Team:LZU-CHINA/Human Practices

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Promoting our ideas~
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Terrific ideas are in need of promotion!
We consulted people from various walks of life, including some stakeholders of pancreatic cancer (such as patients, doctors), staff members of social insurance and commercial insurance companies, and ethic committee. Here follow their constructive opinions..
Stakeholders
Policies Researching
Ethics
Stakeholders

Patients

We have in-depth communication with pancreatic cancer patients. They say that the current treatment is expensive but ineffective, so they are eager to have a new treatment for pancreatic cancer, and they are willing to try this new treatment. In addition, most patients mentioned in the conversation that they had bad habits such as smoking and drinking.

Family

We communicate with patients'families to gain their acceptance of new pancreatic cancer treatments and their thoughts after their relatives develop cancer. Family members of patients tell us that they are also very painful when they see that patients are painfully treated but can not prevent their death. Families say they are willing to try as long as effective treatment can prolong life or reduce pain.

Doctors

We interact with doctors from different parts of Lanzhou, from general family doctors to oncologists. They have first-hand data on pancreatic cancer patients in Lanzhou, which is more credible and in-depth than many news media reports.
Although it has not been carefully demonstrated, most of the pancreatic cancer patients in Lanzhou have the characteristics of smoking, overweight, diabetes and excessive drinking. Especially excessive drinking, many people in Lanzhou are addicted to alcohol, which may be an important reason for the high incidence of pancreatic cancer in Lanzhou. Xxx tells us that early pancreatic cancer has atypical symptoms and is difficult to diagnose. At the same time, early pancreatic cancer is prone to metastasis. In addition, the side effects of chemotherapy are large and the metastasis of pancreatic cancer cells is rapid, so it is very difficult to treat pancreatic cancer at present.

Nurse

Nurses are the people who have the most contact with patients besides their family members. They can better reflect the needs of patients and tell us the state of patients objectively and comprehensively.
Nurses said that patients with advanced cancer had little desire to survive in the latter stage of treatment, and their quality of life was low. They suffered from pain, weakness, inability to take care of themselves and were in pain every day. The early symptoms of pancreatic cancer are not obvious. Generally, the patients found are advanced. The patients with advanced chemotherapy are very painful, and few patients can really be cured.

Researchers

They have a better understanding of the current status of research, development and application of pancreatic cancer drugs.
At present, there are few effective drugs specifically for pancreatic cancer. XXX tells us that although the clinical research of pancreatic cancer has made relative progress, it is relatively backward in drug research. Nowadays, there are many difficulties in drug research and development of pancreatic cancer. The traditional methods are used to develop drugs, and the R&D investment is large, the failure rate of approval to market is high and the time is long. On the other hand, they say that if there are drugs specifically targeted at pancreatic cancer, there will be a better market at present and they can guide them in the research of other cancer drugs.

Enterprise

We are trying to talk to pharmaceutical companies to get their support for the development of drugs to treat pancreatic cancer, the feasibility of developing new drugs, and the prospects for research on drugs to treat pancreatic cancer.
We communicate with pharmaceutical companies of different sizes in China. Many pharmaceutical companies say that they have laboratory support and are willing to invest in drugs for pancreatic cancer. Mr. Zhang of Harbin Sanlian Pharmaceutical Co., Ltd. told us that there is a great prospect for the treatment of pancreatic cancer, because although there are many drugs for the treatment of pancreatic cancer, such as tegafur injection produced by their company, the pertinence is not strong. If we can develop effective drugs for pancreatic cancer, there are many pharmaceutical factories. We will all be willing to support our work.

Social Insurance

Cancer reimbursement accounts for a large proportion of national medical reimbursement. We want to understand the impact of cancer on medical insurance.
We have conducted in-depth exchanges with social insurance practitioners. We found that with the rising incidence of cancer and the higher cost of treatment, and the lower cost of social insurance charged by the state, social insurance has been in a state of insufficient income or even a large loss.
Policy Researching
After the communication with iGEM teams from different countries, we found that the related insurance institution demanded highly of punctual physical examination. If people could not do it on time, they might be charged more insurance fee.
In China, insurance can be divided into two types: social insurance and commercial insurance. Both two of them have no requirements for the physical examination. We hope that insurance organization can encourage people to do physical examination by some reward mechanism. At first, we thought people could be forced to do examination by increasing the insurance fee. However, some of our members argued that this would just cause people’s unsatisfaction of government and insurance company, because of the economic development of China and people’s ignorance of physical examination. We hoped to come up with some practical suggestions for insurance organization, so that they could utilize some economic methods to increase people’s awareness of physical examination, thus decreasing the incidence rate of cancer.
Social Insurance

