Seoul, South Korea (CNN)One Friday night, Kwon Tae-hoon received a call.




"Are you the brother of Mr. Kwon Dae-hee?" the caller asked. "Your brother is in the ER. Could you come to (the hospital) now?"

His brother's condition "wasn't that serious," the hospital said. Kwon assumed his brother had gotten into a fight after drinking, and, as he took a taxi to the Seoul hospital, he prepared to scold him for getting into trouble.

But he never got the chance. When Kwon arrived, the 24-year-old was unconscious. After having a surgery to make his jawline more slender, his brother had bled so much that the bandage around his face had turned red.

Kwon never made it. He died in hospital seven weeks later.


Kwon's family say he was the victim of a "ghost doctor," the name given to someone who performs a surgery another surgeon was hired for when the patient is under general anesthetic.

The practice is illegal in South Korea, but activists say weak regulations in the country's booming $10.7 billion-dollar plastic surgery industry have allowed factory-like clinics, where unqualified staff substitute for surgeons, to thrive. Doctors sometimes simultaneously conduct multiple operations -- meaning they rely on substitutes who may be freshly qualified plastic surgeons, dentists, nurses, or, in some cases, medical equipment sales people -- to undertake some of the work for them.


Under South Korean law, someone who orders or performs an unlicensed medical act is subject to a maximum punishment of five years in prison or a maximum fine of 50 million won ($44,000). If a ghost surgery is performed by a licensed doctor, that could lead to charges of causing harm or fraud. But these crimes are hard to prove -- many substitute doctors don't note down the work they've done and many clinics don't have CCTV cameras. And even once the cases get to court, ghost doctors rarely get heavy penalties, which emboldens clinics to continue with the practice, lawyers say.

But Kwon's high-profile case has brought renewed attention to shadowy operators. His family aren't only bringing criminal charges against the doctors involved -- they're demanding legal changes, too.


Kwon's story



Kwon was a warm and humble university student, the kind of son who cooked seaweed soup for his mother's birthday, his family remembers. He was a high-achiever but was insecure about his looks and believed plastic surgery could make him more successful, his brother said.

In photos taken shortly before his death, Kwon had digitally altered his face to have the sort of pointy, V-like jaw seen on many K-pop idols.

Kwon's elder brother and mother, Lee Na Geum, tried to talk him out of getting plastic surgery, but Kwon secretly booked into a well-known clinic that specialized in jawline surgeries in the glitzy Seoul neighborhood of Gangnam, an area traditionally home to the country's biggest K-pop labels.

On September 8, 2016, a doctor removed bone to change the shape of Kwon's jawline, a popular surgery in East Asia that usually takes one to two hours. It cost 6.5 million won ($5,766), according to his mother.




After bleeding excessively, he was moved to hospital. At 9 a.m. the next morning, the plastic surgeon who had operated on Kwon arrived at the hospital. He told Kwon's family that the procedure had gone as normal and even offered CCTV footage of the operating room to prove it -- something that isn't required nationwide, but which some clinics do to increase trust. "I immediately felt that I needed that evidence," said Kwon's mother, Lee.

Lee watched the CCTV footage from the operating room 500 times, she says. The footage showed the surgery started at 12:56 p.m. when the plastic surgeon began to cut Kwon's jaw bone. Three nursing assistants were also in the room.

After an hour, the plastic surgeon left, and another doctor entered the operating room. The two entered and left the room, but for almost 30 minutes, there was no doctor in the operating room at all, although nursing assistants were present.


Lee saw that although the surgeon Kwon hired cut his jaw bones, he did not complete the surgery. Much of rest of the operation was done by the other doctor -- a general doctor who did not have a plastic surgery license and who had recently graduated from medical school, despite an advertisement for the clinic explicitly saying that the head doctor of the clinic would operate from start to finish.

Source: https://edition.cnn.com/2021/04/10/asia/south-korea-ghost-doctors-plastic-surgery-intl-hnk-dst/index.html?utm_source=pocket-newtab-intl-en




The world’s first mRNA vaccines — the COVID-19 vaccines from Pfizer/BioNTech and Moderna — have made it in record time from the laboratory, through successful clinical trials, regulatory approval and into people’s arms.

The high efficiency of protection against severe disease, the safety seen in clinical trials and the speed with which the vaccines were designed are set to transform how we develop vaccines in the future.

Once researchers have set up the mRNA manufacturing technology, they can potentially produce mRNA against any target. Manufacturing mRNA vaccines also does not need living cells, making them easier to produce than some other vaccines.



So mRNA vaccines could potentially be used to prevent a range of diseases, not just COVID-19.

Remind me again, what’s mRNA?


