Replicating GM Viruses in Cancer Therapy; A Conflict of Emotions?
Ruth Mampuys* and Sabine Roeser**
*Netherlands Commission on Genetic Modification, 3720 AN Bilthoven, The Netherlands
**3TU.Centre for Ethics and Technology, Philosophy Departments of Twente University and TU Delft, Jaffalaan 5, 2628 BX Delft, The Netherlands
The use of genetically modified (GM) viruses to cure diseases is a fast developing and promising field. Besides biosafety and ethical concerns, public opinion will also becomemore important as replicating viruses are used as therapy. Not only the risk/benefit considerations of the patient, who might have nothing to lose, will play a role, but also those of the general public, who might be unwillingly confronted with these viruses if they accidentally spread into the environment. Based on experience with social debates about other medical treatments and GM-technologies, it is reasonable to assume that patients will mainly focus on the benefits and downplay the risks of this new therapy while the general public may have a blind spot for the possible benefits and will focusmainly on the risks. These biases can cause tension in the embedding of this new technology in society. In this article we develop recommendations on how to develop a risk communication that diminishes these biases, in order to enable people to make a well-grounded ethical evaluation of the use of GM viruses. We argue that emotions such as hope, empathy but also fear and disgust should be taken into account in order to facilitate an ethical risk communication about GM viruses.
-  K. Rowan, “Oncolytic viruses move forward in clinical trials,” J. Natl. Cancer Inst., Vol.5, 102(9):590-5, Apr. 26, 2010.
-  S. Meerani and Y. Yao, “Oncolytic viruses in cancer therapy,” European Journal of Scientific Research, Vol.40, No.1, pp. 156-171, 2010.
-  E. M. Karapanagiotou, J. D. Chester, H. S. Pandha, G. M. Gill, M. C. Coffey, K. Mettinger, and K. J. Harrington, “A phase I/II study of oncolytic reovirus plus carboplatin/paclitaxel in patients with advanced solid cancers with emphasis on squamous cell carcinoma of the head and neck (SCCHN),” J. Clin. Oncol., 28:7s, 2010.
-  E. Galanis, L. C. Hartmann, W. A. Cliby, H. J. Long, P. P. Peethambaram, B. A. Barrette, J. S. Kaur, P. J. Haluska Jr, I. Aderca, P. J. Zollman, J. A. Sloan, G. Keeney, P. J. Atherton, K. C. Podratz, S. C. Dowdy, C. R. Stanhope, T. O.Wilson, M. J. Federspiel, K.W. Peng, and S. J. Russell, “Phase I trial of intraperitoneal administration of an oncolytic measles virus strain engineered to express carcinoembryonic antigen for recurrent ovarian cancer,” Cancer Res., Vol.70, No.3, pp. 875-82, PMCID:2890216, Feb. 2010.
-  C. Sheridan, “Gene therapy finds its niche,” Nature Biotechnology, Vol.29, 2-121-128, 2011.
-  J. B. Connolly, “Conditionally replicating viruses in cancer therapy,” Gene therapy, Vol.10, pp. 712-715, 2003.
-  T.Würdinger, “The development of tumour-selective Coronaviruses as anti-cancer agents,” PhD thesis, 2005.
-  D. Ferber, “Gene therapy: safer and virus free?,” Science, Vol.294, No.5547, pp. 1638-42, 2001.
-  D. Koppers-Lalic and R. C. Hoeben, “Replication competent nonhuman viruses for use in clinical gene therapy: an inventory study,” COGEM research report CGM 2010-10, 2010.
-  J. T. Mullen and K. K. Tanabe, “Viral oncolysis,” the Oncologist, Vol.7, pp. 106-119, 2002.
-  E. A. M. Schenk-Braat, M. M. K. B. van Mierlo, G.Wagemaker, C. H. Bangma, and L. C. M. Kaptein, “An inventory of shedding data from clinical gene therapy trials,” J. Gene Med., Vol.9, pp. 910-21, 2009.
-  T. L. Beauchamp and J. Childress, “Principles of biomedical ethics,” New York: Oxford University Press, 1st ed, 1979; 5th ed, 2001.
-  M. Cavazzana-Calvo, A. Thrasher, and F. Mavilio F, “The future of gene therapy,” Nature, 427, 26 feb, 2004.
-  S. Lehrmann, “Virus treatment questioned after gene therapy death,” Nature, Vol.401, pp. 517-518, 7 Oktober 1999.
-  J. Savulescu, “Harm, ethics committees and the gene therapy death,” Journal of medical ethics, Vol.27, pp. 148-150, 2001.
-  R. K. Zimmerman, R.M.Wolfe, D. E. Fox, J. R. Fox, M. P. Nowalk, J. A. Troy, and L. K. Sharp, “Vaccine criticism on the world wide web,” Journal of Medical Internet Research, Vol.7, 2005.
-  A. Tversky and D. Kahneman, “Judgment under uncertainty: heuristics and biases,” Science, Vol.185, pp. 1124-1131, 1974.
-  A. Bowling and S. Ebrahim, “Measuring patients’preferences for treatment and perceptions of risk,” Quality in Health Care, Vol.10, Suppl. I, pp. 2-8.
-  E. Peters, K. D. McCaul, M. Stefanek, and W. Nelson, “A heuristics approach to understanding cancer risk perceptions: contributions from judgement and decision-making research,” Annals of Behavioral Medicine, Vol.31, No.1, pp. 45-52, 2006.
-  J. Costa-Font, E. Mossialos, and C. Rudisill, “Optimism and the perception of new risks,” Journal of Risk Research, 12:1, pp. 27-41.
-  D. Kahneman and A. Tversky, “Choices, Values and Frames,” Cambridge: Cambridge University Press, 2000.
