AMAZON ADVENTURE: A CASE STUDY IN MEDICAL TECHNOLOGY AND BIOETHICS

Bobbi Swain and John Nishan
Woodrow Wilson Biology Institute

Introduction

In this exercise you will test your problem-solving skills, your ability to see connections, and your ability to draw conclusions and inferences from information provided in this case study. The case involves some of these ideas:

• medical technology - using organisms and biological processes to aid in the treatment of human disease or disorders.
  
  
• epidemiology - the investigation of the causes and spread of diseases.
  
  
• pharmacology - the study of the origin, extraction, and use of drugs.
  
  
• bioethics - examining the risks, benefits, and consequences of biological research and application in order to establish priorities and conditions for the survival of the global ecosystem and its human inhabitants.
  
  
• ethnobotany - the use of plants and their properties in relation to a culture or group of people.
  
  

The Scenario

Joy Rhodes and her husband, Fred, are pharmacologists and epidemiologists and have been "prospecting" (searching) for and developing drugs for many years. Although their previous work had been in Africa, they have decided to make a trip to the Amazon rain forest at the suggestion of Barbara Morgan, an anthropologist whose parents worked as missionaries in the area for 25 years. Barbara has found a village of people called the Iboti, who have had little or no contact with the modern world.

On the visit in 1985, Joy and Fred communicate with the Iboti using Barbara to translate the language. In the village, many of the people are ill with a disease they call akalua hisbanani, roughly translated to mean "that which weakens the body and drains it of fluids" or "wasting sickness." The disease is not new to the Iboti. Chills, fever, diarrhea, vomiting, fatigue, and a rash across the abdomen are the symptoms. For many years, it has been successfully treated with a tea made by boiling the leaves of the noa tree. Joy and Fred decide to take blood samples to investigate the cause of the disease since symptoms indicate that it is probably viral or bacterial in origin. They take leaf samples from the noa tree as well as many other specimens identified by the natives as having medicinal applications. They carefully record the names of the plants, the parts used, and the particular ailments treated.

They take plant specimens and blood samples to the United States where Joy and Fred work at Baltimore University Hospital with grants from Phillips Pharmaceuticals, the National Institutes of Health (a federal agency) and Colco Oil Company.

Part One

Exercise I

Individual: Place yourself in the role of one of the investigators. You now have frozen leaf samples and blood samples in the laboratory. List some of the initial procedures or experiments that you would undertake. (5 - 10 minutes)

Exercise II

Group: Share your list of initial procedure with members of your group. Work together to combine your lists to be shared with the rest of the class. (10-15 minutes)

Exercise III

Class: Each group shares its lists so that similarities and differences can be noted. (Remainder of period)

Part Two

Joy and Fred have identified six isolates from the "chemical tea" extract from the noa plant leaves. A chart appears below. In addition, they have classified "wasting sickness" as viral in origin and have tentatively named it wasting sickness virus or WSV. A picture of the virus is shown below:

Table of Noa Leaf Chemical Isolates
Pathogenor Cancer Cells	Isolate A	Isolate B	Isolate C	Isolate D	Isolate E	Isolate F
Staphylococcus aureus	-	-	-	-	-	-
Hepatitis B Virus (HBV)	+	-	-	-	-	-
Mumps Virus	-	-	-	-	-	-
Breast Cancer	-	-	-	+	-	-
Prostate Cancer cells	-	-	-	-	-	-
Herpes Virus	-	-	-	-	-	-
Wasting Sickness Virus (WSV)	+	-	-	-	-	-
	+ stops growth			- no effect on growth

Exercise I

What conclusions or inferences can be made form the table and information given above? An inference is an idea which seems to be implied in the results but was not tested or observed directly. An inference can become a hypothesis for a later experiment.

Exercise II

1. Joy and Fred decide to pursue isolate A as a treatment for Hepatitis B. What would be the next steps?
   
   
2. HOW should the drug be obtained? What benefits and problems are associated with growing the plant natively versus growing it in another country? Also, what factors need to be considered when planning to build a facility to extract the active ingredient(s) from the leaves? Is there an alternative to the extraction process?
   
   
3. If Phillips Pharmaceuticals gets FDA approval to market the drug, what environmental and ethical issues should be considered?

