Stem Cell Ethical Concerns

This particular post should be read after (at least!!) reading the previous 3 posts - Stems Cells 101, & the Potential Impact of Stem Cell Research Part1 & Part2.

I shall try to outline some of the concerns surrounding this issue. Again, this is done in a rather over-simplified manner.

Of course, I think almost everyone involved or interested in the whole debate, is hoping that the recent research where adult stem cells, or even cells harvested from the umbilical cord will prove to be a successful route in the future. This technique should remove many (but not quite all) of the concerns that people have on the issue. I promise you that no scientist is choosing to research this area because of the ethical issues, or merely to make use of spare blatocysts that there may be in his lab. Every researcher I have met in this field is fully aware of the sensitive nature of the research. Certainly none of them are the evil mad scientists, that some sections of the popular media try to portray them as! (Well OK, I cannot comment on some of the North Korean labs…)

The main concerns are:

• Human embryonic stem cell research involves the destruction of a blatocyst, which some people regard as a human life.
• Some people have an issue with creating a blatocyst with the sole intention of destroying it.
• A concern is that this research could lead to the exploitation of women, as more and more donor oocytes may be needed.
• Some people object to the mixing of human and non-human genetic material in the research.
• Some sections of society even have objections to any advances in not only stem cell research, but genetics, molecular biology, and many other similar medical interventions are manipulations which undermine human dignity.
• There are other concerns, certainly but I hope this touches on the main ones.

Any research on human embryos is going to raise profound questions about the status of the human embryo, the extent to which it is justifiable to use human embryos to expand knowledge and ameliorate human suffering, and the conditions under which these goals may be pursued. Many people hold the view that a human embryo (of any stage) is morally equivalent to a human life. Some claim that any manipulation of a human embryo undermines human dignity. These are philosophical views which should not just be ignored. However, these philosophical views do not always manifest themselves culturally in our societies. A natural miscarriage (which, I have had the misfortune to witness) is a harrowing experience, but we do not conduct a funeral afterwards. Similarly, for most couples, the excess blatocysts from IVF treatments can be disposed of without any need for ceremony or specific interventions that we may feel appropriate for, say, the death of a child. Many religions do not recognise the human embryo as human life until a specific stage (around 40 days after conception).

I do feel that any discussion on the ethics of stem cell research should respect these deeply held views. But I do not feel that these, alone, should bring all research in these matters to a complete halt, as the potential benefits to so many people are so huge. But I do feel that these views should assist us in developing workable ethical codes, which take into account the special status of the human embryo, and try to protect that status in a serious manner.

An excellent overview can be read at

http://books.nap.edu/openbook.php?record_id=11278&page=47

Potential Impact of Stem Cell Research (Part 2)

Right, so we have covered what stem cells basically are (Stem Cells 101), and I touched on their potential impact in the next post Potential Impact of Stem Cell Research Part 1. Now let's look at the more controversial issues of cloning. I think this is the area which is most misunderstood, and seems to cause most problems for many people.

There are two distinct subjects to cover:
a. Therapeutic Cloning.
b. Reproductive Cloning.

Therapeutic Cloning
This is where cloned tissue is used to "grow" replacement organs for people who have sustained damage to their organs (through disease, or injury, for example). It so happens that this month (August) is organ donors month. I would encourage everyone to consider signing up for organ donation. Discuss it with your family, as obviously your decision will effect them. But organ transplants are becoming more commonplace (as we know, the first heart transplant was performed in SA). Transplants are held back for 2 main reasons; the availability of organs, and also the fact that the human body tries to reject foreign tissue. To get around the second problem, the recipient has to be pumped full of very strong anti-rejection drugs (which also leaves the person with vastly weakened immune systems). This can often lead to complications, other infections and death. Our knowledge is increasing in this though. The concept of therapeutic cloning is to use (ideally stem cells derived from that person, from potentially umbilical cord cells, or from adult stem cells) tissue that has been grown from stem cells that have had the recipients own DNA introduced into them (by the use of Somatic Cell Nuclear Transfer - SCNT). This would negate the rejection problem. Recently, in Imperial College London, a heart valve was produced and transplanted into a patient. Because stem cells have the ability to grow into any cell, then it is hoped that almost any tissue or organ could be produced in this manner. The potential of this is huge, and could dramatically improve the survivability of people who are severely injured in car accidents, properly functioning pancreases may be grown for people with diabetes, brain tissue producing the right amount of dopamine for people with Parkinson's Disease, new kidneys for people in renal failure, eye tissue & retinas for people with different conditions causing blindness such as RP, the list is very long… Of course we have a long way to go, and it may well be that we have some more huge hurdles to overcome. The mass media has overplayed the timings (and ease) of this science. It is hugely complex, and the likely benefits are still some time away.

