Stem cells: the hope and the hype
Neil Scolding, Burden Professor of Clinical Neurosciences, Bristol
Open Door - August 2009 pages 8-9
picture:Katjaja
What a perplexing and difficult topic stem cell therapy has become, and how many misleading lines of evidence there now are! On the one hand, newspapers and other media constantly trumpet new and exciting stem cell advances, talking unrestrainedly of 'miracle cures' on the horizon, often, in fairness quoting enthusiastic and highly committed scientists. These are rarely completely inaccurate, but scientists have little incentive to belittle their own work, while at the same time editors know well that "small advance cautiously welcomed" is not a newspaper-selling headline. And so there is a conspiracy of incentives to 'enhance' the story.
But scandal and fraud also make good media stories, and so an equal and opposite amount of attention has also lately been directed at the numerous scam overseas 'clinics' selling bogus 'stem cell therapies' to innocent victims at enormous price. Quacks and charlatans have plied their parasitic trade for as long as there has been medicine itself; but the sums of money now involved - and the luxurious lifestyles this buys the conmen-doctors - still make great copy.
So page 1 of your daily news says 'stem cells are miracle cures,' but on page 2, 'don't believe these wicked conmen and their claims of miracle cures'! Where are we now, and where is the balance between these two opposing narratives?
Personally I find it difficult to know what is best to say to patients who ask in particular about going abroad to buy a stem cell 'treatment'. Most are of course full of enthusiasm, and many have spent enormous amounts of time on the internet researching the subject, the clinics and the options. And most patients also know that I am now about to pour very unwelcome and very cold water on their carefully laid plans. So neither of us, I think, can find it a comfortable situation. I strongly suspect what I say is far from the best answer. I do think it important that people considering this path - people who are often, if not always, desperate and petrified of the future - should be reminded of three things:
- first, please remember that the medical charlatan knows exactly how desperate and frightened you are: that is precisely the reason he targets people with MS (or motor neurone disease, or any disorder which currently cannot be cured by conventional medicines). He depends on your desperation - and, frankly, also uses it as a basis for calculating his price;
- second, remember these clinics are set up in Central America or China or wherever for a reason: because the regulatory systems would not allow them to function in Western Europe or the US. They are outside regulation. This doesn't just mean they avoid boring Health and Safety inspections and the minimum wage. It means that you can have no idea at all what is in the pink fluid in the syringe about to be injected into you. It could be coloured water (which at least would be safe). It could be cancer-forming embryonic stem cells. Tumour formation is not just a theoretical risk: the first case of a child, treated in Russia with embryonic cells and later developing tumours formed by the stem cells, has now been reported in the literature: others must surely follow.
- third, despite everything you might read on the internet, including accounts allegedly written by patients themselves, remember that clinics like these have now been running for well over a decade. Over this time hundreds - thousands - of desperate patients will have handed over their £30,000 or more for their miracle cure. If, in all this experience, a single patient with motor neurone disease had been cured of their illness, or a single patient with definite and progressive MS had thrown away their wheelchair and run a three hour marathon, or even had an MRI scan that had returned to normal, be in no doubt that the medical journals would have been buzzing with red hot case reports, time and time again ever since this started. They are not. There is not a single corroborated report of an MS 'cure'.
All this having been said, I firmly believe there will be useful treatments using stem cells in the future, once we have worked out the best and safest ways of harnessing the healing power of stem cells. But the right way forward is the tried and tested way of rigorous clinical science: of cautious laboratory science followed by carefully regulated clinical trials, which are only reported after intense scientific scrutiny by other independent experts. These trials have now started: the time frame is not one of endless further decades but the immediate future. We have seen time and time again in medical history that short cuts are dangerous - and it is the patient infinitely more than the doctor who suffers from this danger.
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