There are many ethical implications surrounding the use of levodopa combined with carbidopa to treat Parkinson's disease. Firstly, the drug does not cure the disease, it only relieves the symptoms. The drug does not stop or slow down the loss of the dopamine producing cells, so the treatment cannot prevent the effects of the disease.
Also, "in the longer term, the response to these drugs can become less reliable, and people may experience increasing periods when the effect of the most recent dose wears off before the next one is due or has begun to work (end-of-dose deterioration)"1. So, this means after the sufferer has been taking the drug for a while the response becomes less and less effective, meaning that the drug could only be giving sufferers false hope.
Furthermore, the drug has to be taken several times a day so it will interfere with everyday life and prevent people from doing things that they want to do. Also, "a high-protein diet may reduce its absorption"2 so sufferers would have to change their diet if they were using this drug, disrupting their normal lifestyle.
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Ethical benefits of treating Parkinson's with this drug is that it is giving people a better quality of life. As it is relieving the symptoms, it is allowing the sufferer to go on living their life as they used to for longer. Because one of the main symptoms the drug relieves is muscle stiffness, it reduces the amount of pain suffered. It also gives the sufferer more mobility as movement will not be as stiff and slow.
The main ethical risks associated with using levodopa are the side effects of the drug. Less serious side effects of the drug, provided by http://www.drugs.com/ include:
" mild nausea, vomiting, or decreased appetite
constipation, dry mouth, or blurred vision
dizziness or drowsiness
insomnia, confusion, or nightmares
agitation or anxiety
darkening of the urine or sweat
Although these side effects are less serious they can interfere with the sufferers life and can lead to a lower quality of life than is trying to be achieved by using the drug in the first place.
There are also some more serious, less common side effects, also provided by http://www.drugs.com/ are:
" an allergic reaction (difficulty breathing, closing of the throat, swelling of the lips, tongue, or face or hives)
uncontrolled movements of a part of the body
persistent nausea, vomiting, or diarrhea
an irregular heartbeat or fluttering in the chest
unusual changes in mood or behavior
depression or suicidal thoughts" 3
Although these side effects are less common they are very serious and some, such as an allergic reaction, can result in death. The ethics of the risks and benefits need to be carefully weighed up before deciding to use the drug for treatment to see if the benefits do outweigh the risks, so that the desired effect of the treatment can be achieved.
Economic Implications of Using Levodopa combined with Carbidopa to treat Parkinson's Disease
The main economic implications is how much it costs the government to produce and provide the drugs. Drugs are expensive to make and since the majority of people receiving the drug are over 60, therefore receiving the drug for free, the government pays for the whole drug. Although this money is going towards helping someone suffering from a disease, it is a lot of the governments money that goes towards providing it.
However, seeing as the drug improves peoples life and allow them to be more mobile, they could potentially still work and contribute money to the economy. Also, if they are more mobile they do not have to be cared fore as much, and are less likely in need of being cared for in a home. This saves the government money on staffing costs for care homes. Furthermore, they are less likely to be hospitalised, so it also saves the government money in hospitals.
An Alternative solution: Deep Brain Stimulation
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Deep brain stimulation (DBS) is a surgical procedure that has been
shown to improve symptoms of Parkinson's disease and is often offered
to patients who do not respond well to the drug treatments.
"Surgery for Parkinson's disease is carried out on structures within the
brain that are responsible for the modification of movements, such as
the thalamus, the globus pallidus and the subthalamic nucleus"1. These
are all structures which are found within the basal ganglia.
The procedure complies of inserting needles, through small holes in the
skull, into the brain. This is done to find the exact location of the nucleus that needs to be stimulated. Once it has been found a permanent electrode is attached to the nucleus. It is
connected to a pulse generator that has been inserted under the skin at
the front of the chest.2 This is shown in the diagram to the right.
Through electrical stimulation the function of the nuclei, that connect with the substantia nigra, is changed. Stimulation of different areas of the brain can relieve different symptoms of the
disease. For example "Stimulation of the ventral intermediate nucleus of
the thalamus can dramatically relieve tremor associated with essential
tremor or Parkinson disease"3 The procedure can also relieve
bradykenisia and rigidity by stimulating other areas of the brain.
There are a few risks associated with the surgery, mainly stroke,
confusion, speech and visual problems.1 This brings up ethical issues
regarding whether the risk of the side effects is worth it. If a patient
suffered a stroke as a result of the surgery it could result in many new neurological problems and the whole aim of the surgery, to improve symptoms of Parkinson's, would seem pointless. Furthermore, similarly to the use of drugs as a treatment, this surgery does not cure Parkinson's and is simply just a symptom reliever.
However, there are many ethical benefits. If the procedure goes well and works then the patients quality of life would be drastically improved, as the symptoms suffered would be dramatically lowered.
An Alternative Solution: The Use of Stem Cells in the Future
Stem cells are unspecialised cells that can change into different types of cells that are needed. Due to this there is a great potential for them to be used to replace or repair damaged or lost cells in the body.
For Parkinson's research is specific to embryonic stem cells because they can develop into any human body cell needed.
The use of stem cells would be useful for treating Parkinson's as the new stem cells would replace the lost dopamin producing cells. This means that the cells wouldn't just be treating the symptoms, but also the cause, and could potentially be a cure.
The graph to the left shows the results
of a study carried out by The X-Cell Centre
in which patients were injected with stem
cells.4 As you can see the treatment
gave a high percentage of
improvement in many symptoms.
There is a problem with this method in
which the stem cells could replicate
too quickly and a tumour could develop
in the brain. This is an ethical issue
surrounding stem cell research
questioning whether it is right to put
people at risk by testing out this
treatment. Another ethical issue is the
use of embryonic stem cells, which
many people see as immoral.
However,there are many ethical
benefits, such as the possible cure,
which could save a sufferers life.
If enough research is done to create a
working treatment the use of stem cells
could be much more effective than
drugs or deep brain stimulation because
of the ability for it to cure the disease