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Hospital Interview

What is reality? Reality is not only the theorem, formula and definition we learned in textbooks. It also not only the report and data we read in papers and journals. It is supposed to be the changes of surroundings and the joy and sorrow of human beings that we can really see, hear, touch and feel. How can our scientific research make some differences to people’s daily life? What we should do first is to discover the reality, thus the doctors’ clinical experience and the patients’ living condition are the reality we are concerned about initially. Answering the doctors’ concerns and doubts about current therapies and meeting the patients’ needs and hopes about current treatment are the goals that we are always pursuing. The next one is to put our idea into reality. We spent the whole summer vacation on the experiments and data analyses hoping to achieve the initial goal. Afterwards, we interviewed doctors again to ask for advice for our preliminary results to improve our project. The third one is to respect the patients’ real feelings and thoughts however positive or negative. We all must esteem the reality.

Why we do such a human practice project? We believe that the meaning of human practice is not only to give suggestions and feedbacks to the laboratory work but also to discover and realize the real world and connect our idea with the people, environment and even the world. When we learn about all the sever problems such as the increasing frequency of cardiovascular diseases, the sufferings of patients, the incapability of treatment, the complaints of medical staff and the tensions of physician - patient relationship, we may just read, learn and forget it some time. However, when you really go to the outpatient clinics to see the doctors heavy work (A doctor in the cardiovascular unit of a major hospital is always seeing 100 or 200 patients from morning till night.) and go to the wards of inpatient departments to see the lean, pale and painful patients who are tortured by the daily treatment, you will be really touched, shocked and desired to spare no efforts to make your project better.

Our human practice may give us not all the positive attitudes and compliment, even more negative concerns and doubts, but we still don’t give up and try our best to achieve our dream, because your project is not only your own research but also the one that connects the people in need, surroundings and even the world who care about your project. It may really ease patients’ pain, relief the burdens of medical staff, and make a little difference to the world.

That is enough for us to be excited and encouraged.

A.Interview Reports (With Medical Staff)

(We are at Cardiology Unit2 )

a.Interview Summary of Doctors

According to our findings, medical staff in basic hospitals of small towns are not familiar with synthetic biology, let alone gene therapy, because of lack of higher medical education and research.

However, after we came to the First Affiliated Hospital of Sun Yat-sen University, a super major hospital in Guangzhou and had dialogues with Dr. Guo, a young and outstanding woman, twice, we realized that there was a long way to go to put our innovative idea and method into clinical research. She thinks our project has a significant meaning and can be a challenging project to try. She really hopes that we can make some differences to the current cardiovascular therapies.

To tell the details, she says that although modern medicine has a variety of methods and a large armory of drugs for the treatment of myocardial ischemia, there still remains some technical bottlenecks that are difficult to break. For instance, for patients with multiple coronary stegnotic lesions or disease in multiple vessels, percutaneous coronary intervention or surgical coronary revascularization procedures cannot cure the disease and often end with repeated procedures. Although the intervention is minimally invasive compared with the surgery, it has many limitations and cannot replace the surgical operation. It actually depends on placing a stent on the stegnotic position like the surgery. The surgery is more risky and it also cannot cure the disease. Its effect usually keeps at most 10 years, which has only 60% possibilities. Patients have to take more medicines after the stents don’t work. While if we use lentiviral vectors as a tool to deliver the packaged target gene into the cardiovascular tissues cells may provide a relatively permanent mechanism to regulate NO-sGC-cGMP pathway so that it may cure the disease to a certain extend. More significant, it can be considered as a prototype of gene therapy. And it provides a new idea based on synthetic biology for researchers who are trying to break the difficulty, a proud hope for those who are struggling mightily, stubbornly doing battle with the disease even the fate every day.

She suggests that we should not consider the detected increase of the concentration of cGMP as the end of our experiment. We must do more experiments to show what positive changes that will happen to cells and body functions after cGMP increases. Because of over-expressing the gene of sGC and silencing PDE5A, the concentration of cGMP is bound to increase if our experiment is successful. While doctors and patients don’t care about the increase; it is whether the changes in cell and body functions relief of the symptom of myocardial ischemia or not that they take considerable interest in.

In addition, as we know, the lentiviral vector can integrate gene into chromosome randomly, indicating it can transcript anytime. There still remains some questions of biosafety to be answered. For example, we should do deep discussion about how long the RNA interference will last for and whether the interference is reversible or not. In addition, if PDE5A is silenced for too long even forever, how do we assess the side effect like the apoptosis?

If successful, this new therapy can help to save time and money for patients who suffer from myocardial ischemia. Those patients will not need to take medicine every day because the new therapy has more lasting and steady-going effect. Additionally, those who live in outlying poverty-stricken areas don’t have to go to major hospitals. Moreover, it can also be helpful for patients to get rid of a series of side-effects resulting from drug tolerance, drug adverse reaction and so on. Therefore In this way the pain of patients and the pressure of their families can be relieved a lot. As Dr. Guo says, we really hope to make differences to those in need!

