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THE TALK SHOW

A BIOETHICAL DILEMMA ABOUT NEUROLOGICAL DISORDERS

Shari Cohen and Patricia Lisoskie

Overview

This integrated, multidisciplinary, cooperative learning activity is designed to raise student's awareness of neurological societal problems. The information they accumulate will enable them to assess the ramifications of ethical, economic, political, and social issues.

Each group will research either Parkinson's Disease or Huntington's Disease using the Internet, school library and pertinent audio visual materials. These activities are designed to motivate students to organize their research in several different formats and mediums using whole brain thinking (right and left hemispheres).

Students will apply writing, decision making and presentation skills by doing a simulation of a talk show.

Biological Concepts

• Brain Biochemistry

• Neurobiological Disease

• Neurotransimitter physiology

• Inheritance and Detection of Genetic Disease

Class Time

Two to seven school days divided into: one -three class days for introduction, research, and writing of talk show dialog. One day for talk show presentation of each disease and one day for assessment.

Background Information

PARKINSON'S DISEASE

This information may be used for introduction/motivation, or for teacher reference. Students will be doing their own research to acquire this information.

Parkinson's Disease is one of the most baffling and complex of all neurological disorders. The cause is still a mystery but much research is being done. The fundamental defect which is a hallmark of the disease is the loss of brain cells that produce the chemical dopamine. This chemical helps direct muscle activity and when not enough is produced the neurons of the corpus striatum fire out of control causing resulting tremor and or loss of movement . Since people are living much longer and age of onset is usually in the fifties/sixties it is estimated that the cost of this disease alone exceeds $5.6 billion annually.

Symptoms: tremors, rigidity or stiffness of limbs, bradykinesia and slowness of movement, impaired balance & coordination, difficulty walking, talking, eating, depression, difficulty in swallowing and chewing, urinary incontinence,etc. The disease is chronic and progressive over time.

Cause: Hypotheses suggest free radical production which damages neurons, or environmental causes such as exposure to pesticides or toxins in the food supply. A genetic component is hypothesized in a small number of cases.

Treatment: Levodopa can be used by neurons to make dopamine to replenish the brain's dwindling supply. Selegiline (deprenyl) enhances and prolongs the effect of levodopa by delaying the breakdown of levodopa at the neurotransmitter site. Three experimental surgical procedures are currently being used. Cryothalamotomy is the surgical insertion of a supercooled metal probe tip into the thalamus ("relay station") to destroy the brain area that produces tremors. Pallidotomy is a procedure in which a portion of the brain called the globus pallidus is lesioned, thereby interrupting the neural pathway to the thalamus. This procedure may improve symptoms of tremor, rigidity, and balance and coordination. Fetal tissue transplantation replaces defective brain cells with cells of fetal tissue. Further research on the value of these procedures and the side effects is currently being conducted.

HUNTINGTON'S DISEASE

This information may be used for introduction/motivation, or teacher reference. The students will be doing research to acquire this information.

• Symptoms usually appear between 30-50 years of age

• Approximately 10% of gene carriers affected during juvenile years (age 2-20)

• Characteristic: rapid, uncontrollable, irregular dance like body movements (chorea)

• Motor symptoms include erratic, involuntary movement, slurred speech, and difficulty swallowing

• Emotional problems are depression, suicidal, irritability or aggressiveness

• Cognitive disturbances include recent memory and judgment impairment

• Inherited in an autosomal dominant manner only one copy of the gene is necessary to express the disease

• Affects families of an estimated 125,000 Americans

• Currently there is no cure or prevention for the disease, only treatment of the symptoms

• In the absence of prevention or cure, the value of predictive testing for people " at risk" is debatable

• Genetic testing can be costly and may or may not be covered by health insurance

• Presymtomatic testing may pose problems with privacy and confidentiality

Materials

• Scenarios for student information

• Roles students play: Name and job description of character. See below.

• Rubric for assessment: see assessment form

• Library or Internet research

Teacher Preparation & Directions: Talk Show

Talk Show scenarios are located in the Student Activity pages.

Use background information at your discretion to introduce the topic or have students begin the research without any introooduction.

Assign scenario and roles using choice cards (attached sheet) to groups of 4 to 9. Students should research their position.

Roles: Moderator, Medical Researcher, Neurologist, Affected Person, Spouse, Teen-age child, Insurance Agent, Commercial Sponsors (2-3 persons)

Allow sufficient time for research and collaboration depending on the level of your class.

Do simulation. (Students may dress for their role.)

Students not participating in this simulation are the members of the audience.

