IDIS173

(yle)

For many, the post-march 2020 to 2022 COVID-era was a time of relaxation. I can attest that waking up 2 minutes before school, rolling over in bed and logging in, then going back to sleep was bliss. But being confined to our homes and having our movement restricted wasn’t so fun for many others. Protests, riots, and civil unrest called to question whether the idea of “quarantining” was ethical. Let’s take a deep dive into whether infringement of civil liberty and quarantining, were truly hand in hand.

Quarantine, originating from the Italian  ‘quarant(a),’ historically referred to isolating ships for 40 days during plague outbreaks to prevent the infected from entering plague-overrun cities (Dr. Duffin – 14th Century Black Death Vodcast). Citizens would offer jugs of water/food to starving passengers, unknowingly infecting them with plague-causing fleas. This led to outbreaks on ships, as people didn’t realize the correlation between these actions and the spread of disease due to the lack of germ theory understanding, thus causing this measure to oftentimes not work well (Dr. Duffin – 14th Century Black Death Vodcast). Milan was famous for its very low mortality rate due to their draconian law that forced any family with even 1 sick individual to be permanently bricked up in their home, condemning everyone to death (Dr. Duffin – 14th Century Black Death Vodcast).While such extreme measures don’t exist today, there’s still pushback to quarantining.

(UNCTAD)

One major argument against quarantine, is the economic downturn. The cumulative global GDP loss over 2020 and 2021 attributed to the pandemic and the national quarantining was estimated around 9 trillion dollars (The Great Lockdown). In Canada specifically in just April of 2020 alone unemployment rose to 7.8%, the highest Canadian average in over 4 decades, and over 10% of Canadians suffered severe financial impairment (BlackRock – Guarding the Impact of Covid-19 on the Canadian Economy) homeless increasing by 20% in many communities across Canada (Everyone Counts 2020-2022). This highlights the negative impact of quarantines on the economy, leading to layoffs for individuals in labor-intensive and non-remote work roles. From homelessness to general financial ruin, quarantines severely damaged Canadian and global economy, who’s effects are still trying to be overcome today.

(abc news – Governments Dealing with Protests)

Another major argument about quarantine was the infringing of autonomy and invasion of privacy, along with the coinciding mental health effects. People were told that they couldn’t leave their homes unless absolutely necessary. Not going to work, school, to the movies, religious establishments infringed on one’s freedom of assembly, freedom of religion and right to education. Lets be honest, online school while nice, for many kids was a subpar option that left them without support. Protests for social causes were often violent suppressed due to social distancing laws. Fearmongering by overexaggerating statistics, and especially right-wing media outlets spreading falsehood conspiracy theories only exacerbated the widespread fear.

(COVID-19 Science Advisory)

My initial stance on quarantines and liberty curtailment were that they were necessary, and it remains so. By March 20, over 1000 COVID cases were confirmed in Canada; 3 days after quarantine orders were established (cp24 – Timeline of Events). Although cases and deaths increased over the next 2 years, without such an early implementation of quarantine it would have been much worse (NIH – Health Effects of Quarantine). People fail to see, that while wide-scale death and anarchy may not have happened in front of their eyes, thus making quarantining feel pointless, in many places around them, and the world, it was happening. In India, COVID-19 spread had spread so bad partly due to refusal in following quarantine laws, that people would die outside hospitals waiting for oxygen tanks, and cremations sites would be set up in parking lots because of massive cadaver influxes (Vox – India’s Mass COVID-19 Cremations).

(Financial Accountability Office of Ontario)

I see the limitations of my view, where people have certain rights stripped. However the major limitation of the flipside, is increased mortality. The primary argument I agree with “against” quarantining, is the economical one. For that I have 3 policy recommendations. One, is reciprocal aid. Governments should provide aid to those most affected by emergency laws impacting livelihoods and freedoms. Things like food, shelter, educational support, and some type of workers compensation (International Monetary Fund). For us to lose our civil liberties, and bear the penalties is fundamentally wrong. The second policy recommendation, is further flattening COVID-19 spread. Countries should invest in health systems, equitable vaccine access, and maintain stringent measures like lockdowns to combat COVID-19 spread (International Monetary Fund). There’s no tradeoff between saving lives and livelihoods, and only after an economy can “reopen” (by adequately reducing cases) is there any true hope for fiscal rebound. Lastly, we should implement less restrictive regulations before quarantine, focusing on hygiene, targeted isolation, and public education on COVID-19 risks. We should all remember, that even amid a health crisis, a balance is essential between preserving our fundamental rights and saving lives.