Communication

We communicated deeply with social insurance practitioners from different regions. We found that the incidence rate of cancer increased continuously, and that the treatment cost was high. However, the social insurance fee was relatively low, so the social insurance organizations was always running behind their expenses. At present, the arrears of medical insurance is about 2 billion yuan, and the cost of medical insurance is still growing. Although the state has adopted policies to control the growth of medical expenses too fast, the effect is not very good.
Mr. Xi Laodong said that the government demanded nothing for punctual physical examination. He also mentioned that even if they ask for people to do physical examination on time, even freely, few people would do that.

Our Ideas

There are now two major problems: 1, the social insurance organizations run behind their expenses; 2, people don’t do physical examination actively.
Idea1: We propose to increase the amount of insurance to promote people's physical examination, but after investigation, it is found that the cost of social insurance in our country is only 40 dollars a year. If the cost is raised slightly, it will have little effect on solving the problem of insufficient income and expenditure of insurance institutions, and it will not have the effect of urging people's physical examination. However, if the insurance cost is raised substantially, it will cause dissatisfaction among people, which is not conducive to improving people's living standards.
Idea2: Considering that social insurance can't promote people's physical examination by raising the fee, we put forward the idea of increasing the reimbursement rate to promote the active physical examination of the insured party if the insured person accepts the free physical examination voluntarily. In addition, we should vigorously publicize the beneficial effects of this policy on people. It can not only detect and treat diseases early, but also reduce the economic burden caused by diseases.
In this way, the insured will take the initiative to check-up under the motivation of interests, which will benefit both economically and healthily.
As far as insurance institutions are concerned, people should be urged to find out their condition and treat it as soon as possible. The cost of treatment for early cancer will be greatly reduced compared with that for advanced cancer. This method can not only guarantee people's living needs, improve people's living standards, but also reduce the financial burden on major diseases. Large expenditure to ensure the normal operation of insurance institutions.

Feedback

We started a seminar with staffers in social insurance administration. We expounded to them the idea of increasing the rate of reimbursement to encourage people to do physical examination, and explained to them that this policy would not only decrease the possibility of terminal cancer, thus improving people’s standard of life, but also save lots of medical funds that could have been saved to support construction in other field of medicine. Our idea won the high praise of these staffers. They thought it was a terrific idea, because they were facing the problem that they paid too much for serious disease such as cancer to run the insurance organization normally. Meanwhile, we talked with the insured from different aspect of society and different regions. They all said that if punctual physical examination could help them save money, they would be willing to accept it.

Result

We provided our results of investments to the Social Insurance Administration of China, Chinese Political Consultative Conference and representatives of People’s Congress in Gansu Province.
Commercial Insurance

Communication

Mr. Luo Bida, who worked in PICC, told us that though insurance companies have developed rapidly in recent years, compared with other businesses, the income of medical insurance is lower.

Our Ideas

Idea1: We suggested with insurance companies that people could get medical checkups in the same way as social insurance would increase the amount of claims, so as to reduce the large amount of expenditure on pancreatic cancer, but found that they did not support the idea very much. Mr. Zhang of the insurance company told us that most insurance companies want to increase their income and reduce their expenditure, and the above plan will reduce their expenditure in the short term.
Idea2: According to their demands, we consider that people can be urged to have a physical examination by raising the premium. In addition, most insurance companies do not allow professionals with high incidence of pancreatic cancer to buy their company's insurance, so we propose an idea that insurance companies can promote pancreas by increasing the amount of claims. Although insurance companies provide insurance services for high-risk professions, they will not increase the company's expenditure on high-risk groups, but also increase their income, so this way is conducive to improving the benefits of insurance companies.

