American Transplant Congress Philadelphia 2011

April 30 - May 4, 2011

Pennsylvania Convention Center
Philadelphia, PA
  ==> http://2011.atcmeeting.org/

The Stem Cell Hype Machine: The Top Five Over-Hyped Claims About Stem Cell Research

SOURCE: AP Photo/Andy Manis

"A technician shows off a vial that contains about 1 million viable human embryonic stem cells from one stem cell line. WiCell, a stem cell bank funded by the National Institutes of Health, is a clearinghouse meant to distribute human embryonic stem cells approved by the Bush administration."

By Arthur Caplan (1) 
Monday, April 18th, 2011

"Proponents of embryonic stem cell research have too often engaged in hype about cures. Well, now that I have your attention, let’s get all the hype about embryonic stem cell research out on the table.

I say this because I was a little surprised to recently find myself the object of an Internet tempest for a few days over an interview I did with my friend, conservative political theorist Robert George of Princeton University. Robbie, with whom I disagree about many things but deeply respect for his willingness to engage in honest debate, understood what I had to say and knew I said so prior to this interview. Apparently, other critics of stem cell research had chosen to ignore my caustic comments about some proponents overpromising cures over the years.

In the interview I said many scientists and their supporters favoring public funding of embryonic stem cell research had gone too far in hyping the prospects of rapid cures following right on the heels of generous government funding. They did. My saying so, however, was hardly the news The American Spectator, First Things, and other electronic conservative outlets made it out to be.

Anyone who has followed my advocacy for embryonic stem cell research would know I have long been critical of claims that funding today means people tomorrow will leap from their wheelchairs and walk. This is me in 2006 describing overpromising of embryonic stem cell research in Wired: 'There’s big expectations, a lot of hype.' And saying the same thing at greater length two years ago: 'There has been hype and overpromising. … I don’t know if stem cell research will work, I think it’s very interesting, I support doing it, but I think you have to be honest and say there’s a small chance nothing will work.'

I then explained why the hype had grown so loud:

There was such a bitter battle over funding, so one side was screaming that you can’t kill embryos to try and save people and in response, the defenders of stem cell research began to say, 'look, if you would let us do this research we can save lives. … it was in the heat of that political battle to score points that they [proponents] overstated the case.'

Having lived during the 1990s when the hype machine was spinning full throttle about the curative powers of gene therapy, the clinical wonders that would quickly follow from mapping the human genome, and the frothy promise that genetically engineering plants would quickly cash out in the form of fortified foods such as golden rice that would rapidly solve the nutritional deficiencies of the world’s poor, I am keenly sensitive to the kind of overpromising that occurs when a novel form of science is in search of public funding. The fact that the fight over public funding of embryonic stem cell research had the critics screaming 'murder' regarding the destruction of human embryos evoked even more overwrought language from proponents about the speedy cures lying right around the corner.

Since everyone for some reason now seems very interested in coming clean about hype in the embryonic stem cell debate, I thought I might take a quick tour of five of the most outrageous, overhyped claims by critics that have characterized what has passed for debate during the years since George W. Bush addressed the nation from the Rose Garden in 2001 to offer his 'compromise' position over public funding of embryonic stem cell research.

Hyped claim #5: The Bush 'compromise'

The president tried to offer a 'compromise' about government funding of embryonic stem cell research. Government funds could be spent on stem cell lines made from human embryos prior to August 9, 2001, but nothing else. The president said there were cell lines available from 64 embryos for which consent had been obtained to use them in research.

Except there were not. Some of the cell lines were owned by non-U.S. companies who would not share them. Some of the cell lines did not grow well. Some of the cell lines had been generated without informed consent from anyone. What was touted as a brilliant 'solution' by many conservatives and not a few middle-of-the-road commentators was nothing more than a ban dressed up as a compromise.

Hyped claim #4: Adult stem cells can do it all

The number of antiembryonic stem cell researchers offering up this bit of hype are legion. The argument goes that since adult stem cells have been used to cure many people while embryonic stem cells have not, there is no need to pursue embryonic stem cell research. Father Thad Pacholczyk, often quoted in right-wing circles, who is a staunch critic of embryonic stem cell research, offered one of a zillion such examples in 2006 of why there is no need to pursue embryonic stem cell research, because there are 'dozens of diseases currently treatable using these [adult] stem cells, including sickle-cell anemia, leukemia, spinal cord injury, and heart disease.'