Reproductive Cloning
Reproductive cloning is where a completely genetically identical embryo is produced. Think Dolly the sheep (whose stuffed body can be viewed in the Museum of Scotland), or Booger the pitbull. Again, I feel that the mass media are at fault in badly reporting the issues around reproductive cloning, with visions of armies of identical Aryan peoples. The media has also falsely reported that human cloning has already happened in some countries, but a more detailed look at the evidence would suggest that this is very unlikely. Reproductive cloning is also fraught with complex problems (aside from the ethical considerations). There is also a complete misunderstanding about what a clone is. A clone is a genetically identical twin. But this would not mean that the clone would think exactly alike to the donor. But, as we know in the nature / nurture observations, genes are only part of the make up of any characteristics. Identical twins, that have been separated at birth, while still displaying obvious visual similarities, can often grow up to have completely different characters, molded by the environments in which they grew up in. Dolly would not have had the same thought processes as her donor animal. Very few people see any benefit of producing human (or indeed any animal) clones, as there is no increase in the genetic profile. There is the theoretical possibility of producing a reproductive clone with the sole purpose of harvesting donor organs, but there are obvious moral & ethical issues to this. But nevertheless, it is important that any discussion on ethics and morals around this subject must also consider this possibility.

Potential Impact of Stem Cell Research (Part 1)

Stem Cells 101 gave a very brief, simple look at stem cells. Now we will look at the possible areas in which they may be used. I really want to unpack this before touching on the ethical issues. In this post I am concentrating on impairments and diseases. Part 2 will look at the potentially more contentious issue of cloning.

It is important to realise that while there are applications were adult stems cells are being used in medical procedures to good effect (in particular bone marrow transplants to treat Leukemia, and one of my friends is alive today because of that particular procedure!), presently there are no medical procedures being used based on Embryonic stem cells. So is all this noise a waste of time? Well, no. Research is still in the early stages. Indeed the first time that human stem cells were first derived was only in 1998. In the 10 years since then a lot has been found out, but this has also been hampered by restrictions, many political in nature. Certainly no one is doubting that this is a complex part of medical science. The mass media has not helped, by some of the very poor reporting, and exaggerated claims that they have fed the general public. Even if this research will produce cures & applications (which I am confident they eventually will), these are not "just around the corner", as has been reported in many instances in the previous decade. The reality is that I shall keep my wheelchair for the time being, and my father is probably too old for him to receive any cure for his Parkinson's Disease in time.

But the potential of stem cell research is enormous. Not only for the number of diverse conditions that may finally have a cure (or even a prevention), but also because of the nature of many of those diseases. Medicine has made some amazing advantages over the last century, and probably each of either would be, or have a close family member who would have died, if it were not for some medical intervention or other. Certainly 75% of my immediate family would be dead, including me. But there are still many really serious conditions and impairments that we just have no answers for yet. Many of these have a profound effect on peoples' lives. The possible diseases and impairments that stem cell research has the potential to effect includes (this list is not meant to be exhaustive!):