Assessment: Students will evaluate the presents or do a concept map.

Explain and use the rubric (assessment form) to evaluate presenters. There are three rubrics: one for the teacher, one for the audience, and one for the presenters. All evaluations should be confidential.

Assessment: Two possible assessments are available for all class participants.

1. Evaluation of presenters and presentation by the audience, by the people in the group(who evaluate each other), and the teacher. See assessment forms below.

2. Concept Map: Students work in groups to design a Graphic Organizer using neurological terminology with or without illustrations to show the connection between the nervous system and the disease presented. This may be used for the entire class or only the audience as the talk show presenters are already rated by the forms below.

Assessment Forms:

CONFIDENTIAL: Evaluation by Audience, Group Members or Teacher. CIRCLE the one you are doing.

Please rate the people in your presentation group on a scale of 1 - 5 with 5 being the highest ranking and 1 being poor.

NAME:_______________________ DATE: _______________________ PERIOD: _____

	Appearance	Performance	Content	Examples	Terminology

1. Moderator
2. Medical Researcher
3. Neurologist
4. Affected Person
5. Spouse
6. Teen-age child
7. Insurance Agent
8. Commercial
9. Commercial (2)

Extensions/Variations

• Students may write a reaction paper discussing the simulation.

• Groups of students may do an editorial page representing adverse sides of the bioethical problem, a cartoon, and quotes from other class members.

• Test on neurological terminology.

• Students will research other neurological disorders such as Adrenoleukodystrophy (ALS), Alzheimer's disease, Fetal Tissue Transplants and Muscular Dystrophy, etc. and write a paper or present them to the class.

Resources

1. National Institute of Neurological Disorders and Stroke (NINDS) - The NIH Neurological Institute, P.O. Box 5801, Bethesda, MD 20824

2. Brain Tissue Resource Center, McLean Hospital 115 Mill Street, Belmont, MA 02178 1-800 BRAIN BANK (1-8-272-4622)

3. National Disease Research Interchange (NDRI), 1880 JFK Boulevard, 6th Floor, Philadelphia, PA 19103 1-800-222-NDRI

4. MCET The Human Genome Project: Huntington's Disease Overview, Building 1500., 1 Kendall Square, Cambridge, MA. 617-252-5700

5. Huntington's Disease Society of America, 140 West 22nd Street, New York, NY.

6. Nova Video: "The Case of the Frozen Addict"

About the Authors:

Pat Lisoskie is a biology/bioethics teacher at Tumwater High School in Tumwater, Washington. Pat can be contacted at Tumwater High School, 700 Israel Rd. Tumwater, WA 98502. Contact the school for her current e-mail address.

Shari Cohen is a biology teacher at Homewood-Flossmoor High School in Flossmoor, Illinois. Shari can be contacted at Homewoood-Flossmoor High School, 999 S. Kedzie. Flossmoor, Il 60422. Shari's current e-mail address is sjcohen@kiwi.dep.anl.gov

Student Activity

NAME: ________________DATE:_________PERIOD:_______

THE TALK SHOW

Student Procedure

1. Read the following scenarios.

2. Research the disease you are assigned.

3. Prepare a script for the talk show to be handed in to your teacher.

4. Present the talk show.

5. Carefully fill out your assessment form.

6. Perform any other assessment your teacher directs.

SCENARIO - Parkinson's Disease

Maryanne and Steve both work for the Department of Fisheries and Wildlife. They have two children who are in high school. Lately Maryanne has noticed that she often seems off balance and has fallen twice. Her right hand has started shaking which is interfering with her computer work. She was diagnosed with Parkinson's Disease. She has read about an experimental surgical procedure which may stop her tremors and would like to have this surgery performed. Her employer is against this procedure as this will raise their insurance premiums. She has been a secretary all her working career and with a shaking hand this might not be possible to continue much longer. How will she be able to continue to maintain her quality of life and work so that her children can attend college?

SCENARIO Huntington's Disease

This should be a happy time in Susan Knapp's life. She just received the call notifying her that she got the job as research leader for a material engineering plant on the east coast. Her husband, Bob, had said he would be happy to move out east and find another job as a computer analyst. Their children David 14, and Jennifer 16 were surprisingly excited about the move. Susan was worried about Bob's father, who was suffering in the last stages of Huntington's Disease. Would the new company require a genetic test for Bob? Would they find out that Bob had been tested by their personal physician and the results were positive for Huntington's Disease? Would the family be covered by another insurance company?

COMMERCIAL

INSURANCE AGENT

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