I am not sure what he was talking about regarding spinal cord injuries, which as far as I know remain completely incurable, but it is true that bone marrow transplants have cured a lot of children and adults. And bone marrow is a type of adult stem cell. That is where the truth of this claim ends and the hype begins.

The research behind bone marrow transplantation began in the 1950s. It received generous government grant support for the next 50 years. It still does. Embryonic stem cells were first discovered in 1998. Research involving those cells has received minimal funding from any source since then. As Robert George forthrightly said in our discussion, it is just dishonest not to concede that you are giving up a key line of research if you don’t fund embryonic stem cell work by pretending you know that it can be completely replaced by adult stem cell research.

Hyped claim #3: If embryonic stem cell research is so promising, then why isn’t private research behind it?

A typical example of this absurd claim appeared in The Wall Street Journal where Richard Miniter opined in 2001:

Of the 15 US biotech companies solely devoted to developing cures using stem cells, only two focus on embryos. Embryo stem cell research is at the drawing-board stage – not for lack of funds but for lack of promising research to finance. Venture capitalists have no agenda beyond making money; if they see embryo projects that are likely to bear fruit over the next five to seven years – the usual VC time horizon – they will fund them. That the market is speaking so loudly against embryo stem cell research probably explains why embryo researchers are so eager to reverse the ban on government funding.

It has been echoed in the conservative right-wing blogsphere ever since.

This is hype in a very pure form. No venture capitalist or firm is going to back research in a big way that (a) is just starting out, (b) does not yet understand the basic science involved, and (c) has elicited huge opposition from the then-president of the United States and his supporters in Congress. Governments fund basic, early-stage research. The U.S. government has long been the 100-pound gorilla of such funding. It is only later, as commercial possibilities emerge, that the private sector gets really interested. Keep the NIH out of funding basic stem cell research and few private dollars will flow no matter how promising that line of research might be.

Hyped claim #2: IPS cells are the magical solution to the embryonic stem cell quandary

Conservative columnist Charles Krauthammer led the hype machine on this subject. Back in 2007 an announcement was made that researchers in Japan had discovered how to reprogram adult skin cells to resemble embryonic stem cells. Krauthammer immediately declared Bush had been right to ban public funds for embryonic stem cell research (I thought that had been a 'compromise') since there was now a way to create 'a magical stem cell that can become bone or brain or heart or liver' without using human embryos. Magical—really? Could there be any claim more fraught with hype then declaring that any biomedical discovery is ready to go right out of the lab to your doctor’s office?

Making adult cells into embryo-like cells remains the current darling of critics of research involving embryos. But the technique is barely understood and its safety is a huge concern to those working in the area. Not only was it hype to declare in 2007 that the game was over for embryonic stem cells or even to continue to say in 2011 that there is no need to pursue embryonic stem cell research (note, by the way, no cures from IPS—five years and counting) is nothing less than unadulterated hype driven by an agenda utterly disconnected from the nascent state of the science.

Hyped claim #1: Frozen embryos should be put up for adoption rather than used as sources of stem cell lines

The meshugana lawsuit that Dr. James Sherley, a biological engineer at Boston Biomedical Research Institute who works on adult stem cells, has brought is currently holding up NIH funding of expanded embryonic stem cell research. Sherley implausibly argues that permitting more funding for research on stem cells derived from human embryos would harm his work by increasing competition for federal funding.

What has been forgotten about this suit is that it was originally joined by an adoption agency called Nightlight Christian Adoptions, which argued that expanding funding for research on embryos obtained from fertility clinics reduces the number available for use in adoption.

Now the Nightlight folks got the axe from a federal judge and were kicked out of the lawsuit. What needs to be remembered, though, is that far too many critics of embryonic stem cell research, including President Bush, advance adoption and continue to do so as if it were an alternative to either the destruction of embryos at fertility clinics or the use of abandoned frozen ones in research.

This is Bush in 2005: 'There’s an alternative to the destruction of life, with little babies being born as a result of the embryos that had been frozen.'

