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Lessons need to be learnt in medical ethics from Covid pandemic: Dr Aaron Ciechanover


Nobel Laureate delivers ‘Distinguished Lecture on Bioethics in Medicine at SRHU

By Arun Pratap Singh
Dehradun, 31 Mar: Nobel Laureate and eminent biochemist Dr Aaron Ciechanover today stressed on the significance of bio-ethics in medicine. Delivering a Distinguished Lecture series address at Swami Rama Himalayan University here, today, he highlighted the dilemma on bioethics in the medical profession. He stated that Israel is a relatively small country in terms of population on only 9 million but more than 30,000 cases of cancer of various types are reported every year. Sometimes patients come with terminal stages of cancer and it always remains a difficult task to inform the patient or the family that the patient is going to die. Morally speaking, this fact should not be hidden from the patients or the immediate families, but it has been a tough task. They come to the Hospital with hope and think that everything is fine, but when the MRI or other tests are being conducted, they are a little concerned. When it is found that the disease is incurable and they will die it comes as a shock to the patient and the family. For the doctors, it is a dilemma on how to deal with this and how to tell patients that they don’t have long to live. Here, bioethics comes into picture and doctors need to learn how to deal with this.
Dr Aaron Ciechanover said that, when speaking about bioethics, he would like to remind the people about the Covid pandemic. The pandemic created other problems besides the deaths and the problems specific to Covid. The official death count is 5 million but the recount amounts to around 20 million. Israel, itself, saw more than 14,000 deaths with such an advanced medical system and such a small population. The world was not prepared for this pandemic. There were not enough ventilators to put every needy patient on life support in the world. There were not enough beds in hospitals, not enough doctors. Ventilators were not enough since one needed accompanying medical experts like cardiologists, pulmonologists, etc. So an urgent need arose how to prioritise which people should be put on ventilators and which ones allowed to die. In Israel, in Italy and other countries, some criteria were worked out, based on which over 100 parameters were identified on whether patients were chosen or rejected for treatment and hospitalisation. The criteria involved bioethics. Later, studies revealed that 99 percent of the patients of age 65 years or more with Covid complications died despite ventilators and only the younger ones survived. Hence, this led to what appeared to be cruel decisions not to admit elderly patients.
Dr Ciechanover said that Covid also led to neglect of other medical issues. Hospitals were emptied and many patients with other critical illnesses were asked to go home while a large number of hospitals were turned into Covid Hospitals. The response was led by public panic. Covid was stigmatised to an extent that everything else was ignored because everyone including the governments wanted to get rid of this problem at the earliest. Other critical patients had to suffer a lot and many of them probably died due to resulting neglect. Even issues like climate change were neglected due to the pandemic and many children lost the formative years of education.
Dr Ciechanover further stated that, because of lockdowns and cancellation of flights, people died in Africa because of hunger. New cancer drugs were also delayed by as much as 18 months and this also might have led to deaths of many patients. He also cited the response to vaccines. He said that there was a lot of mistrust and misconception over the vaccines. In democracies, people can’t be forced to get vaccinated but the hesitation was also due to lack of trust in the governments and misinformation spread over social media. This, he said, could be described as ‘infodemic’. He also felt that the mistrust was also on account of racial and other kinds of discrimination. He mentioned a study conducted in the US where it was seen that 27 percent of white population was hesitant and 16 percent was not at all interested in vaccination. On the other hand, 32 percent of black population was hesitant and 40 percent simply unwilling to take vaccines. This mistrust was a result of a long history of racial discrimination. Blacks do not have reasons to trust the whites. They have been used as experiment subjects without their knowledge for decades and cheated by doctors through a horrendous betrayal of the medical oath. He cited experiments conducted on blacks – syphilis research conducted in the US was an example. He said that there are good reasons behind the campaigns such as Black Lives Matter.
He also referred to certain people like Dr Wakefield, who spread a lot of misconceptions about vaccinations in general. He had claimed that many of the problems were result of vaccines and it finally took billions of dollars and decades worth of studies to establish the safety of the vaccines.
The speech was followed by an interesting question and answer session. Some questions were related to his research on characterising the method that cells use to degrade and recycle proteins using ubiquitin, which got him the Nobel Prize. He said that while he agreed that special diets can help to some extent in control of the diseases, but added that he couldn’t really see any direct linkages between controlling protein degradation and nutrition. He agreed that antioxidants may have a role to play and added that these days many rich people paid high amounts of money to get extra oxygen and oxidants to help treat cancer.
In response to another question, Dr Ciechanover said that environmental changes can create problems but he did not see any direct linkage between environmental change and diseases such as cancer. Genes have a far bigger role behind these medical complications, he stressed.
Dr Vijay Dhasmana, Vice Chancellor of SRHU, delivered the welcome address while Dr Vijendra Chauhan, Pro-VC, proposed the vote of thanks. Dr Sunil Saini moderated the question and answer session.
Philanthropist Dr S Farooq, Dr Rakesh Kumar, Dr Rajendra Dobhal, Rakesh Oberoi were also present amongst others.
Dr Seema Madhok was the MC.
A large number of faculty members, students and distinguished guests were present on this occasion.