of malaria in a region with multiple subpopulations, the benefits of precision medicine become obscure. Due to the individual focus that is associated with precision medicine, the focus on population-level treatment ends up being lost, and in global health, this can be a problem. When treating groups of people or somewhat large populations, cost-efficiency and treatment on a large scale are necessary in order to achieve the goals set by the organization working on a solution. Instead of this policy and implementation efficiency focus, precision medicine works to treat the individuals and ends up losing cost-efficiency with the whole population. The extensive use of genomics, genetics, and computer analysis in precision medicine also fail to take into account the intricacies of environmental and socioeconomic effects that are real challenges in a global health setting. So, even though precision medicine provides a great way to treat individual patients and provides a hopeful future for the treatment of specialized cases, especially in developed countries, it does not have the same effect in the context of a developing country, where cost efficiency and financial burden are all key factors in treating as many people as possible.

Edited by: Laura Wang

Graphic Designed by: Amber Smith

References

Kosorok, M. R., & Laber, E. B. (2019). Precision Medicine. Annual Reviews, 263-286. https://www.annualreviews.org/doi/pdf/10.1146/annurev-statistics-030718-105251

Mentis, A.-F. A., Pantelidi, K., Dardiotis, E., Hadjigergiou, G. M., & Petinaki, E. (2018). Precision Medicine and Global Health: The Good, the Bad, and the Ugly. frontiers in Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5861134/

Role of the Human Microbiome in Precision Medicine

What does it mean to be human? At the fundamental biological level, we all share a core set of DNA contained inside our cells, and the material held in these cells defines us as “humans.” In fact, we have over 30 trillion cells[1] in our bodies. However, it’s not just cells that reside inside of us–our bodies are also home to a vast array of microorganisms. These bacteria outnumber our cells more than 10 to 1[2]–so on a biological basis, we’re really more bacteria than human. Gross.

These microorganisms that live inside of us, known collectively as our “microbiome,” are an integral part of our health and wellbeing, thought to influence everything from gastrointestinal diseases to our immune system. Our microbiome is also constantly changing. We receive our first set of organisms from our mother as we’re born, transferred through direct skin-to-skin contact. As we interact with the world, we pick up different species of bacteria along the way, diversifying our microbiome as we interact with different environments. While our microbiome changes a lot during childhood, these changes become less and less frequent as we age, though we can still change our microbiome as adults. And because each person’s microbiome is unique, these diverse clusters of organisms can act like living fingerprints, not only identifying an individual but also providing information about their health and wellbeing.

Variation in the microbiome is common among all people and oftentimes benign. However, certain variations in the microbiome are associated with diseases, like Crohn’s disease, colorectal cancer, eczema, and acne, among others. One potential method of treatment, or at least mitigation, involves genetically modifying the microbiome. This movement exists in the context of a new era of precision medicine centered around the individual. For example, genetic engineering technologies attempt to modify the human genome, an integral and unique part of each person’s identity. While there are many methods of altering the microbiome, like dietary changes and fecal transplants, neither has the precision of gene editing, the accuracy of which has already been tested in the editing of various organisms using CRISPR-Cas9 technology. We know it’s possible to edit the human genome–but what if we were to edit the bacterial genome inside of humans? Could we restore a healthy microbiome to individuals whose organismal ecosystem is unbalanced and potentially treat dozens of diseases?

Yes–possibly. But there are also potential consequences to editing our microbiome. First, our microbiome isn’t well understood. While there is ongoing research regarding the effects of altering the microbiome and its potential implications, we currently lack a comprehensive understanding about the human microbiome. Given the pervasiveness of the microbiome in our body and its systems, I would argue that it is unsafe to edit the organisms living inside of us.But what about the future? What if we reach a point where editing the microbiome is not only safe but can also act as a potential treatment for a multitude of ailments? Not so fast. We still don’t know the long-term effects of microbiome-alteration, or whether the change is permanent. Additionally, as more microbiome research is conducted, enough data will eventually be gathered that it could be possible to identify a person and their specific environmental history based on a simple swab of their skin microbiome. What does this mean for our privacy as individuals? What does this mean for convicts or others who might suffer from stigmatization and discrimination? What would you do if, with a simple touch of your hand and some lab experiments, someone could figure out every place you’ve visited in the past week?

There are also questions about access. Like genome editing technology, it’s likely that microbiome-editing, if ever approved for medical use, would have a large, competitive market. Access to these elusive tools would be limited to only a few with the financial resources to afford such treatment, broadly excluding most people and worsening pre-existing socioeconomic disparities.

Unlike genome editing technology; however, microbiome-editing has potential group-wide effects. While genome editing at the somatic level only affects the individual who has undergone the treatment, microbiome editing has the potential to rapidly affect hundreds of thousands of people. Edited bacteria could be passed from not only from parent to child, but from person to person via a simple touch or even a doorknob. This ability to pass on genetic changes to others raises strong issues of consent–after all, while one person may have agreed to having genetically-modified bacteria living inside of your body, the others who they come into contact with have not and cannot consent to that invisible and inevitable transmission.

Microbiome editing holds great promise for the future to treat a multitude of chronic diseases. But we should also be cautious as we move forward about the potential harm it could cause to us not only as individuals, but as a society.

Edited By: Elissa Gorman

Graphic Designed By: Eugene Cho

References:

[1] Bianconi, E., Piovesan, A., Facchin, F., Beraudi, A., Casadei, R., Frabetti, F., Vitale, L., Pelleri, M. C., Tassani, S., Piva, F., Perez-Amodio, S., Strippoli, P., & Canaider, S. (2013). An estimation of the number of cells in the human body. Annals of human biology, 40(6), 463–471. https://doi.org/10.3109/03014460.2013.807878

[2] U.S. Department of Health and Human Services (2015). NIH Human Microbiome Project Defines Normal Bacterial Makeup of the Body. National Institutes of Health. https://www.nih.gov/news-events/news-releases/nih-human-microbiome-project-defines-normal-bacterial-makeup-body#:~:text=The%20human%20body%20contains%20trillions,vital%20role%20in%20human%20health.