Now I am very sensitive on the matter of unwanted embryos left behind at fertility clinics. In 1999 I published a paper with George Annas and Sherman Elias, 'Stem Cell Politics, Ethics and Medical Progress,' in which we first outlined the ethical case for using unwanted frozen embryos at infertility clinics as the true compromise position about where to obtain embryos for stem cell research. It was a good idea then and remains so now.

There have been about 50 reported adoptions of frozen embryos from infertility clinics in the past five years. Few will have any interest in using embryos from couples having infertility problems to try and have a child. And the whole point of using infertility treatment in the first place is to create a genetic tie between the child and one or both parents. Knowing there are hundreds of thousands of unwanted frozen embryos in clinics today means pointing to adoption as an 'alternative' to their use in research is utter hype.

While I am on this particular bit of hype, I should add that those who do not favor the use of unwanted and certain-to-be-destroyed frozen embryos languishing in clinics worldwide never ever say what they propose be done with them. Conservatives say destruction is unthinkable, however, since it is inevitable then what are they talking about? ( I suppose this constitutes hypocrisy and not hype.)

There is plenty more hype to be had from what has passed as debate over the past decade or so since human embryonic stem cells were first isolated. I don’t mean to suggest that most of the hype has come from critics rather than proponents. I do mean to suggest, however, that those who live in very fragile houses often constructed of hype ought not be quick to cast stones."

(1) Arthur Caplan, PhD, is the Director of the Center for Bioethics at the University of Pennsylvania.
http://www.scienceprogress.org/2011/04/the-stem-cell-hype-machine

http://2011.atcmeeting.org/

"Just Say No!" To Organs from Suicide Victims?

"According to Wesley Smith on his SHS blog, 'Suicidal people need help in living, not reasons to die.' Profound statement indeed. Yet, Smith goes on, 'to prevent people from using the pretext of organ harvesting as a justification for their suicides, we need to make it very clear that their organs will not be so used...' and therefore the organ transplant community must come out against the use of organs suitable for transplant from those who have terminated their lives.

Smith's argument amounts to little more than a call for OPOs to 'Take a Stand Against Suicide!' yet ignores the fact that tens of thousands die each year waiting for an organ. Those who die waiting on a transplant list have no other choice they can make--and yet those opting for suicide, as sad and troubling as that choice may be, can benefit those who are suffering in organ failure.

And while it would be truly disturbing if a person willingly killed him- or herself to provide organs to others, this mentally disturbed individual opting for suicide for all the wrong reasons would, I'm certain, be rare indeed.. For those individuals who are so beset by mental anguish, pain and other symptoms that they want no longer to live for these reasons in and of themselves, there can be no good reason why organs harvested and given to others would be morally objectionable. While such suicides are a tragedy, should we simply compound the harm of that choice by denying those suffering from organ failure the chance to live?

Show me the data that says those committing suicides are actively thinking about the organ recipients they could benefit, and then we can talk, Wesley. Otherwise, your argument is nothing but simple moralizing and judgmental thinking about the suicidal dressed up in concern for their welfare."

Summer McGee, PhD
http://blog.bioethics.net/

La loi de bioéthique adoptée au Sénat

Nouvelle offensive pour la recherche sur l’embryon

"Les sénateurs ont infligé un revers au gouvernement en adoptant l’autorisation encadrée de la recherche sur l’embryon lors de la discussion en première lecture du projet de loi de bioéthique."
 
Le Quotidien du Médecin, 11/04/2011

Le cœur artificiel chez l’enfant, ça existe et en France

"L`utilisation du cœur artificiel chez l’enfant n’est pas une nouveauté, mais elle reste largement méconnue du public mais aussi du corps médical."

Le Quotidien du Médecin, 11/04/2011

Mon commentaire : Ce n'est pas nouveau ... En 2004 déjà, un chirurgien membre senior de l'Académie Nationale de Médecine signalait ce sérieux problème (lire) ... L'assistance circulatoire mécanique permet à un coeur défaillant de récupérer, dans certains cas IL N'Y A PLUS BESOIN DE TRANSPLANTATION (lire).

