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방은화(Yinhua Fang),김옥주(OckJoo Kim),정준호(Junho Jung) 한국생명윤리학회 2020 생명윤리 Vol.21 No.2
2019년 12월 중국 우한에서 처음 보고된 이후 코로나19는 전세계로 퍼져나갔다. 코로나19가 세계적인 판데믹으로 접어들면서 대유행을 종식시킬 수 있는 효과적인 치료제와 백신의 빠른 개발에 대한 국제적 요구가 높아지고 있다. 연구 대상자들을 의도적으로 병원체에 노출시켜 질병에 백신 효능을 테스트 하는 인간 챌린지 연구가 코로나19에 대응하기 위한 도구로 주목되기 시작하였다. 인간 챌린지 연구가 백신 개발을 크게 단축시킬 것이라는 기대도 사회적 지지층을 형성하게 하였다. 하지만 사람들을 의도적으로 치명적인 병원체 노출시키는 연구 방법은 여러 윤리적 논란을 낳게 된다. 뎅기열, 콜레라, 지카바이러스 등 인간 챌린지 연구의 역사적 사례로 분석하여 볼 때 코로나19 인간 챌린지 연구는 수행의 윤리적 근거로서 충분한 사회적 가치를 가져야 한다. 코로나19 인간 챌린지 연구가 백신 개발 기간 단축에 유의미한 기여를 할 수 있을 지가 분명하지 않다면, 사회적 가치에 대비해 얼마만큼의 위험을 용인 할 수 있는지에 대한 판단 보류 되어야 한다. 위험성의 관리가 정당화되기 위해서는 치료제의 확보, 약독화된 균주의 생산 및 적용, 혹은 그에 준하는 병원체에 대한 안전 조치는 대상자 안전 확보를 위한 최소한의 윤리적 기준이 되어야 한다. 코로나19 인간 챌린지 연구의 윤리적 고려에 대한 논의는 현재 백신 개발 단축이 가져다 줄 수 있는 불확실한 사회적 가치 보다 장기적인 판데믹 대응 역량의 일환으로 논의될 필요가 있다. 신종 감염병에 의한 전세계적 유행은 코로나19에 그치지 않고 지속적으로 반복될 것으로 예측되고 있으며, 이에 대응할 수 있는 신속한 과학적, 윤리적 대응이 무엇일지에 대해 고려해봐야 한다. Since the first case of coronavirus reported in Wuhan, China in December 2019, COVID-19 has been spread worldwide. As COVID-19 became the global pandemic, the demand of development of effective therapeutics and vaccines that can end this pandemic is increasing. Human challenge study, which test vaccine efficacy against diseases by deliberately exposing the volunteer to pathogens, have begun to attract attention as a tool to combat COVID-19. Social support has been formed with the expectation that this study will significantly shorten the period of vaccine development. However, research methods that deliberately expose people to lethal pathogens lead to ethical controversy. Analyzed as the historical cases of human challenge research such as dengue fever, cholera, zika virus. It should have sufficient social value as an ethical basis for conducting COVID19 human challenge research. If it is not clear whether the COVID-19 human challenge study could make a significant contribution to the shortening of the vaccine development period, the judgment on how much risk can be tolerated for social value should also be withheld. In order to justify risk management, the securing of therapeutic agents, production and application of attenuated strains, or safety measures against pathogens equivalent thereto should be the minimum ethical standards for securing subject safety. The ethical considerations of COVID-19 human challenge research need to be discussed as part of a long term pandemic response capability rather than the uncertain social value that current vaccine development shortening can bring. The worldwide epidemic caused by new infectious diseases is predicted to be repeated continuously, not just for COVID-19, and it is necessary to consider what will be a rapid scientific and ethical response to this.
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1950-60년대 한국의 뇌폐흡충증과 심보성의 대뇌반구적출술
박지영(PARK Jiyoung),미야가와 타쿠야(MIYAGAWA Takuya),홍정화(HONG Jeonghwa),김옥주(KIM Ockjoo) 大韓醫史學會 2011 醫史學 Vol.20 No.1
This paper deals with cerebral paragonimiasis and cerebral hemispherectomy conducted as a treatment of cerebral paragonimiasis by Bo Sung Sim in Korea in 1950s-1960s. He demonstrated that cerebral hemispherectomy could be used for unilateral diffuse cerebral paragonimiasis. Sim learned cerebral hemispherectomy from Dr. L. A. French. at the University of Minnesota from 1955 to 1957 in America. The authors argues that Bo Sung Sim’s introduction of cerebral hemispherectomy to Korea was not a simple application of an advanced medical technology, but a complicated and active process in that Sim used the technique to intervene intractable complications from cerebral paragonimiasis such as generalized convulsions, spastic hemiplegia and mental deterioration. Bo Sung Sim, one of the neurosurgeons of the first generation in Korea, was trained in neurology, neuropathology, neuroradiology and animal experiments as well as in neurosurgery at the University of Minnesota. After returning to Korea, Sim faced parasitic diseases, one of the most serious public health problems at that time, which were far different from what he learned in America. As a neurosurgeon, Sim tackled with parasitic diseases of the central nervous system with various diagnostics and therapeutics. In 1950s, more than one million populations suffered from pulmonary paragonimiasis acquired by eating raw crabs or by feeding juice of crushed crayfish for the treatment of measles in Korea. About 26.6 percent of people with paragonimiasis had cerebral paragonimiasis. Before bithionol therapy was introduced in 1962, neurosurgery was the only available treatment to control increased intracranial pressures, intractable epilepsy, paralysis and mental deterioration. Between 1958 to 1962, Bo Sung Sim operated on 24 patients of cerebral paragonimiasis. In two of them, he performed cerebral hemispherectomy to control intractable convulsions when he found diffuse cerebral paragonimiasis and cerebral atrophy at the operating table. The two patients were recovered dramatically after the operation. The first patient became a part of medical campus for 20 years after hemispherectomy, doing chores at the hospital and helping Bo Sung Sim for his teaching neuroanatomy. The presence of the hemispherectomized patient in the classroom impressed the students deeply. Furthermore, the hemispherectomized patient stimulated Sim and his school to perform research upon the neuroanatomy and neurophysiology of the brain with hemispherectomized animals.
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