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Australasian ScienceStem promises give way to abuses

Occasionally something comes along in medicine which changes the whole way that things are done or thought about. Some examples are the discovery of the structure of DNA, vaccination, antibiotics. I can remember the first successful heart transplant.

A technique being researched today which could have enormous benefit in the treatment of seemingly intractable conditions is stem cell transplantation. There are already conditions which can be treated in this way, but they generally rely on the transplant of specific types of stem cells. As an example, someone I love has multiple myeloma and one treatment for this is to take stem cells from the patient, wipe out the immune system using chemotherapy, and then restore it by using that person's own stem cells to rebuild the immune system and the way that blood components are made in the body.

Unfortunately there are some objections to the use of one source of stem cells for reasons which have nothing to do with science. Possibly the most productive stem cells which can be used to treat a multitude of conditions are those derived from blastocysts, the small clusters of cells developed within 5 to 6 days after fertilisation. Objections have been raised on religious grounds, ethical grounds, and by politicians simply pandering to potential voters. This is not the place to discuss religious objections, but the ethical situation can almost certainly be handled by applying some of the rules already used to cover the ethics applying to research on humans and in IVF programs. Little can be done about politicians.

Because embryonic stem cells can be used to create almost any organ and part of the body they offer enormous potential to grow and produce organs to replace those that have been damaged or have failed or have not developed properly in the first place. Promising avenues already seen in research with animals, and even early human trials, have suggested that stem cells may provide an answer to such conditions as Type 1 diabetes, macular degeneration, spinal cord injuries, and neurological conditions like Alzheimer's disease or ALS (Amyotrophic lateral sclerosis). It's very early yet, but this line of research provides hope that in the future, maybe even in the near future, some of the world's most dreaded medical conditions will be successfully treated, allowing those who would have in the past had very dismal future prospects to lead long, disease-free, and productive lives.

Unfortunately there is a dark side to this. Surveys over the last few years have shown a very high acceptance by the public of the idea of stem cell research, with around 90% thinking that the research is worth doing, it should be done, and the result will be worth the cost. Simultaneously, only about 40% have felt that the risk of this research is too great, or that even the risk of using the results of the research is too great. This large gap between the perceived risk and the expectation of benefits has been filled by charlatans who offer hope, at a high cost of course, to people who are desperate to find cures. The methods of recruitment, the marketing, and even the cost of the treatments are almost indistinguishable from those of the cancer quackery industry. Patients are paying large amounts of money to do what is called "stem cell tourism", where they travel to foreign countries to pay large amounts to "doctors" who offer them cures. Also like the cancer quackery industry, there are testimonials from people who feel that it has benefited them or even those who say that even if it didn't have benefit the hope provided was worth the dollars spent. These dollars are not insignificant, with costs ranging from tens of thousands and up to hundreds of thousands of dollars for "cures" which are untested, unproven, and which might be administered either by untrained or incompetent people.

Cell transplantation is not new. In the 1920s and 30s Serge Voronoff transplanted monkey tissue into human testicles (the famous "monkey glands"). In the 1930s to 50s, Paul Niehans transplanted cells from sheep and other animals. Successes were few, and seem to be limited to celebrities who could provide good testimonials. Transplanting human stem cells could possibly be less dangerous than using cells from other species, but that doesn't give a licence to charlatans to exploit the sick and desperate.

On the day that I'm writing this (in October, 2014) there is news of a man whose spinal cord was completely severed being able to walk with a frame following transplantation of nasal cells. This follows four decades of research by the doctor involved and the team is warning against too much optimism but feels that further breakthroughs might be as close as five years away. And that conservative approach is the difference between science and pseudoscience.

This article was published as the Naked Skeptic column in the December 2014 edition of Australasian Science
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