Les obstacles culturels à l'utilisation de la microturbine pour assister un coeur défaillant ? On pense qu'il vaut mieux une transplantation cardiaque. Or ... d'un point de vue scientifique, ce raisonnement ne tient plus la route ... pourtant les clichés ont la peau dure ... Et la pénurie de coeurs à greffer est une réalité ... A bon entendeur ...

Bioéthique : les Sénateurs s’emparent du débat

"Adopté à l’Assemblée le 15 février, le projet de loi est désormais examiné par les sénateurs en première lecture jusqu’à vendredi, au plus tard. D’importantes modifications ont été entre-temps apportées par la commission des Affaires sociales.

À la tribune, la secrétaire d’État à la Santé, qui a ouvert les discussions cet après-midi, a rappelé la position du gouvernement (retenue par les députés mais modifiée par la commission) concernant les recherches sur l’embryon : 'Il n’y a pas lieu de modifier le régime instauré en 2004 qui a permis de concilier le haut degré de protection accordé à l’embryon avec une qualité de la recherche internationalement reconnue', a insisté Nora Berra. 'Les symboles ont leur importance', considère-t-elle, tandis que d’autres, comme les sénateurs Bernard Cazeau (PS), Gilbert Barbier (RDSE) et Guy Fischer (CRC-SPG) dénoncent l’hypocrisie du régime d’interdiction assujetti à des dérogations. 'Le législateur ne doit pas être à la remorque de la science et doit créer le cadre des conditions du vivre ensemble', propose Gilbert Barbier.

Mais pour la sénatrice Marie-Thérèse Hermange (UMP), toute la discussion consiste à savoir si 'c’est la science qui crée la vie ou si c’est la vie qui crée la science'. 'Le législateur doit encourager les avancées de la science quand elles servent les êtres humains et non quand elles se servent' d’eux, répond-elle, indiquant qu’elle veut déposer un amendement contre le diagnostic préimplantatoire HLA. François Zocchetto (UC) ne conçoit pas, pour sa part (une idée partagée par les premiers orateurs), d’accorder le transfert d’embryon post-mortem pour un enfant qui naîtrait de facto sans père. Après les 'bébés-médicaments', 'nous aurions les bébés-souvenirs', déplore-t-il. Seule la gestation pour autrui semble rassembler contre elle. 'Je ne dirais mon vote qu’à l’issue du débat', prévient Guy Fischer, en expliquant que 'le projet de loi peut être très mouvant'."
› S. H.
http://www.lequotidiendumedecin.fr/information/bioethique-les-senateurs-s-emparent-du-debat?ku=9v7668AB-BBy8-96EA-vDDE-vDx58ywBy6DC#utm_source=lequotidiendumedecin&utm_medium=email&utm_campaign=news_derniere_heure_qdm

La révision de la loi au Sénat

"L’AMP suspendue au débat éthique

Le Sénat entame aujourd’hui la deuxième lecture du projet de loi de bioéthique. L’un des enjeux majeurs est la levée de l’interdiction de la recherche sur l’embryon."
 
Le Quotidien du Médecin, 05/04/2011

"Evolution by Intelligent Design"

Nos généticiens et éthiciens 1.0 vont avoir du boulot !

"Genome Biology:  Artificial chromosomes like these could be used as Trojan horses to sneak useful new traits into the human genome."

"'There are no shortcuts in evolution,' famed Supreme Court justice Louis Brandeis once said. He might have reconsidered those words if he could have foreseen the coming revolution in biotechnology, including the ability to alter genes and manipulate stem cells. These breakthroughs could bring on an age of directed reproduction and evolution in which humans will bypass the incremental process of natural selection and set off on a high-speed genetic course of their own. Here are some of the latest and greatest advances."

 ==> Read further
http://discovermagazine.com/2009/mar/02-evolution-by-intelligent-design

Should you be paid to part with a kidney?

"It's an unseemly question, but it's one that medical professionals have been grappling with as the waiting list for kidneys gets longer, supply of the organs stagnates and other solutions fall short.

In 1999, just over 40,000 Americans were on the waiting list for a kidney, according to the Scientific Registry of Transplant Recipients, a record that's overseen by the government. By 2009, the list had grown to nearly 83,000 people, the National Kidney Foundation says. That same year, just 16,500 people received a transplant.

