The current issue of Kennedy Institute of Ethics Journal contains the first installment in a two part series on the ethics of stem cell tourism, by long time stem cell watcher Cynthia Cohen and Peter Cohen. The Cohens pull together a large body of news reports and internet posts on Russian and Indian private clinics offering stem cell interventions to foreign patients (who travel to these clinics because they cannot receive the nonvalidated interventions in their native countries).
They provide a very critical view of these clinics and the practice of offering nonvalidated stem cell interventions to large numbers of patients outside of clinical trials- a view that readers of this blog will recognize as one that I share: “those who travel to other countries for stem cell treatments enter into a sort of medical Russian roulette.” I would add: they pay large sums to shady characters for the privilege.
The back end of the article takes issue with commentators who have offered a quasi-defense of stem cell tourism, viewing stem cell development as analogous to surgical innovation. These commentators have thus defended the idea of offering stem cells outside the trial context. According to the Cohens, these commentators “do not explain in what respects these interventions resemble surgical procedures and do not furnish reasons why clinical trials are not possible for them.”
There is an intriguing theme in this article that ties in with my recent Science article. Namely, the Cohens are careful to point out that there are many legitimate stem cell scientists in Russia and India that have called on their governments to regulate stem cell clinics because their activities harm the reputation of unaffiliated stem cell researchers in the same country. More on how stem cell scientists have attempted to draw boundaries between their own work and that of these clinics in my next post…(photo credit: Alex McGibbon, (courtesy Banksy), 2006)
Jonathan Kimmelman. "Information: Stem Cell Tourism Redux (part 1)" Web blog post. STREAM research. 17 Jun 2010. Web. 05 Dec 2024. <http://www.translationalethics.com/2010/06/17/information-stem-cell-tourism-redux-part-1/>
APA
Jonathan Kimmelman. (2010, Jun 17). Information: Stem Cell Tourism Redux (part 1) [Web log post]. Retrieved from http://www.translationalethics.com/2010/06/17/information-stem-cell-tourism-redux-part-1/
In the September 2009 issue of Nature Biotechnology, Jane Qiu reports on a thriving trade in nonvalidated stem cell interventions for incurable illnesses (“Trading on Hope”). The article provides numerous examples of overseas clinics that cater primarily to North American and European clientele in offering pricey, unproven stem cell transplants for incurable conditions like spinal cord injury, Parkinson’s disease, and autism. Many of these clinics make extravagant claims in their promotion materials.
Encouragingly, policy makers are beginning to take notice. China, for example, has issued new regulations on clinical application of novel interventions; it requires licensing for clinics that provide unproven stem cells. India has issued guidelines on stem cell research and therapy. As noted previously in this blog, the scientific society ISSCR issued guidelines urging clinicians to offer nonvalidated stem cell interventions to patients only in the context of clinical trials designed to test safety and efficacy. Problem is (according to the article), guidelines are sporadically enforced, if that.
I think there is much more that governments and professional societies can and should do to stem this unethical conduct. Though most of these clinics are located outside of North American and Europe, some overseas clinics have reputable, North American / European scientists and clinicians on their advisory board or have partnerships with biotechnology companies that are based in North America / Europe. Examples include Stemedica (which includes several Stanford and UCSD faculty on its advisory board), and Theravitae (which has involved close collaboration with University of Pittsburgh clinicians), and Vescell (which includes Nobelist Aaron Ciechanover on its scientific advisory board). All of these companies offer stem cell interventions to large numbers of patients outside trials, and make claims that their interventions are effective when, in fact, they remain unproven.
1- Research ethics policies should condemn scientist-clinicians who travel or collaborate abroad in delivering nonvalidated, potentially risky interventions overseas outside the context of a clinical trial. Policies should state clearly the imperative of subjecting nonvalidated interventions to systematic study.
2- Institutions should not allow these clinics to trade on their reputations, and should sanction faculty members who are involved in such activities.
3- professional societies in medical fields (e.g. cardiology) and research areas (stem cells, gene transfer) should steward the standing and credibility of their research field by developing policies and standards that discourage inappropriate activities– through social pressure– by providing a benchmark against which the conduct of scientists and clinicians can be judged.
@Manual{stream2009-84,
title = {Quack You! Medical Tourism and Stem Cells},
journal = {STREAM research},
author = {Jonathan Kimmelman},
address = {Montreal, Canada},
date = 2009,
month = sep,
day = 23,
url = {http://www.translationalethics.com/2009/09/23/quack-you-medical-tourism-and-stem-cells/}
}
MLA
Jonathan Kimmelman. "Quack You! Medical Tourism and Stem Cells" Web blog post. STREAM research. 23 Sep 2009. Web. 05 Dec 2024. <http://www.translationalethics.com/2009/09/23/quack-you-medical-tourism-and-stem-cells/>
APA
Jonathan Kimmelman. (2009, Sep 23). Quack You! Medical Tourism and Stem Cells [Web log post]. Retrieved from http://www.translationalethics.com/2009/09/23/quack-you-medical-tourism-and-stem-cells/
The current issue of Kennedy Institute of Ethics Journal contains the first installment in a two part series on the ethics of stem cell tourism, by long time stem cell watcher Cynthia Cohen and Peter Cohen. The Cohens pull together a large body of news reports and internet posts on Russian and Indian private clinics offering stem cell interventions to foreign patients (who travel to these clinics because they cannot receive the nonvalidated interventions in their native countries). 