 

(DTCA – All About Lawsuits)

From diabetes to arthritis, we all want to cure our health issues. But does our desperation give pharmaceutical companies the right to advertise directly to us? Let’s explore DTCA (direct-to-consumer advertising), and all its’ shades of grey.

(ResearchGate)

DTCA is the practice of pharmaceutical companies advertising their products directly to their target population, through the internet television, or other media (Health Charities Coalition of Canada). Canada’s FDA prohibits DTCA by preventing the promotion of any drug as a cure, treatment or prevention to serious diseases like cancer, diabetes, etc. (DTCA in Canada – NIH). Despite government regulation, at the end of the day shouldn’t it be every business’s right to advertise their product? Not exactly. Over 20% of new Canadian drugs receive ‘black-box’ warning (having caused severe side-effects/death) after airing ads, highlighting the importance of DTCA regulations (DTC prescription Advertisements in Canada). The back and forth of companies wanting to advertise, while considering the seriousness of the product is primarily why this such a controversial social issue.

(Pharma Marketing Network)

(ResearchGate)

Deciding whether DTCA should be allowed or not, requires considering both sides of the argument. One reason against DTCA is over-prescription. Three Canadian studies between 2000-2002 found that 48% of physicians didn’t agree with DTCA drug referrals, yet still prescribed them for the patient’s peace of mind (DTC advertising and prescribing), demonstrating serious impact on patient care and prescription patterns (DTC advertising and prescribing). This over-prescription directly impacts healthcare costs. Because so many government-led programs pay for brand-name prescription drugs, vastly more expensive than generic counterparts, these schemes utilize increasingly higher amounts of tax dollars (Dangers and Opportunities of DTC Advertising). Less money goes into resolving bigger health determinants like SES/food deserts, which more immensely impact health.

Another major issue is misinformation. When ads list dangerous side-effects like the visuals try to illicit classical conditioning (Public Health Effects of DTC Drug Advertising). Someone happily playing with their dog gets associated with the drug, demonstrating the manipulative tactics used to lure people into becoming ill-informed customers. A study from the US found that amongst 97 advertisements, 0% provided adequate information regarding risks, and over 13% promoted an off-label use, which isn’t allowed as per FDA rules (Dangers and Opportunities of DTCA) demonstrating the manipulation DTCA uses to draw attention away from risks, towards the over-exaggerated benefits. While perhaps beneficial in some ways, DTCA manipulates vulnerability for profit.

(AAMC)

While reasons against DTCA are valid, many reasons support it as well. When drug dispensaries first became publicly available, it revolutionized healthcare by giving people the opportunity to take charge of their own health, which is something I believe we take for granted today (The Emergence of the Drug Dispensary – Module 5). DTCAs are also excellent at informing the public about their treatment options. A study in 2004 found that 73% of physicians believed that DTCA helped their patients ask more thoughtful questions (DTC Pharmaceutical Advertising – NIH). This encourages conversations between patients and physicians thus improving disease awareness and health outcomes (Direct-to-Consumer Advertising and the Patient–Prescriber Encounter – NIH). In today’s 15-minute appointment world, people taking initiative for their health and reaching out to doctors allows for better health literacy/discourse, and quicker treatment (Understanding Health Literacy – CDC).