To help increase supply of the organs, some transplant professionals have suggested establishing a market for kidneys so that donors could receive cash or other incentives — such as health or life insurance — in exchange for their healthy organ. (Donors can live a healthy life with only a single kidney.)

Those who are against the idea worry that it could exploit the poor and encourage unethical medical practices. Those in favor counter that without a market, people on the waiting list for a kidney will die unnecessarily.

Read on for two views on this topic.

People who need kidneys are dying unnecessarily, and an organ market would save lives.

Dr. Benjamin Hippen is a transplant nephrologist at the Carolinas Medical Center in Charlotte, N.C.

The most compelling reason for setting up a market for organs is that there really isn't any other plausible solution to the growing disparity between the demand for and supply of organs. Even if we were to maximize organ procurement from deceased donors, we still couldn't meet the demand.

As that demand grows, it's not just potential kidney recipients who get desperate — it's also potential donors, who often have a close-up view of what their loved ones are going through. We then see people with health problems, like high blood pressure or obesity, say that they're willing to take on a certain amount of risk so that their loved one can live a better life.

A regulated market would be, in some sense, safer — the pressure would be taken off folks who want to be donors but perhaps shouldn't be for medical reasons. Transplant professionals could then select the healthiest donors, who are at the lowest risk for long-term complications. With a regulated market, we could say to high risk-donor candidates, 'No, you shouldn't be a donor, and your loved one isn't going to suffer as a consequence of that decision.'

There's also a significant difference between what it costs to maintain a transplant versus what it costs to maintain someone on dialysis. In 2007, $28 billion was spent nationally on people on dialysis; about $2.2 billion was allocated to kidney transplantation. So transplants are vastly more cost-effective, and in general they confer a longer survival benefit. Also, a larger proportion of people are able to go back to work compared with people on dialysis.

The unregulated, underground black market in organs in developing countries has been catastrophic for both donors and recipients. But the reason that someone who is desperately poor may be able to sell their kidney on the black market is that people in countries of comparative wealth have failed to solve their own supply problem. That is a policy failure. If the demand for organs could be met through legal, ethical strategies, some of the driving forces that support black markets would disappear.

If, indeed, the current system isn't meeting demand, then there's a sense in which it's unethical not to establish regulated incentives for living donors or to think more carefully about not doing so. The cost is being paid by the people who are dying on the waiting list, getting sicker on dialysis or selling their kidneys under terrible circumstances.

An organ market would exploit the world's poor and set the precedent for medical transplant tourism that puts everyone at risk.

Dr. Francis Delmonico is the director of renal transplantation at Massachusetts General Hospital and a professor of surgery at Harvard Medical School. He is also the medical director of the New England Organ Bank in Newton, Mass.

Despite the good intentions of those who would suggest that an organ market could be regulated, it's impossible to do so. A market for organ sales enables brokers and extra payments, and in a global society, the market could not be restricted to the United States.

Right now, our country sets the tone on this issue. Once we say it's OK to have a market here, it condones markets everywhere else in the world, and with medical tourism being what it is, those in search of kidneys will go to the place where it's the cheapest price — Americans won't be limited to undergoing transplants locally.

From there, transplant tourism in global markets brings unanticipated consequences. It increases the risk for diseases like hepatitis, tuberculosis or malignancy, and it also opens the door to a variety of unethical practices involving the donor and their medical care.

The central problem of organ sales is that it's a victimization and exploitation of poor people, notwithstanding good intention. The source of these organs is always the lowest socioeconomic class of a particular country — we know that has been the case in the Philippines, in Pakistan, in Egypt and in Iran. And the payment isn't that substantial of an amount, so rather than making them better off or helping them, the money is quickly used, and the donor is left with one less kidney. It's a reality that there's no escaping.

It's true that there has been a plateau of living donors in this country, and something has to be done. For that reason, I do believe in eliminating disincentives for donors. The living donor who doesn't have health insurance should have it — and even life insurance — provided for them, as it pertains to the donation event."

http://www.latimes.com/health/la-he-pro-con-kidney-donors-20110328,0,4492170.story
health@latimes.com
Copyright © 2011, Los Angeles Times