Feedback

After drawing the conclusion, we started a seminar with staffers from three insurance companies. They said that this method is of great feasibility. If they just adjusted the policy for several high risk vocations, it would not influence the number of their clients. What’s more, physical examination might decrease the population of terminal cancer patients, thus decrease the funds paid for cancer, which would be beneficial for development of company. They would like to consider our method.
Ethics

Question

When our researching achievement is used in practice, gene therapy is needed, which is a huge challenge to ethics in China, where transgene plants are even refused. Therefore, it is essential that learning people’s view of transgene and the future of gene therapy application from many ways.

Patients

When we communicated with patients suffering from pancreatic cancer, we found that commonly they would accept any therapies if only they could live. Although they are still a little afraid and doubted about this new technology, they said that they were willing to try the gene therapy if there was the possibility to be cured. When it comes to ethic problems, most patients tended to choose their lives but not ethics.

Ethicist

We organized a seminar with ethicists to discuss the ethical issues brought about by gene therapy and the current policy on this phenomenon in China. Zhang said that the development and application of genetic technology is closely related to commercial operation. In the process of pursuing functions and benefits, the utilitarian value of technology is constantly strengthened. There is a bad tendency in the social application of genetic technology: rejecting human moral responsibility, rejecting the guiding role of ethical norms on technology, and leading to the abuse of technology. 。 The emergence of such ethical challenges, to a large extent, stems from the lack of binding implementation mechanism of ethical norms. Without institutional safeguards and constraints, ethical norms are difficult to exert their influence and will eventually become nothing.
The intuitive point we and our teachers reached in the discussion is that if the state can formulate effective policies to prevent the infringement of human rights and interests by GM technology and trample on human dignity, then it is a good choice to solve the incurable diseases by changing human genes at this stage.

Religion

There are two third of the population believing in religion. Most of these people believe that god creates the best things, and transgene is greatly disrespectful to god and people themselves. Therefore, we hope to know how the religious people think about gene therapy.
We wanted to talk with iGEMers in other countries on the forum of iGEM, in order to learn about the views of believers from different countries. Through the communication, we found that though transgene products made people’s life more convenient, many believers thought it betrayed the will of god, showed no respect for god and it was going to be punished by god. So, it is impossible for them to accept altering person’s gene. After investing believers in America, we found that 43% of them ate transgene products, and 13% of them would choose gene therapy to prolong their life if they were diagnosed to suffer from cancer.

Doctors

We interviewed the Dr. Majun Xiao from Lanzhou University Second Hospital. He said that he was willing to support the promotion of this technology if it can be ensured that it only affect the specific gene without the influence to other gene. What’s more, this technology is very possible to be accepted by patients’ family and realized in large scale. He also told us that most patients were willing to try the gene therapy when talking about therapies, though they were afraid and doubted about it to some degree.

College Students

They are the main force of future construction. Whether can gene therapy be promoted or not is closely related to their views. Thus, it is important to learn about their views about it in the aspect of ethics. In our discussion, most students were just afraid of this technology. If there was any success case, they may be willing to try it.
A student in College of Philosophy told us that they had fiercely discussed this problem after the “He Jiankui Affair”. They worried that the rich might improve their gene, which would be harmful to social impartiality and the development of human society. However, if government could establish more strict laws related to the gene therapy, it would become a major development direction of Chinese medical science.

Ethic Committee

Mr. Ma Woni, who work in the ethic committee, told us that the ethic committee in our country was developing rapidly, though it started relatively late. Nowadays, the mechanism that ethic committee members from different levels carry out ethic investigation and supervision to the medical researching or application projects related to human beings has been built in our country. The ethic committee will strictly carry out related regulations according to the laws, and will do ethical evaluations when the government makes decisions on significant questions of life science.
He also said that the government was trying its best to set and improve the specific ethic committee, in order to better supervise and investigate the research, experiments and application of this technology. And, at last, the gene therapy could survey human beings better, and best fulfilled its potential.

Legislator

We interviewed Mr. Meng Yang, who worked in the legislative. He told us that our country was continuously exploring in the space of improving laws related to gene therapy, which was an important field in gene technology. At present, a relatively systematic law system has been built, and the government tries its best to make related ethic problems can be solved by laws.
Although the gene therapy is not mature enough now, it is an important method to cure many incurable diseases, from many views. From the view of ethics, the application of this technology may cause social instability and people’s scare, but with the development of technology and management from related organizations and the promotion of the concept that transgene do no damage to human beings, this technology will be accepted and used by more and more people. Also, the social ethics may change because of it, just like the vaccine was not accepted many years ago.