(Propulsid – Myportfolio)

Organization like the FDA claim to “maintain comprehensive surveillance of medications to both consumers and physicians”, however many examples show it’s not enough. Propulsid was a gastric reflux drug heavily marketed to US consumers for 7 years before it was “black-boxed” due to high incidences of fatal heart arrythmias (DTC Pharmaceutical Advertising). Janssen the parent company, marketed Propulsid as a magic bullet; a drug only affecting the disease/issue and harming nothing else in the body (Magic Bullet Treatments – Dr. Duffin). Just looking at the advertisement, manufacturers used misleading graphs to lure consumers, while in fine print stating that it actually showed no effect in clinical trials. This demonstrates a clear example of DTCA being fatally misleading, and why it’s wrong.

Overall, I oppose DTCA. DTCAs sometimes use ghost-written studies where clinician academics ”co-investigate” heavily biased studies, but publish results as “properly conducted” (Ghost Management and Ghost Writing – Module 5) causing disease mongering by creating a demand for an issue that isn’t really there (Disease Mongering – Module 5). This leads to many drugs being ‘black-boxed’ with parent companies under-advertising risk and over-advertising benefits; why YOU need THIS drug NOW. Perhaps combatting DTCA misinformation requires imposing stricter regulations and gaining a better understanding of our healthcare system and our doctors’ choices. Decreasing prescription dependence, and increasing herbal medicine consumption can also help (Plant-Based Treatments – Dr. Duffin). Normally for a cold, instead of taking pills I drink “haldi doodh”, an ayurvedic plant-based drink that combats inflammation, to feel better.

I acknowledge that all DTCA pharmaceuticals aren’t inherently “evil”; and ultimately it’s up to the consumer to “talk to their doctor and see ­­if ___ is right for them”. However, DTCA poses risks like over-prescription, and manipulative/misinformed advertising which harm patient care, and strain healthcare systems. This is why I believe it shouldn’t be allowed.

Alamy – Drug Addiction Concept

Hit after hit, the agonizing, insatiable urge never ceases. According to the NIDA, addiction is a chronic disorder that’s “characterized by compulsive drug [and alcohol/medication] [mis]use despite [knowing] adverse consequences” (NIDA- Drug Misuse and Addiction). I believe calling addiction a disorder undermines the severity of its physical effects… ones that do more than just “disrupt normal body functions” (verywellhealth). Let’s take a deeper look into addiction: disease vs disorder, shall we?

ResearchGate

Following in Vesalius’s footsteps, “pathologists” Bonet and Morgagni were critical in the development of nosology away from religion, toward pathology. Bonet’s contributions to abnormal anatomy were pivotal in creating Morgagni’s “Seats and Causes of Disease” (Pathology In Pre-Modern and Modern Eras) which connected disease to physical anatomical changes deviating from normality (Pathology In Pre-Modern and Modern Eras). Modern pathology not only looks at a specific anatomical/bacteriological disease elements, but the cause and effect. For substance-use addiction, dopamine is fired in the brain, creating euphoria that reinforces the consumption of the substance enticing it (NIDA – Drug Misuse and Addiction).

CSUH – Substance Use Costs In Canada 2020

When classifying disease, the Hippocratic triangle (representing a disease concept) teaches us that amongst the 3 facts of disease (illness, patient, and observer) (Disease Triangle), the observer has most importance in defining the condition (Pathology From Antiquity To the Renaissance – Dr. Duffin). Dr. Duffin states how pathologists discover diseases by recognizing symptoms, assigning an anticipated cause and finding a treatment/prevention or outcome (Pathology From Antiquity To the Renaissance – Dr. Duffin). All these can be identified for addiction. Encouraging more dialogue in the medical community can help those who have power to reconsider their definition and shine a spotlight on the severity of addiction, saving lives.

 

Alongside helping, medical professionals can delay constructive action when physiological cause-based theory is used to describe addiction. It encouraging patient blaming and stigma propagation with terminology like junkie, or clean instead of not using (Stigma of SUD – Drug Misuse and Addiction PHAR100). Such language causes isolation and societal shame when asking for help, thus preventing outreach (Theories of Disease). Labelling addiction as a disease would bring validity to concerns, and courage to the afflicted for self-advocation. With 47000 deaths linked to substance abuse yearly (addictionhelp – Canadian Addiction Statistics), defining it as a disease can help change attitude toward its seriousness; improving treatments, saving lives and uplifting voices reaching for support.