• Neurological
• Parkinson's Disease (think Michael J Fox, Muhammad Ali)
• Spinal cord injuries (Think Superman…and...dissol!!?)
• Retinal disorders (Stevie Wonder)
• Multiple Sclerosis (up to 150 out of every 100,000 of the population)
• Alzheimer's Disease (26.6million people worldwide think Ronald Reagan, Terry Pratchett), although it has to be said that some recent research in this particular field is painting a less promising picture than we had thought...
• Motor Neurone Disease (Prof Stephen Hawking, David Niven)
• Muscular Dystrophy
• Huntington's Disease
• Spinal Muscular Atrophy

• Others (Blood & Pancreas mostly)
• Leukemia (2% of all cancers)
• Sickle-cell Anemia (especially important to us in sub-Saharan Africa)
• Immunodeficiency (including HIV & AIDS)
• Lymphomas (5% of all cancers)
• Lupus (Michael Jackson, Elaine Paige Seal)
• Arthritis (Nelson Mandela)
• Bone Marrow Failure
• Diabetes (171million people or 2.8% of the global population, and rising, rapidly)

Of course, I am not claiming for a moment, that stem cell research will find absolute cures for the above, or any of the above. That is a common mistake made by the mass media. It may be, that some of the hurdles that researchers are finding out about, that they are insurmountable. But the research is looking very exciting in many of these different areas. I doubt we shall see any cures in widespread use soon. The best estimates seem to be looking 3 - 10 years ahead. That is also sometimes used as a argument against stem cell research; they ask "where are the cures?" This is not unreasonable, but the reality is that we do have some (small) cures and advances already, but also that this whole area of research is very complex, and by the nature of the research much of it is slow moving. Remember human stem cells were only first isolated in 1998…a mere 10 years.

Next post will be looking at the more contentious (and I would suggest less well understood) issues of cloning, both therapeutic and reproductive cloning. Only then, once we can agree some baselines, should we begin to think about some of the ethical issues around this research.

Stem Cells 101

This post is an attempt to explain what stem cells are, and the differences between the different types. I am not going to touch on the ethics of stem cell research in this post, but leave that for a later discussion. I do think it is important that people understand what a stem cell is before they are able to make a judgment call on the ethics surrounding the subject. That may sound obvious; but experience has shown me that again, and again, people (including very powerful people) will make a really serious decision, without fully understanding the issue behind stem cells.

I am also going to try to keep this short and therefore I may be accused of over-simplifying. I apologise in advance for that, and should be able to give more information if anyone requires it. I am not going to talk about the research at this stage either. It is just looking at the stem cell themselves, what they do, and where they come from.

Almost all living organisms have stem cells. The name comes from the fact (like a plant) these are the stem, that have the capability to produce different types of cells & therefore tissue. They are of course the cells which allow animals to grow (both in the womb, and later in life). They are also the cells which allow our bodies to repair damage. So if you want to see them at work, then you can cut yourself. Eventually the cut will heal over, and new tissue will be grown to heal the cut. Clever things…we would be in trouble without them.

Now there are different types of stems cells, and they are identified by the number of different types of tissue that they are able to produce.

• Totipotent - can produce any cell within the body
• Pluripotent - can produce almost any cell of the 3 germ layers.
• Multipotent - can produce any cell of a particular family of cells
• Unipotent - is only able to produce one type of cell

The potentially most useful cells are the ones that can produce the most type of cells - the first 2 (actually the focus is mostly on pluripotent) groups. And indeed it is these cells (and how they are harvested) that cause almost all the controversy.

In humans, pluripotent stem cells are taken from blastocysts, which are 3-5 day old embryos. The embryos are provided by fertility clinics. When females are receiving certain fertility treatments then they are given drugs to cause them to super-ovulate (or to produce many eggs). These are removed from the uterus and fertilised with the sperm. In other words, these embryos have never been inside a human body and would never go on to produce a foetus. If they were not to be used for stem cell research then they would be discarded, thrown out with any other organic waste.

A really exciting recent development from 2 separate pieces of research from last year, is the possibility to use adult multipotent skin stem cells, and alter them so that they could become pluripotent. Should this technique be fully successful, then it may remove almost all of the objections that people may have against stem cell research.

