Dr. Fleck presents at Centre for Cancer Biomarkers Symposium in Norway

Leonard Fleck photo Center Professor Dr. Len Fleck recently traveled to Bergen, Norway to present a keynote address at the 6th Annual Centre for Cancer Biomarkers (CCBIO) Symposium. Dr. Fleck’s presentation, “Just Caring Challenges: Visible Biomarkers and Invisible Rationing,” addressed some of the critical ethical issues related to the use of biomarkers in cancer research and clinical care.

Dr. Fleck addressed two main problems in his lecture. First, the ragged edge problem. One of the primary purposes of finding biomarkers is to determine whether a cancer drug is likely to be effective for a particular metastatic cancer patient. However, rarely will a biomarker yield a simple answer. Most often, the biomarker will be expressed along a continuum. If a drug were very inexpensive and side effects tolerable, it would be easy to say that the ethically right choice would be to respect patient autonomy. But these drugs all cost more than $100,000 for a course of treatment. Consequently, if a drug has a 20% chance of having a beneficial effect, there is a conflict between considerations of justice and respect for patient autonomy. Invisible rationing (just not offering the drug to the patient) can bypass this conflict, but invisible rationing is ethically problematic so far as justice is concerned.

Secondly, recent liquid biopsies can identify eight common cancers at a very early stage–in the form of circulating cancer cells in the blood–at a cost of $500. However, the critical question would need to be raised: How often would 170 million adults (all anxious about cancer) in the U.S. have a just claim to access that test? Every six months? Every year? Note that each such offering of that test to that population would cost $85 billion. Would that represent either a just or prudent use of health care resources?

The CCBIO symposium was well-attended by an international mix of junior and senior researchers and scholars. Dr. Fleck had the opportunity to meet with many European researchers to discuss their respective work in the field of cancer research.

Dr. Fleck also gave a public lecture at the University of Bergen’s Centre for the Study of the Sciences and the Humanities, titled “Precision Medicine, Ethical Ambiguity: Rough Justice, Ragged Edges.” Dr. Fleck addressed precision medicine as it currently exists, in particular the costly FDA-approved targeted cancer therapies. Treatments for patients with metastatic cancers, which are not curative, can cost $100,000 to $475,000 per treatment course. For example, 30% of patients who are candidates for CAR T-cell immunotherapy will not gain more than an extra year of life. As things are now, we do not know before the fact who those patients might be. But one goal of biomarker research is to identify before the fact who those marginal responders most likely will be, so that we could save money by denying those patients access to this therapy. As a citizen of a just and caring society, would you endorse the research to accomplish that result? Why or why not? This is what Dr. Fleck calls “rough justice.”

What level of risk will be tolerated for interventions that are developed for treating “pre-diseased” patients?

Crossing the Biology to Pathobiology Threshold: Distinguishing Precision Health from Precision Medicine

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Diseases have long been defined by their symptoms, and therefore patients have typically been treated when they are symptomatic. However, through advances in “omics,” wearable sensors, insertable microscopes, liquid biopsies, point-of-care pathology, and other innovations, it is possible to make a molecular diagnosis prior to apparent symptoms. These tools will enable a transition from Precision Medicine where the molecular etiology is determined after symptoms appear, to Precision Health in which the molecular etiology of diseases can be anticipated and symptoms averted. However, is it ethical to treat “asymptomatic disease” and at what cost to the healthcare system? What level of risk will be tolerated for interventions that are developed for treating “pre-diseased” patients? Since many of these assays will predict likelihood of disease and not absolute progression to disease, what level of certainty is needed to intervene at all? Medicine is being redefined and we are behind in understanding what is meant by the simple terms health and disease.

Join us for Dr. Contag’s lecture on Wednesday, October 11, 2017 from noon till 1 pm in person or online.

Dr. Christopher H. Contag is the chair of the inaugural Department of Biomedical Engineering and founding Director of the Institute for Quantitative Health Science and Engineering at Michigan State University. Dr. Contag is also Professor emeritus in the Department of Pediatrics at Stanford University. Dr. Contag received his B.S. in Biology from the University of Minnesota, St. Paul in 1982. He received his Ph.D. in Microbiology from the University of Minnesota, Minneapolis in 1988. He did his postdoctoral training at Stanford University from 1990-1994, and then joined Stanford faculty in 1995 where he was professor in the Departments of Pediatrics, Radiology, Bioengineering and Microbiology & Immunology until 2016. Dr. Contag is a pioneer in the field of molecular imaging and is developing imaging approaches aimed at revealing molecular processes in living subjects, including humans, and advancing therapeutic strategies through imaging. He is a founding member and past president of the Society for Molecular Imaging (SMI), and recipient of the Achievement Award from the SMI and the Britton Chance Award from SPIE for his fundamental contributions to optics. Dr. Contag is a Fellow of the World Molecular Imaging Society (WMIS) and the recent past President of WMIS. Dr. Contag was a founder of Xenogen Corp. (now part of PerkinElmer) established to commercialize innovative imaging tools for biomedicine. He is also a founder of BioEclipse—a cancer therapy company, and PixelGear—a point-of-care pathology company.

In person: This lecture will take place in C102 East Fee Hall on MSU’s East Lansing campus. Feel free to bring your lunch! Beverages and light snacks will be provided.

Online: Here are some instructions for your first time joining the webinar, or if you have attended or viewed them before, go to the meeting!