CCSA – Canadian Drug Summary

When looking at why substance-use addiction shouldn’t be considered a disease, let’s understand why people misuse. Neuroscientist Carl Lewis states that addiction isn’t a disease, but rather “deep learning triggered by stress or alienation… unlearned [with] stronger synaptic connection[s]” (NDARC UNSW Sydney). I can mostly agree with his belief, as it essentially states that ontological cause-based theory contributes to addiction (Theories of Disease). External (ontological) factors like abuse, isolation, and peer pressure increase your likelihood of developing substance-use addictions (Mayo Clinic – Drug Addiction). Regarding internal genetic factors, Professor of health Dr. Suzanne Fraser states, “geneticists… acknowledged that genes [are] too complex to [be addiction’s main] cause” (NDARC UNSW Sydney). It’s possible that social issues encouraging addiction are too interwoven to understand, so we overstate genetic contribution to stop people from feeling guilty. Tackling instead the social issues that encourage addiction is more proactive in its treatment/prevention and possibly, wholistically better for the afflicted.

statcan – Primary Health Care Providers

In 2023, the Canadian government pledged $359.2 million over 5 years for a “renewed Canadian Drugs and Substances Strategy” (Government of Canada). Before we rush to put more money into research/awareness for addiction, we must ensure current resources are adequately distributed to necessary levels of our health care system for everyone. Did you know that almost 15% of Canadians claim to not have a regular primary physician (Statistics Canada)? Classifying addiction as a disease could put excess strain on the system, decreasing quality of care for others. Organizations like CAMH devoted to addiction research/treatment/social destigmatization while calling it a disorder, further shows me the unnecessity of labelling it a disease. Some professionals claim addiction’s “cause” to be a dopamine hypothesis (Dopamine Hypothesis – Drug Misuse and Addiction PHAR100) meaning that since it isn’t a definitive cause, addiction can’t be a disease. Furthermore, addiction being self-inflicted and not necessarily having a physical cause (a tumor, virus, etc.) denies it disease classification (Is Addiction A Disease of a Choice? – americanaddictioncenter).

CBC News – Thousands of Canadian drug users dying as government red tape limits help, advocates say

Regardless of it being a disease or disorder, addiction causes serious suffering to millions of Canadians yearly. I see the physiological cause-based theory hurting people by instilling stigma, while recognizing that addiction is already medicalized (Medical Model of Disease Today), and support systems are currently in place for willing participants. I also understand the limitation of protecting 47000 lives lost yearly, to the immorality of sacrificing healthcare quality for 40 million people. Overall, the continual rise of substance misuse (increasing incidences of addiction/death) (NIH – Drug Misuse In Canada), makes considering it a disease the right choice. However, instead of stretching an already tight budget, let’s expand the wallet and fill it with societal reform and monetary contributions for research/treatments. Changing mindsets is something we can start today, so let’s get to it!

 

Image from: Animals Australia: Australia’s Secret Primate Experiments

Animal experimentation has always been vital to our survival and scientific advancement. During the Renaissance, trapping mice in vacuum seals led to the discovery of oxygen being the key to our survival, allowing doctors to better understand organ systems (Physiology In the Renaissance Period – Dr. Duffin). The rise of Positivism saw beliefs moving away from theology, toward real observations. Francois Magendie conducted experiments that involved removing animals’ organs and keeping them alive to see how their bodies adapted (Physiology In the Pre-Modern Period – Dr. Duffin). This progressed the field of physiology, and helped in the discovery of different disease treatments.

Image from: Animals in Biomedical Research: What They have Given Us and What We Owe Them

Animal experiments since, have saved lives around the world. For the anti-emetic Thalidomide, it was only after being tested on pregnant animals and observing babies born with severe deformities that the FDA banned its sale across America, saving many babies from lifetimes of suffering (Animals in Biomedical Research). This shows the unequivocal importance of animal experimentation to human life.

