Team:Tufts/techno-moral scenarios


Tufts University

Regulatory Agencies and Black Market Phage

  The man and woman sat in two chairs in front of the doctor. They were holding each other’s hands tightly. “I really think we should try phage,” the husband stated. “It may be her only hope.”
  The doctor replied, “I would love to try... none of the antibiotics are working, but phage isn’t regulated. No companies can sell it for human use. Even the Eliava Institute is no longer allowed to sell phages to people in the United States. Though besides phage, I’m not sure what more I can do to try and stop her infection from spreading.”
  “My daughter will die if we don’t use phage,” the husband continued.
No one spoke and a silence filled the room. The doctor realized that the man was right: bacteriophages, viruses that infect and can kill bacteria, probably were the young girl’s only hope. Her infection was antibiotic resistant and no other medicines were helping. Over the past few years, word about phage had slowly spread. Now, as an increasing number of people desired to use phages beyond agricultural applications, regulatory agencies delayed the possibility given their uncertainty of how they should control phage, especially genetically engineered phage. It had been just one year since the doctor had learned about phage and their great uses in fighting bacterial infections. He had read about bacteriophages and thought them a miraculous tool for when normal antibiotics did not work, which had been occurring more frequently these past ten years. The doctor knew the implications in using phage: that they were not allowed and their use would go against the rules of the hospital. However, the doctor also wanted to help the patient. He had become a doctor because he wanted to save people.
  “Doctor, what if I can find phage,” the wife inquired. “There are ways and there are places.”
  Both the doctor and the woman’s husband looked at her surprised. Even the husband had not realized that his wife had found a phage supplier. The husband and the doctor had heard the rumors of black market phage, a way to get unregulated phages. These treatments were risky, though, since there was no governance or supervision. No one was quite sure what was in each phage cocktail, but some people, especially those who had nothing left to lose, were willing to take the risk.
  The doctor spoke first. “I can’t be a part of this. I wish I could help, but the governmental agencies do not allow phage. If anyone found out about this, my license would be revoked. Are you sure you two want to do this?”
  The wife nodded first, and then the husband. “We are sure.”
  The doctor continued, “You must take your daughter from the hospital then, if you wish to use phage. We cannot be responsible for what may happen and we cannot let you endanger other patients if something goes awry with the phage, especially since there is no regulation on the phage cocktail contents. I am very sorry.”
  The husband spoke up, perplexed by the dilemma. “This could cause more problems! She will no longer have medical help. What if something goes wrong or she gets worse?”
  “Phage is not approved by the regulatory agencies,” the doctor explained. “We are not allowed to have phage treatments here. I want to be able to help your daughter, I truly do, but I cannot do it while risking the lives of other patients. That is why I’m suggesting you remove her from the hospital and follow whatever path you believe will benefit your daughter the most.”
  “She may die,” the wife whispered.
  The doctor answered, “That is a risk the regulatory agencies have created.”

  The girl survived. The phages saved her. Those around her, however, found her astounding recovery surprising and quite nearly impossible. Teachers, relatives, and community members began to talk about what could have helped the girl. They wanted to know the cure. “How had she suddenly recovered when the antibiotics did nothing?” they questioned. One of the girl’s neighbors was a doctor. He had recently become aware of phages and brought them up first. “Bacteriophages could have done this. They are illegal, but I can think of no other explanation,” he told his coworkers around him after he described the girl’s story. “I am surprised her doctor or even her parents would choose phage. It is untested and no one knows what it could do if released accidentally or used incorrectly. And where could they even get the phage?”
  Spiraling outwards from the small group, the news of the girl and her phage treatment spread. A minor city newspaper picked up the story. No names were used but the concept of phage was explored in the article. Phage was depicted as a topic of interest, an important mechanism for combating antibiotic resistance that should be examined more.
Within a year, the little girl was the new poster child for phage: a modern-day miracle used by scientists and doctors who supported phage therapeutics. Her story was used to try to pressure the regulatory agencies, to bring them closer to investigating phage and its possible uses. She became embroiled in the fight for and against phage, as some opponents argued the risk her parents took was too great.
  Over time, the anonymity of the case became impossible. The doctor, who had let the girl’s parents use phage to save their daughter’s life, felt harassed by those around him even though he had not been the one to first propose phage treatment or to give phage to the girl. He soon left the hospital amid criticism. All he had wanted to do was help his patient.