Enhancing Children against Unhealthy Behaviors--An Ethical and Policy Assessment of Using a Nicotine Vaccine
Sapir Academic College, Israel.Public Health Ethics (Impact Factor: 1.18). 07/2013; 6(2):197-206. DOI: 10.1093/phe/pht006
Health behaviors such as tobacco use contribute significantly to poor health. It is widely recognized that efforts to prevent poor health outcomes should begin in early childhood. Biomedical enhancements, such as a nicotine vaccine, are now emerging and have potential to be used for primary prevention of common diseases. In anticipation of such enhancements, it is important that we begin to consider the ethical and policy appropriateness of their use with children. The main ethical concerns raised by enhancing children relate to their impact on children's well-being and autonomy. These concerns are significant, however they do not appear to apply in the case of the nicotine vaccine; indeed the vaccine could even further these goals for children. Nevertheless, concerns about broadly applying this enhancement may be more challenging. The vaccine may be less cost-effective than alternative public efforts to prevent tobacco use, utilizing it could distract from addressing the foundational causes of smoking and it might not be publically acceptable. Empirical research about these concerns is needed to ascertain their likelihood and impact as well as how they could be minimized. This research could help determine whether behavior-related enhancements hold promise for improving children's health.
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ABSTRACT: Background and AimsThe ongoing development of novel nicotine vaccines makes it urgent to identify the normative questions around this innovative health technology against smoking.MethodsA qualitative thematic analysis of peer-reviewed papers on nicotine vaccination published between 2001 and 2013.ResultsIn the scientific discourse, nicotine vaccination is presented in a neurobiological frame as a potent concept for (long-term) smoking cessation. Nicotine vaccination is also considered a hypothetical strategy to prevent nicotine addiction in minors. Ethical assessments are conducted for the use of nicotine vaccination in public health and clinical medicine. Whereas vaccination for primary prevention is usually associated with public health, the hypothetical case of nicotine prevention in minors is also assessed for individualized protection. Therapeutic and preventive applications are given uneven attention: the classic goal of vaccination (primary prevention in minors) receives methodical consideration and invokes lively debate. The unprecedented use of vaccination, namely smoking cessation, is left largely unattended in the ethical analyses.Conclusions While health innovations such as nicotine vaccination need broad reflection to guide decisions on their further development and possible future implementations, only a small part of the ethical and social issues of this innovative technology has been discussed. For a debate to come into existence, a ‘neurobio-psycho-socio-cultural’ frame of smoking and quitting appears fruitful. Important topics for reflection are the human activities and social processes in a vaccine-supported quit attempt, next to respect for individuals, possible harms and questions of (global) justice and research ethics.
Article: Human enhancement: The new eugenics[Show abstract] [Hide abstract]
ABSTRACT: Supporters of human enhancement through genetic and other reproductive technologies claim that the new liberal eugenics, based on science and individual consent differs from the old eugenics which was unscientific and coercive. Supporters claim it is the parent's moral obligation to produce the best children possible. At this time, a defective gene that is identified in an unborn child cannot be repaired. To prevent the manifestation of the undesirable trait the unborn child is destroyed. The arguments in support of human enhancement are based on an ethic of consequence that could allow for nearly any means as long as the desired end is reached. Medical enhancement may affect the parent-child family unit; the parents' love for the child may be conditioned on the expected results. The new eugenics, although based on science, continues to pursue the same goal as the old eugenics, the development of a superior individual and the elimination of those considered inferior.
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ABSTRACT: This review examines the range of vaccines designed to treat non-infectious and non-cancer diseases and conditions. In the main, the approach is to develop high antigen-specific, neutralizing antibody titers. Thus, vaccines have been developed to target key fertility regulating proteins in order to control conception and hormone-induced conditions, while proteinopathy in neurodegenerative diseases such as Alzheimer's disease and Parkinson's disease have resulted in several vaccines undergoing clinical trial. For other brain-targeted conditions such as addictions, antibodies have been raised against the small chemical entities to prevent them crossing the blood-brain barrier and to interrupt pleasure effects. One area where innovations are being applied to increase antibody-neutralizing effects is in the allergy field. The examples so far detailed mainly use antibody induction against direct targets; however, with a better understanding of interactions of the immune system, indirect targets are also being sought for treatment of other conditions such as stress and depression. This highlights that improvements are needed to increase our knowledge of immune responses, antigen discovery, and the mechanisms of action. This has allowed new tools to drive vaccine innovation, and examples of state-of-the-art technologies are outlined.
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