(Talk with nurses)

b.Interview Summary of the Interns

Actually, gene therapy is a trend we must follow up. It is a great innovation to combine gene therapy with synthetic biology, where scientists use biological information technology to design and stimulate firstly. With the help of modeling, great achievement will be made in the experiment, while the experiment would feedback to modeling and stimulating. Additionally, we have to say that some existing clinic treatment methods used in myocardial ischemic have lasted for decades, especially the drug, which mainly relieves the symptom, not radically solve the underlying problem. Thus, there is a great necessity in developing a different technique, even though there is a long way to reach remarkable breakthroughs.

B.Interview Report (With Patients)

During the summer vacation, we paid a visit to the In-patient Department of Cardiology Unit, Higher Education Mega Center Branch, Guangdong Province Hospital of Chinese Medicine three times. We interviewed tens of patients with the diversity of conditions and conducted a questionnaire investigation. We found that the three main methods were percutaneous coronary intervention, surgical coronary revascularization and medication, which are recognized internationally as standard therapeutic tools. However, none of them can help patients get rid of lifelong treatment. Although patients with the same disease are treated with the same plan, the levels of physical and mental tolerance and the clinical effect varies greatly from individual to individual. It is hard to say whether a therapy will come into effect.

We tried to promote the concept of synthetic biology and introduced our idea for the treatment of myocardial ischemia. Most of the patients did not have a chance to receive higher education, which makes them not very aware of our research. To our delight, a large quantity of the patients we interviewed show great interests and hope we can make it. Some of them even said they are willing to have a try if our therapy succeeds. More significantly, the experience of the therapy and how their life is affected are what can be told, and that still gave us different perspectives. Certain typical examples are as follows:

Mr. A

Gender: Male
Age: ~80
Disease: Myocardial ischemia , hypertension
Duration: ~15years
Therapeutic regimen: Surgical coronary revascularization , medication

The grandpa we interviewed is one of those who recover well after his operation in 2003. He has continued taking medicine since then. However, hypertension, a common complication of myocardial ischemia, was examined in 2013, so he had to change the drugs he used to take. And now his condition stabilizes. He could have convalesced at home and taken medicine on time, but he had to stay in hospital because he cannot be paid enough compensation from the Public Health Insurance if he is only treated at home. We also learned that the operation cannot cure patients’ disease, and it still relies on medication to extend the time of their physical deterioration. Many expensive imported medicines such as Plavix are not listed in the expense sheet, so only taking medicine has caused a huge financial pressure.

Moreover, the society is not justice as we expect, and many people don’t have any public or commercial health insurance. They cannot afford the overwhelming medical fee, so someone has no choice but to wait for death with everyday deterioration. The current therapy do bring patients and their family too much psychological stress and huge financial burden, which worsened the doctor-patient relationship and social turbulence. Thankfully, these patients give us a great trust and encouragement, and they hope we can make it.

Mr. & Mrs. B

Gender: Male
Age: 68
Disease: Myocardial ischemia
Duration: ~5years
Therapeutic regimen: Medication

Gender: Female
Age: 68
Disease: Myocardial ischemia
Duration: ~5years
Therapeutic regimen: Medication

This example proves that although patients are given the same therapeutic regimen, the effect varies from person to person. Dramatically, one couple we interviewed have born on the same day, and they are both 68-year-old. They were even examined suffering from myocardial ischemia at the same time. They both chose medication instead of operation, but the effect divers greatly.

Effective and safe as the imported medicine is, taking for a long time stilcannot avoid a series of untoward effects. Some people can tolerate them while some may have a bad reaction. Therefore, the only way to solve the problem is to change the medicine. It also means that they have to take at least one week to adapt to the new medicine. For instance, the grandma takes Plavix that has a remarkable effect initially to prevent thrombus. However, with the amounts of Plavix accumulating, she appears some bad symptoms such as skin allergies, urine with blood, inflammation of the stomach, vessel hemorrhage and so on.

The grandpa using the same medicine can tolerate the side effects and still takes it regularly now. The grandma also said that she felt uncomfortable, allergic and absent-minded after taking the medicine. But she cannot change the medicine if the symptoms are not serious. She also mentioned that many of them, the old, were always afraid and unwilling to have surgery. They are more willing to take conservative method instead of the risky one. This experience reminds us of a very important thing that is the individual difference. Our project may still face the same question in the future: Can your method be effective to the problem of the majority? Therefore we should do more experiments to prove this question.

In conclusion, like hypertension, cardiovascular disease needs treating by taking medicine for the whole life once it is found. No matter how expensive the medicine is and how uncomfortable and inconvenient he feels, they cannot choose to reject taking it in order to keep alive. Thus, many patients get accustomed to this method and complain less. It is the one example after another that lets us know how fragile life can be, how incapable current technology can be, and how long the way we should spare no efforts to go.

As for our project, due to their education background, most patients we interviewed have no idea what synthetic biology and what gene therapy are. They even never consider the safety of their therapeutic regimens being used now. They just follow the doctors’ instructions because they don’t want to take more risks. It is okay for them to keep alive so some of them hold negative attitudes towards our idea. While there are still a lot of patients in favor of our research, and hope we can make it. They really hope that a painless, safe, high-performance, and safe therapy can replace the current method. More importantly, we believe that as researchers, we are supposed to shoulder the responsibilities of raising the public awareness about individual health, safety of treatment and social justice.

Team:SCUT-China/hospitalInterview