Past ethical failures like the Tuskegee experiments saw disadvantaged Black populations lied to about receiving Syphilis treatment. Public health services justified it as a “study in nature [of the disease]” and purposefully let hundreds of people die (McGill: 40 Years of Human Experimentation in America: The Tuskegee Study). Such events, along with eugenics-based genocide in Nazi Germany sparked the creation of strict regulations, such as the Helsinki Declaration, for human and animal welfare in modern clinical trials (Animals in Biomedical Research). Animal experimentation not only saves human lives, but we actively uphold animal welfare standards.

My opinion on this topic however, is that animal experimentation is generally wrong. I decided to talk to my friend about this issue, and here’s what she had to say:

I believe that animals have moral worth independent of their usefulness to humans, and that their basic interests should have similar consideration to ours (PETA – Why Animal Rights). This concept leads me to the three Rs of animal experimentation used today. They describe the need to reduce animal involvement, replace them when possible with other methods, and minimize their suffering (Animal Use Alternatives 3Rs). This proves that within the scientific community, people already acknowledge that animals are worthy of moral consideration. A researcher at a UK university said “I’d spend entire [days] just breaking necks…and being part of their suffering left me feeling like there wasn’t much point in my existence” (VICE news). Researchers suffering perpetrator-induced trauma gives me a glimpse into how violent experiments truly are which only strengthens my opinion against animal experimentation.

In my opinion, animals are fundamentally people. If we consider a person to be someone who can feel emotions, sensations and have complex thought, animals would have personhood, thus affording them more legal protection (TEDx Cambridge: Are There Non-Human Persons). But they don’t. Why? Peter Singer, a famous philosopher, said “if possessing a higher degree of intelligence [doesn’t] entitle one human to use another for his own ends, how can it entitle humans to exploit non-humans?” (Britannica – Peter Singer). The speciesism prejudice humans show in treating other humans better than non-human animals, is no different than one type of human being owned and exploited by another, on the basis of race. I mean, how would you feel if your freedom was stolen?

Image from: Our Compass: The High Cost of Animal Testing

Image from: Cavendish Historical Society News

Alexis St. Martin was a Canadian indentured servant who was experimented on by physician William Beaumont (Alexis St. Martin: A Hole In the Stomach). Dr. Beaumont healed his abdominal gunshot wound, saving his life. Afterwards, he often forcefully experimenting on the fistula it left, making Alexis suffer. Alexis claimed many times that he didn’t want to live like a guinea pig, and that he owed Dr. Beaumont something but not his whole life (Physiology in the Pre-Modern Period – Dr. Duffin).  When researchers provide animals with “sanitary environments” or other basic needs as a sort of justification to experiment on them, how is that any more ethical than Dr. Beaumont saving Alexis’s life yet forcing him to endure what he had to?

Image from: Animal Research at Queen’s

When I went vegan, my shift in perspective scrutinized not just my dietary choices but how I supported industries that harmed animals. However, the only instance in which I do “support” animal experimentation is when it’s vital to our survival (American Psychological Association). Getting vaccinated, or taking certain medicines saves millions of lives, and the animals’ sacrifices are taken for granted. This is why I realize that my stance still causes immense suffering, and there are many limitations to it. How do researchers decide which types of medicine are worthy to be tested on animals, or how to quantify harms vs benefits?

Image from: Cruelty-Free Kitty: How to Spot a Fake Cruelty-Free Logo

In my daily life, I do my best in making mindful choices such as always buying cruelty-free personal products thus denying money to companies perpetuating unnecessary violence. As experimentation methods advance, animals’ roles in medicine will slowly be omitted. Until a “liberation” day arrives, I believe everyone must make ethical decisions, yet value human life.

Image from: (What Are the Benefits of Thinking About Your Own Death?)

Death is sacred. When someone dies, it reminds us all of the finite existence of our lives and helps put into perspective how much we matter to each other. I want to know, that my time on this planet, in some ways, left it a little better for others than before I was here. One way I plan on doing that is by donating my body. More specifically, for research and anatomical purposes (ex. practicing procedures in hospitals, and dissection in medical schools).