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Chapter from Dr. Fleck published in ‘Cancer Biomarkers: Ethics, Economics and Society’

Leonard Fleck photo A chapter from Center Professor Dr. Leonard Fleck has been published in the book Cancer Biomarkers: Ethics, Economics and Society, published by Megaloceros Press. Dr. Fleck’s chapter is titled “Just Caring: Precision Medicine, Cancer Biomarkers and Ethical Ambiguity.” The book is edited by Anne Blanchard and Roger Strand.

From the Amazon description:

Cancer care is undergoing a shift from a ‘one-size-fits all’ approach to more personalised medicine. One way of personalising cancer treatments is through biomarkers: molecules or biochemical changes found in the patient’s tissues and body fluids. This book reflects upon the promise of cancer biomarkers and asks questions such as: How may the complexity of cancer biology impede the robustness of biomarkers in the clinic? How should one draw the line between the various sub-groups of patients for personalised treatment? How can one evaluate the cost-effectiveness and fairness of personalised cancer treatments? By bringing together authors from the fields of science and technology studies, medical ethics and philosophy, health economics and oncology, the book aims to give a critical yet accessible overview of some of the key social, ethical and economic issues that surround cancer biomarkers. “The book should be required reading for oncologists, medical students, graduate students and especially for those who make policy decisions regarding the use and reimbursement of cancer biomarkers.” – Bruce Zetter, Charles Nowiszewski Professor of Cancer Biology in the Department of Surgery, Harvard Medical School

Watch every lecture from the 2013-2014 Bioethics Brownbag & Webinar Series

Reye’s Syndrome: A Medical Mystery and a Modern Dilemma
This talk from Mark A. Largent, PhD, examines the history of Reye’s syndrome, the hunt to uncover its cause, and the debates that have emerged over last twenty years about the role of aspirin in Reye’s syndrome. View Webinar

Medical Sociology as Vocation
This presentation from Charles L. Bosk, PhD, discusses what it means to speak of ‘medical sociology as a vocation,’ using Weber’s classic essay ‘Science as a Vocation’ as its departure point. View Webinar

The Declining Provider: Refusal, Responsibility, and Reasonableness
This presentation from Deborah Fisch, JD, examines how we arrived at our current VBAC position, its implications for maternal and child health, and the connection to other instances of declining providers. View Webinar

Are Researchers Ever Obligated to Provide Individual Research Findings to Non-participant Third Parties?
This presentation from Allan Loup, JD, addresses an emerging consensus that, in some circumstances, researchers have obligations to return individual research results to research participants. View Webinar

“Enlightened” Breath: Breathing and Biomedicine
While much is known of the physiological importance of breathing in biomedicine, there is almost no appreciation of its possible therapeutic role. This presentation from Sebastian Normandin, PhD, argues for a new era – an age of enlightenment – in the use of breath and breathing as a healing tool. View Webinar

Plastic Surgery Ethics: An Oxymoron?
In this lecture, Dr. Christian J. Vercler examines the distinctions made between cosmetic and reconstructive surgery, discusses how plastic surgeons think about those distinctions, and uncovers the different ethical frameworks that support these practices. View Webinar

Click here to watch more lectures dating back to 2010, and save the date for the first webinar of the 2014-2015 Series: September 17, 2014.

Lyman Briggs Instructor Sebastian Normandin, PhD, will discuss the healing potential of breath at February Brownbag

“Enlightened” Breath: Breathing and Biomedicine

Event flyer: Normandin Flyer

In his famous essay “What is Enlightenment” the philosopher Emmanuel Kant argued enlightenment consisted in “man’s emergence from his self-imposed immaturity.” In his presentation, Dr. Normandin proposes that the same process is required in modern medicine in regards to the healing potential of breath. While much is known of the physiological importance of breathing in biomedicine, there is almost no appreciation of its possible therapeutic role in both psychic and somatic ailments. In this sense the modern medical paradigm remains in a state of immaturity when considering the potential of breath and breathing. Dr. Normandin argues for a new era – an age of enlightenment – in the use of breath and breathing as a healing tool. In this quest the nature of many eastern practices – anapanasati (mindfulness of breath) foremost among them – can provide a model for western biomedicine to follow. The metaphor of enlightenment in the ‘use’ of breath is not only a nod to the eventual hoped-for outcome of this practice in eastern spirituality, but also a conscious reference to some of the potential aspects to consider in implementing it more deeply in a modern context. These include awareness, awakening, individuality, insight and mindfulness. Dr. Normandin suggests that if we move beyond preconceptions about these practices (as being, for example, only spiritual or New Age) and approach them with reason – if we “dare to know” (sapere aude) – then their potential preventative and therapeutic role in medicine can be almost limitless.

Join us for Sebastian Normandin’s lecture on Wednesday, February 12, 2014 from noon till 1 pm in person or online:

In person: The lecture will take place in C102 East Fee Hall on MSU’s East Lansing campus. Feel free to bring your lunch! Beverages and light snacks will be provided.

Online: Here are some instructions for your first time joining the webinar, or if you have attended or viewed them before, go to the meeting!

Sebastian Normandin, PhD, is a Visiting Instructor in Lyman Briggs College at Michigan State University. His research focuses on the history and philosophy of medicine and biology in the nineteenth and twentieth century, vitalism and alternative medicine. He also remains ever fascinated by the concept of pseudoscience and the scientific fringe. His book, with co-editor Charles T. Wolfe, Vitalism and the Scientific Image in Post-Enlightenment Life Science, 1800-2010, was published by Springer in 2013. You can follow him on Twitter @weirdhistorian.

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