targeted drugs
Everolimus (Afinitor) is a targeted therapy drug that seems to help hormone therapy drugs work better. It is approved to be given with exemestane (Aromasin) to treat advanced hormone receptor-positive breast cancer in postmenopausal women. It has also been studied with other hormone therapy drugs and for treatment of earlier-stage breast cancer. In one study, letrozole plus everolimus worked better than letrozole alone in shrinking breast tumors before surgery. It also seemed to help in treating advanced hormone receptor-positive breast cancer when added to tamoxifen. Everolimus is also being studied in combination with chemotherapy and the targeted drug trastuzumab.
Zarish Umar
Independent Scholar
See Also: Breast: Major Pathologies; Cancer Stem Cells: Overview; Fetal Stem Cells.
Further Readings
American Cancer Society. Cancer Facts and Figures. American Cancer Society. http://www.cancer.org/research/cancerfactsstatistics/cancerfactsfigures2014 (Accessed November 2014).
Foukakis, T., et al. “Prognostic and Predictive Factors in Early, Non-Metastatic Breast Cancer.” UpToDate (2014).
National Institutes of Health. Stem Cells Basics. Honolulu, HI: University Press of the Pacific, 2004.
National Institutes of Health. Stem Cells: Scientific Progress and Future Research Directions. Honolulu: HI: University Press of the Pacific, 2004.
Russo, J., et al. “Breast Development and Morphology.” UpToDate (2013).
Buddhism
Buddhism
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Buddhism
Organized religions have varying perspectives on embryonic stem cell research. Theistic religions tend to take an adamant position that cloning is a violation of God’s gift of life. For instance, with exceptions among liberal denominations, organized Christianity has strongly opposed cloning of blastocysts and production of pluripotent embryonic stem cells from the clones. Those who do not condemn the action at least warn and urge caution. The Christian influence is strong enough in many Western countries that research into cloning and creation of new human embryonic stem cell lines is outlawed or heavily restricted.
For some, the answer is a simple “no,” but for others, the answer is closer to “maybe; it depends.” Buddhism, like Judaism, is more nuanced than organized Christianity. While Christians in the United States and Europe tend to be conservative, or opposed, in Buddhist South Korea the attitude differs. Difficult questions include whether the embryo is a person, whether a researcher who destroys an embryo commits murder, where a clone fits into a family, and whether cloning is usurping or tampering with God’s authority over creation.
Two tenets of Buddhism that indirectly apply to stem cell research seemingly conflict and divide the Buddhist community. The first is the prohibition against harming or destroying others. The second is the pursuit of knowledge. Some argue that stem cell research fits the Buddhist advocacy of pursuing knowledge and ending human suffering, but others contend that stem cell research contradicts the tenet of not harming others.
Those who support embryonic stem cell research tend to be liberal to radical and most commonly Western. One argument from this perspective entails challenging the traditional accounts of the reincarnation process. They may question the reality of rebirth, be agnostic and take no position, or accept the concept of rebirth but deny the timing as not consistent with modern scientific knowledge. One reinterpretation is that rebirth is not a one-moment joining of the previous entity with the newly fertilized egg, but a slow process in which the garbha, or inner core, of the fetus slowly develops, offering a loophole for embryo research by contending that the old karmic entity is not yet present. Supporters of embryo research say that the Buddhist doctrine of annatto, or insubstantiality, denies the category of personhood. A person is just a label we put on a set of processes, and there’s no agreed time that the process is a person.
Another argument is from the traditional teaching that size matters, as it were. The killing of a larger animal is more serious an offense than the killing of a smaller one because it takes more intention and effort. By this logic, a late abortion earns more blame than an early one, and the destruction of an embryo, a small life, is less deserving of condemnation than the killing of a fetus or mature human.
According to Professor Yong Moon of the Seoul National University, stem cells serve society and therefore there is no conflict between research and Buddhism. To ABC Science Online he said, “Cloning is a different way of thinking about the recycling of life.... It’s a Buddhist way of thinking.” This comment was made several days after the team Moon worked in announced that it had cloned human embryos and extracted embryonic stem cells, a development that moved therapeutic cloning a step closer to practicality. Stem cell research, according to a compatible view to Moon’s, is consistent with the Buddhist belief in reincarnation in that the cells are pluripotential and can reincarnate as something different from what they once were.
Traditionalists reject the argument from practical advantages arising from embryo research or the intellectual curiosity or other motives that lead to it. The counter argument is that therapeutic cloning entails experimentation on immature human beings, which is in direct conflict with Buddhist ethics. Buddhism values every living being, including fertilized embryos used in or created by research.
Traditionalists and conservatives within Buddhism, Theravada Buddhists especially, are more likely to object to research with embryos. The reasons are threefold. First, Buddhists traditionally believe that personhood begins at conception when the garbha from the previous life unites with a fertilized egg. Thus, as early as the first two weeks after fertilization, the embryo becomes a person. Destroying “surplus” embryos through in vitro fertilization would be murder, a clear violation of the first precept of Buddhism.
However, some argue, indirect killing is not the same as murder, but instead is a consequence of a higher good, the preservation of life. Traditionalists deny that argument, noting that there is no acceptance in Right Livelihood teachings of the selling of poison or arms. In fact, the teaching is that the seller is fully to blame, regardless of the secondary nature of the sale to the ensuing violence. Without the weapon seller, the violence would not occur. Without the scientist, the destruction of the human life, the embryo, would not occur.
The third argument counters the claim that long-run improvement of human life is a worthy goal by challenging whether that is the true and sufficient goal. Rather, it appears that a truer motive is greed, a refusal to accept the impermanence of the living human. There is no demonstrable respect for human life in the use of stem cells to clone spare parts that remain stored until transplanted, not if this lesser end entails the greater wrong of taking a human life.
According to Buddhist philosopher Somparn Promta of Chulalongkom University, Bangkok, Thailand, there are empirical and nonempirical readings of the legitimacy of stem cell in Theravada Buddhism. The former is the consensus, the majority view, while nonempirical views are those based on research in the texts and words of Buddhist philosophers. The nonempirical view may not mesh with the empirical view, although the majority view normally has an underpinning in the common culture and morality. That said, the authority of the church is advisory, not mandatory.
Social ethics in Buddhism involve two rules: the harm principle and the critical principle. The harm principle allows prohibition of personal freedom that harms others in society; therefore, harmful action to others is always immoral. Embryonic stem cell research, like cloning, when rejected by theistic religion, is defined as an abuse of human dignity. Buddhism is atheistic, resting on natural things and laws. Anything in nature is available for inquiry and exploration. Cloning, for example, is natural although