Part Three

Consider the following scenario which might have occurred. Joy and Fred Rhodes find that the treatment of "wasting sickness" contributes to an increased incidence of miscarriages due to one of the other active ingredients which is not related to the treatment of "wasting sickness." The high rate of miscarriages occurs in those women who took the plant remedy when they were children. Apparently the active ingredient stays in the system of these children and manifests its presence when they reach childbearing age. It (the chemical) contributes to low overall birthrate and a problem with the social status of the woman's husband . The tribe values children and a family with only a few children is not considered to be blessed by their God. Furthermore, none of the other isolates identified by Joy and Fred has been found to have any significant value in treating or curing other global diseases or cancers.

1. Should the scientists allow the natives to use the plants, knowing that it contains an ingredient not necessary to cure the "wasting sickness" but contributing to the abnormally high incidence of miscarriages?
   
   
2. Consider that "wasting sickness" does not afflict people outside of this particular region. What if, in working to synthesize the isolate artificially, the Phillips Pharmaceutical Company determines that it is unprofitable for them to manufacture this drug on a small scale, and the demand is not large enough to mass produce the drug. Should they still produce this drug, knowing that it will help the Iboti? Do they have a moral obligation to do this?
   
   
3. The use of plants is commonly tied to religious practices. Suppose this plant is used by the religious leaders of this tribe. When prepared in a different way and used as part of a religious ceremony the leaf extract is found to cause a strong predisposition to another ailment, such as colon cancer or kidney failure. Should the tribe leaders be encouraged or forced to stop the use of the plant?
   
   

Questions for Further Thought

1. The term "serendipity" is relevant to this situation. Look up its meaning and suggest why it applies to this case, particularly in relation to the isolates produced from the original "tea." Can you cite other examples of scientific serendipity?
   
   
2. What precautions should be taken by scientists visiting the tribe to ensure that pathogens uncommon to this area are not introduced into members of this tribe? And, if pathogens are introduced into the tribe, what responsibilities should the scientific community have to treat the diseases which have been introduced?

Further Reading:

Diamond, Jared, "The Arrow of Disease", Discover, October, 1992.

Biodiversity Prospecting, World Resource Center, May, 1993.

Teacher Outline for Presentation of Activity

Introduction

This exercise is designed to be a beginning activity for the first day or two of classes. It can also be used as a problem-solving activity at other points.

It is suggested that you provide a diagram of a virus to represent WSV or "wasting sickness" virus. This can be a modified one of hepatitis B virus since the case data indicate that they are similar. A map of South America would be helpful to show the location of the Amazon.

It is also recommended that you view the National Geographic film "Secrets of the Amazon" to get background for this exercise. It portrays the work of Walter and Memory Lewis, whose experience provided the basis for this hypothetical model. It can be shown to students at the end of the activity. Some possible responses are given for Parts One and Two. This list is not meant to represent the full range of responses. The questions in the student guides are intentionally broad. Due to the nature of the Questions in Part Three, no responses are provided.

Part One:

Leaves:

1. Boil the leaves according to instructions provided by the natives.

2. Analyze the tea for chemical content; and categorize the components.

3. Test each ingredient on some known viral and bacterial pathogens.
   

Blood:

1. Isolate pathogen or disease agent from blood. Students may bring up Kochís postulates.

2. Compare it to known pathogens to see if it is a disease already characterized.

3. Isolate antibodies from blood to characterize particular antigens of the disease.
   

Part Two

Exercise I:

1. Perhaps the Hepatitis B virus and the wasting sickness virus are related?

2. Isolate A is the chemical that cures wasting sickness.

3. This plantís isolate might be used to treat breast cancer. It certainly should be investigated.

4. Other cells, viruses, and bacterial should be exposed to the isolates.
   

Exercise II:

1. 1. Perform tests on laboratory animals; toxicity, dosage, controls.

   2. Human trials in later stages.

   3. FDA approval
      

   
   
   

2. 1. Go to the village and surroundings in South America to get leaves. Set up a factory that collects leaves and refines extract.

   2. Do all work in South America or ship extract to U.S.

   3. Use genetic engineering (recombinant DNA) and forget the rain forest.
      

3. 1. Effect of "leaf mining" on rain forest ecology.

   2. Do village people get any of the profits?

   3. How abundant is the plant? Is it widely distributed in the Amazon?
      

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