Video from: (Ted-Ed Video: Ancient Rome’s Most Notorious Doctor)

Throughout this module, I learned a lot about the evolution of human dissection and body donation trends, and attitudes. During the Renaissance, Vesalius’s contributions to the world of anatomy, defying Galen’s religiously believed observations highlighted anatomy’s importance in medicine. He claimed “You [can’t] rely on other people to do it for you [anatomical dissections], you will never make any observations” (Dr. Jackie Duffin, Anatomy in Renaissance Period). Yet, people were wary of donating their bodies for religious, and dignity reasons (due to the likes of Burke and Hare, body snatching, etc.). The shift in attitude toward dissection came within the past century, as medical schools and research facilities changed the narrative around body donation. After their use, bodies began being returned to the families, or if unclaimed, given honorific burials. Throughout history, without human dissections, countless surgical techniques, medicines, and more would never have been discovered. So many discoveries have yet to be made, so why should we assume the importance is any less today? “It’s a tribute to the [medical] profession that they’ve been able to reassure…[dissection] is an important and respectful activity” (Dr. David Jones, 500 Years of Human Dissection). This is important toward my decision as the mistreatment of my body is a big reason why I’m against using it for public education.

Image from:(Ontario Science Centre, Exhibitions)

Seeing mistreatment happening for myself, helped me decide against public donation. When I was around 8 or 9 years old, I used to love going to the Ontario Science centre with my family. One weekend, we happened to go during a Body Works exhibit. That day onward, human body models, Eyewitness books, and anatomy “label the blanks” filled my bookshelves. I can appreciate from my experience how important these exhibits can be in igniting a flame of passion within people.

Image from: (Ask Gramps, Is There an Official Position on Donating One’s Body to Science?)

That being said, my fear of misuse outweighs this benefit. These exhibits blur the line between art, science, and freakshow (Dr. David Jones, 500 Years of Anatomy). I would have to agree. I can still vividly remember all those years ago, people pointing to the exhibits at and laughing; making comments and mocking the way they looked. Continuing with the lens of misuse, I am particularly concerned about the actual misuse of my body, not just people’s perceptions. In 2016, Calgary opened Canada’s first “body coupling” exhibit showcasing human bodies recreating sexual acts (CBC News – Body Coupling). The vulnerable bodies in these situations were once people, who trusted their bodies would be treated with respect… clearly, they weren’t. Donating my body for medical purposes would omit this risk. I believe everyone is deserving of basic humanity, and I’m not personally willing to subject myself to the risk of not receiving it.

Image from: (Daily, Public Dissection)

When I was interviewing my friend, she asked me a question that took me aback. “Given that there already are very detailed anatomy textbooks and resources, is it still necessary to donate”? I remembered Dr. Mackenzie telling a story of how a surgeon asked a medical student to point out the ureter on an open body, but they couldn’t because they thought the ureter was yellow (how it’s commonly shown in anatomy textbooks and in virtual labs). (Dr. Les Mackenzie, Learning Anatomy). When I had my first ANAT100 cadaver lab, I was so captivated by the body, I instantly realized the important of hands-on training.

I attest to learning more realistically from the cadaver than our paperback content (ex. being better prepared for bellringers where real specimens are often used). That being said, there is a time and a place for easy to understand diagrams/models and I find them a necessity when first learning about anatomy. These situations played a role in my decision as educating our future doctors/health professionals is indirectly helping improve health care. This is something people don’t often think about as things like organ donation are widely more popular.

And while I acknowledge that my organs would save lives, I believe it’s equally important that doctors/students have opportunities to practice their skills. This is why I would prefer donating my body to more anatomical/medical purposes, and not just donating organs.

Image from: (TalkDeath, Donating My Body to Science)

I find solace, knowing that after death, I’ll still be contributing to better the world. They say “[a body donor’s] legacy is that they’re allowing skilled people to go on and… be able to [alleviate human illnesses]” (University of Newcastle representative, The Body Donors). If possible, donating body for anatomical, and then procedural purposes would be ideal!