Messenger ribonucleic acid (or mRNA for short) is a type of genetic material that tells your body how to make proteins. The two mRNA vaccines for SARS-CoV-2, the coronavirus that causes COVID-19, deliver fragments of this mRNA into your cells.

Once inside, your body uses instructions in the mRNA to make SARS-CoV-2 spike proteins. So when you encounter the virus’ spike proteins again, your body’s immune system will already have a head start in how to handle it.

So after COVID-19, which mRNA vaccines are researchers working on next? Here are three worth knowing about.

1. Flu vaccine


Currently, we need to formulate new versions of the flu vaccine each year to protect us from the strains the World Health Organization (WHO) predicts will be circulating in flu season. This is a constant race to monitor how the virus evolves and how it spreads in real time.

Moderna is already turning its attention to an mRNA vaccine against seasonal influenza. This would target the four seasonal strains of the virus the WHO predicts will be circulating.

But the holy grail is a universal flu vaccine. This would protect against all strains of the virus (not just what the WHO predicts) and so wouldn’t need to be updated each year. The same researchers who pioneered mRNA vaccines are also working on a universal flu vaccine.







The researchers used the vast amounts of data on the influenza genome to find the mRNA code for the most “highly conserved” structures of the virus. This is the mRNA least likely to mutate and lead to structural or functional changes in viral proteins.

They then prepared a mixture of mRNAs to express four different viral proteins. These included one on the stalk-like structure on the outside of the flu virus, two on the surface, and one hidden inside the virus particle.

Studies in mice show this experimental vaccine is remarkably potent against diverse and difficult-to-target strains of influenza. This is a strong contender as a universal flu vaccine.




Read more: A single vaccine to beat all coronaviruses sounds impossible. But scientists are already working on one




2. Malaria vaccine


Malaria arises through infection with the single-celled parasite Plasmodium falciparum, delivered when mosquitoes bite. There is no vaccine for it.

However, US researchers working with pharmaceutical company GSK have filed a patent for an mRNA vaccine against malaria.

The mRNA in the vaccine codes for a parasite protein called PMIF. By teaching our bodies to target this protein, the aim is to train the immune system to eradicate the parasite.

There have been promising results of the experimental vaccine in mice and early-stage human trials are being planned in the UK.

This malaria mRNA vaccine is an example of a self-amplifying mRNA vaccine. This means very small amounts of mRNA need to be made, packaged and delivered, as the mRNA will make more copies of itself once inside our cells. This is the next generation of mRNA vaccines after the “standard” mRNA vaccines seen so far against COVID-19.





Read more: COVID-19 isn't the only infectious disease scientists are trying to find a vaccine for. Here are 3 others




3. Cancer vaccines


We already have vaccines that prevent infection with viruses that cause cancer. For example, hepatitis B vaccine prevents some types of liver cancer and the human papillomavirus (HPV) vaccine prevents cervical cancer.

But the flexibility of mRNA vaccines lets us think more broadly about tackling cancers not caused by viruses.

Some types of tumours have antigens or proteins not found in normal cells. If we could train our immune systems to identify these tumour-associated antigens then our immune cells could kill the cancer.

Cancer vaccines can be targeted to specific combinations of these antigens. BioNTech is developing one such mRNA vaccine that shows promise for people with advanced melanoma. CureVac has developed one for a specific type of lung cancer, with results from early clinical trials.

Then there’s the promise of personalised anti-cancer mRNA vaccines. If we could design an individualised vaccine specific to each patient’s tumour then we could train their immune system to fight their own individual cancer. Several research groups and companies are working on this.







Yes, there are challenges ahead


However, there are several hurdles to overcome before mRNA vaccines against other medical conditions are used more widely.

Current mRNA vaccines need to be kept frozen, limiting their use in developing countries or in remote areas. But Moderna is working on developing an mRNA vaccine that can be kept in a fridge.

Researchers also need to look at how these vaccines are delivered into the body. While injecting into the muscle works for mRNA COVID-19 vaccines, delivery into a vein may be better for cancer vaccines.




Read more: 4 things about mRNA COVID vaccines researchers still want to find out




The vaccines need to be shown to be safe and effective in large-scale human clinical trials, ahead of regulatory approval. However, as regulatory bodies around the world have already approved mRNA COVID-19 vaccines, there are far fewer regulatory hurdles than a year ago.

The high cost of personalised mRNA cancer vaccines may also be an issue.

Finally, not all countries have the facilities to make mRNA vaccines on a large scale, including Australia.

Regardless of these hurdles, mRNA vaccine technology has been described as disruptive and revolutionary. If we can overcome these challenges, we can potentially change how we make vaccines now and into the future.

Source: https://theconversation.com/3-mrna-vaccines-researchers-are-working-on-that-arent-covid-157858?utm_source=pocket-newtab-intl-en

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