In the next post I would like to discuss the different research areas, and the lists of diseases / impairments / medical advantages that may be possible through this research. I think only when there is a full understanding of the facts, and issues that we can then go on to discuss the ethics.

Double amputee walks again due to Bluetooth - CNN.com

This is very exciting! It just shows how new technology is breaking new ground every day.

Double amputee walks again due to Bluetooth - CNN.com: "WASHINGTON (CNN) -- Marine Lance Cpl. Joshua Bleill lost both his legs above the knees when a bomb exploded under his Humvee while on patrol in Iraq on October 15, 2006. He has 32 pins in his hip and a 6-inch screw holding his pelvis together.

Joshua Bleill, pictured here with his girlfriend, is walking again with the aid of prosthetics outfitted with Bluetooth.

Now, he's starting to walk again with the help of prosthetic legs outfitted with Bluetooth technology more commonly associated with hands-free cell phones."

BBC NEWS | Africa | South Africa 'losing Aids battle'

This is quite a different slant on the figures as compared to what is being reported in the local press...where some small improvements in some of the figures are being used to show the 'success' of the programmes here... But this is very worrying.

BBC NEWS | Africa | South Africa 'losing Aids battle': "South Africa is in danger of losing the battle against HIV/Aids, the United Nations children's agency has warned. Unicef's South Africa representative, Macharia Kamau, said infection and death rates were outpacing treatment. This was having a devastating effect on children whose parents died of Aids, and sent out a dire message for the future, he said. Mr Kamau said if present trends continued, there could be five million orphans in South Africa by 2015."

BBC NEWS | Health | Stems cells 'slow nerve disease'

More interesting news on Stem Cell research, but the scientists rightly warn that the clinical use is still a long way off.

BBC NEWS | Health | Stems cells 'slow nerve disease': "Stems cells 'slow nerve disease'
Stem cells show potential for treating the debilitating nerve condition motor neurone disease, research suggests. A US team found injecting rats with stem cells delayed the onset of MND. Writing in the Transplantation, the researchers from Johns Hopkins Medical Institutions warned clinical use of stem cells was still a long way off."

BBC NEWS | Health | Find 'offers motor neurone hope'

This could be an exciting breakthrough, although there obviously needs to be a lot more work done on this.

BBC NEWS | Health | Find 'offers motor neurone hope': "Find 'offers motor neurone hope'
Scientists are hopeful that they have found a way to halt the progression of motor neurone disease (MND). A team at Bath University discovered a causal link between the gene involved in the formation of blood vessels and the development of some forms of MND. Mutant versions of the gene's product - angiogenin - are toxic to motor neurones, so blocking this process may stop the disease, they say."

BBC NEWS | Health | Research opens way for bionic eye

A long way off yet, but fascinating nontheless:

BBC NEWS | Health | Research opens way for bionic eye: "Research opens way for bionic eye
Eye
A bionic eye could potentially restore sight
US scientists have opened the way for the development of a 'bionic eye'.

They used electrodes to stimulate an area of the brain that processes visual information, the Proceedings of the National Academy of Sciences reported."

Catholic official asks legislators not to fund stem cell research - The Business Review (Albany):

Catholic official asks legislators not to fund stem cell research - The Business Review (Albany):: "New York state's Roman Catholic church Wednesday urged the state Legislature to reject Gov. Eliot Spitzer's proposal to invest $2.1 billion in stem cell and other biomedical research over the next decade.

Richard Barnes, executive director of the state's Catholic Conference, said church leaders are opposed to embryonic stem cell research. He said the proposal for the research fund is vague about what kinds of stem cell work would be funded if the Spitzer plan is approved."

How dare these religious egomaniacs interfere in science that could be the answer so many conditions? If they have a personal moral problem with it, then fine; but I believe that they have absolutely no right to dictate and try to enforce their code on others. They just don't understand the science or issues.