-  P. Boxal, W. L. Adamowicz, and A. Moon, “Complexity in choice experiments: choice of the status quo alternative and implications for welfare measurement,” The Australian Journal of Resource Economics, Vol.53, pp. 503-519, 2009.
-  B. R. Cassileth, E. J. Lusk, D. S. Miller, and S. Hurwitz, “Attitudes toward clinical trials among patients and the public,” JAMA, Vol.248, No.8, pp. 968-70, 1982.
-  Z. A. Nurgat, W. Craig, N. C. Campbell, J. D. Bissett, J. Cassidy, and M. C. Nicolson, “Patient motivations surrounding participation in phase I and phase II clinical trials of cancer chemotherapy,” British Journal of Cancer, Vol.92, pp. 1001-1005, 2005.
-  D. Wendler, B. Krohmal, E. J. Emanuel, et al., “Why patients continue to participate in clinical research,” Archives of Internal Medicine, Vol.168, No.12, pp. 1294-1299, 2008.
-  L. Jansen, “The ethics of altruism in clinical research in clinical research,” Hastings Center Report, Vol.39, No.4, pp. 26-36, 2009.
-  G. E. Henderson, L. R. Churchill, and A. M. Davis, “Clinical trials and medical care: defining the therapeutic misconception,” PLoS Medicine, Vol.4, No.11, pp. 1735-1738, 2007.
-  J. W. Berg, P. S. Appelbaum, L. S. Parker, and C. W. Lidz, “Informed consent: legal theory and clinical practice,” New York Oxford University Press, 2001.
-  S. Horng and C. Grady, “Misunderstanding in clinical research: distinguishing therapeutic misconception, therapeutic misestimation and therapeutic optimism,” IRB: Ethics & Human Research, Vol.25, No.2, pp. 11-16, 2003.
-  K. P. Weinfurt, D. M. Seils, J. P. Tzeng, et al., “Expectations of benefit in early phase clinical trials: Implications for assessing the adequacy of informed consent,” Medical Decision Making, Vol.28, No.4, pp. 575-581, 2008.
-  L. A. Jansen, P. S. Appelbaum, W. M. P. Klein, N. D. Weinstein, W. Cook, J. S. Fogel, and D. P. Sulmasy, “Unrealistic optimism in early phase oncology trials,” IRB, Vol.33, No.1, pp. 1- 8, 2011.
-  C. Feudtner, “The breadth of hopes,” New England Journal of Medicine, Vol.361, No.249, pp. 2306-2307, 2009.
-  A. J. Lloyd, P. D. Hayes, N. M. J. London, P. R. F. Bell, and A. R. Naylor, “Patients ability to recall risk associated with treatment options,” The Lancet, Vol.353, No.645, 1999.
-  A. Ferrari, “The ethical assessment of unpredictable risks in the use of genetically engineered livestock for biomedical research,” In: The Ethics of technological risk, eds. L. Asveld and S. Roeser, 2009.
-  A. J. Lloyd, “The extent of patients’understanding of the risk of treatments,” Quality of Health Care, Vol.10, Issue suppl. 1, 2001.
-  C. R. Sunstein, “Laws of Fear,” Cambridge University Press, Cambridge, 2005.
-  J. Haidt and J. Graham, “When morality opposes justice: Conservatives have moral intuitions that liberals may not recognize,” Social Justice Research, Vol.20, pp. 98-116, 2007.
-  R. Solomon, “The passions: Emotions and the meaning of life,” Indianapolis: Hackett, 1993.
-  A. Damasio, “Descartes’ Error,” New York: Putnam, 1994.
-  M. Nussbaum, “Upheavals of thought,” Cambridge: Cambridge University Press, 2001.
-  R. C. Roberts, “Emotions. an essay in aid of moral psychology,” Cambridge: Cambridge University Press, 2003.
-  S. Roeser, “Moral emotions and intuitions,” Basingstoke: Palgrave Macmillan, 2011.
-  O. H. Green, “The Emotions,” Dordrecht: Kluwer Academic Publishers, 1992.
-  S. Roeser, “The relation between cognition and affect in moral judgments about risk,” in Lotte Asveld and Sabine Roeser (eds.), The Ethics of Technological Risks, London: Earthscan, pp. 182-201, 2009.
-  S. O. Hansson, “Philosophical perspectives on risk,” Techné 8, pp. 10-35, 2004.
-  N. Möller, “Should we follow the experts’ advice? Epistemic Uncertainty, Consequence Dominence and the Knowledge Asymmetry of Safety,” International Journal of Risk Assessment and Management, Vol.11, No.4, pp. 219-236, 2009.
-  W. I. Miller, “The anatomy of disgust,” Cambridge: Harvard University Press, 1997.
-  D. M. Kahan, “The progressive appropriation of disgust,” in Susan Bandes (ed.), The Passions of Law, New York: NYU Press, 2000.
-  S. Roeser, “The role of emotions in judging the moral acceptability of risks,” Safety Science, 44, pp. 689-700, 2006.
-  COGEM, “Developments in gene therapy in China,” (in Dutch language) COGEM report nr. CGM/060502-01, 2006.
-  J. P. M. Schenkelaars, “International medical tourism from the Netherlands for gene therapy,” COGEM research report, CGM/2010-07, 2010.
-  G. Gigerenzer and A. Edwards, “Simple tools for understanding risks: from innumeracy to insight,” BMJ, Vol.327, No.7417, pp. 741-4, 2003.
-  B. B. Johnson and P. Slovic, “Presenting uncertainty in health risk assessment: initial studies of its effect on risk perception and trust,” Risk Analysis, Vol.15, pp. 485-94, 1995.
-  H. Gottweis, “Gene therapy and the public: a matter of trust,” Gene therapy, Vol.9, pp. 667-669, 2002.
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