Quackwatch Mission Statement

Continuing on from my last post; this is another really useful site which exposes the many fraudsters and snake oil peddlers that inhabit the internet.  While the internet does provide the platform for may fraudsters to sell their wares, it also (if you are prepared to look!) also provides some useful counterbalance to all these different claims.  My business used to be selling herbs, (although the majority to pharmceutical companies, who would extract specific active ingredients for use in various medicines), and therefore I am aware of some of the 'useful' ingredients of certain specific herbs.
But the experience from their also provided me with an insight into certain dubious claims, and actions of a variety of different companies, who produce all manner of different substances, with all manner of weird and wonderful claims.  I hope that sites like the one below, will educate people, so they can make informed decisions about certain claims.  I am not for a moment proposing that I agree 100% with everything that is written on this site...but I do believe it does give me some useful FACTS and information that I use to decide the "Bullshit Rating" of what I read or am told elsewhere.

Mission Statement: "Quackwatch, Inc., which was a member of Consumer Federation of America from 1973 through 2003, is a nonprofit corporation whose purpose is to combat health-related frauds, myths, fads, fallacies, and misconduct. Its primary focus is on quackery-related information that is difficult or impossible to get elsewhere. Founded by Dr. Stephen Barrett in 1969 as the Lehigh Valley Committee Against Health Fraud, it was incorporated in 1970. In 1997, it assumed its current name and began developing a worldwide network of volunteers and expert advisors. Our activities include:

• Investigating questionable claims
  
• Answering inquiries about products and services
  
• Advising quackery victims
  
• Distributing reliable publications
  
• Debuking pseudoscientific claims
  
• Reporting illegal marketing
  
• Assisting or generating consumer-protection lawsuits
  
• Improving the quality of health information on the Internet
  
• Attacking misleading advertising on the Internet"

Spiders and Horse's Tails

It has been suggested by a friend that I should give an explanation of my medical condition. Normally I really don't like to make a big deal of my disability (I am not even sure I like the name of this blog; another friend's idea). But the wheelchair is part of me, and Disability is an intrinsic part of my business (see my business website - www.disabilitysolutions.co.za).
I am a wheelchair user, and unable to walk or stand unaided. It is a long (and mostly boring) journey that got me here, but to summarize it (as it could be useful for other people who may be starting out with a new disability or know someone who is):
I managed to fracture 3 vertebrae playing rugby in 1984. It did not hurt much at the time, and I played on to the end of the season in blissful ignorance.
Eventually, it was becoming apparent that all was not well (pain, and a loss of sensation). So I got checked out (another story for another day), and passed from one specialist to another. Eventually they had to operate and I have been really fortunate to always have good surgeon's for this (Mr. Maurice-Williams of the Royal Free Hospital in London), and subsequent operations. I had a fusion (T5-T10) and everything was fine for about 15 years.
Then the fusion collapsed, top and bottom, damaging both my spinal cord, and the bundle of nerves that look like a horse's tail which come out of the bottom of the cord (Cauda Equina).
I had a further 6 operations during 1999 and 2000, which managed to halt further damage (again, with having a fantastic surgical team - led by Dr. Daan Botes). However I was left with some spinal cord damage (T4-T12) and damage to the other nerves which led to a condition called Cauda Equina Syndrome. I also had some weird scarring in one of the protective larges around the spinal cord. This looks like a faint spider's web when it is viewed using a MRI scanner - this appearance gives it its name of (Adhesive, in my case) Arachnoiditis. It may look faint, but it can be really bloody painful! Anyway there is very little available information on either of these conditions, and I think it was searching for information on these that I really discovered the power of the Internet. I will try to collect some of the information I have on these two conditions and post them here sometime.
But I do need to mention one of the vital lifelines that saw me through the rough period. Number I has to be my wife and immediate family, but I also happened upon a fantastic support group - Cauda Equina Syndrome Support Group CESSG. The friends (Vickie, Sandy, Colette, Carlos, Gina, etc, etc) there saved my life on many occasions. I know I have not mentioned everyone there, as the mailing list was very well supported with hundreds of members, and the mutual support was tremendous. I know the mailing list has moved recently, and I shall try to find it again.