Thursday, March 20, 2008

Stem Cell Tourism in China

I've written before about StemEnhance, a piece of pseudomedicine that purports to improve "wellness" by stimulating stem cell release from the bone marrow. In that post I questioned whether the supplement a)did what they claimed and b)whether, if it worked as advertised, the mobilization of stem cells would have a positive, negative or no effect.

Well now, instead of $60 a bottle for algae extract, you can drop a grand on a flight to China and another $20000 to be injected with umbilical cord cells - guaranteeing an at least temporary boost of stem cells in the body. (Nevermind that these cells are foreign and will be attacked by the immune system) Of course the same questions remain: Will this kind of treatment have positive, negative or no effect? Dr. Hu, the chairman of the company selling this treatment claims that 70% of the 3000 patients who have had these injections for a variety of conditions have seen an improvement. On the other hand, the NPR article (linked above) points out:
No rigorous, controlled clinical trials were carried out before the treatment was offered to patients. No research has yet been published in established peer-review journals overseas. And no one knows for sure what the possible risks might be.
So once again, we have an untested, unproven therapy. Let's look at the possible scenarios:

1) The injections work. People's varying conditions are being improved. Great! Test it. Prove it. Show it's safe. Yes trials are expensive, but why wouldn't you want to do it to silence skeptics, better understand what's going on and potentially improve this kind of treatment. However, the likelihood of this therapy working as advertised is small.
Bruce Dobkin is director of the neurologic rehabilitation and research program at the University of California, Los Angles. In response to questions from NPR, he writes in an e-mail that "it is extreme nonsense to think that cells can be incorporated into the complex nervous system and do so much, when we cannot even get cells in mice and rats to do very much.
There's also no evidence that umbilical cord stem cells can become the kind of neurons these doctors are claiming, nor evidence that they'll even get to the desired site to begin with.

2) The injections have negative effects. Regardless of whether these injections are a useful treatment, there's the very real posibility that there could be serious consequences that haven't been discovered (no testing means no awareness of effects good or bad). Immune response. Cancer. Take your pick.

3) The injections have no effect at all. Thanks for your 20 grand! Goodbye.

This kind of treatment may hold some future promise, but once again someone is putting the cart before the horse when it comes to stem cell treatments. Do the research, then treat. And don't ask desperate families to plonk down crazy amounts of money for what is generously described as experimental treatment. Sadly, this makes StemEnhance look good by comparison.

More blog reaction here and here.


Doctor David said...

So I have to go with choice 3 here. And there's even evidence for it. Choice 1 (benefit) is absurd. There are animal models to base skepticism on (injection of bone marrow stem cells into syngeneic mice can result in the occasional cell incorporating into the recipient's liver or small bowel or lung, but no evidence of function yet, and no possibility that just a cell or two would change organ function, especially in the brain). Choice 3 (no effect) is most likely because bone marrow transplants done without a prep regimen (to destroy host immunity) uniformly result in graft rejection. If HLA disparate umbilical cord blood cells are injected into you, your perfectly healthy immune system will rid your body of them within days.

It's sad, because this is yet another example of someone unscrupulous taking advantage of media hype to part desperate people from their money.

The gruntled traveler said...

There seems to be a whole host of issues, but one that strikes me is the difference between autologous stem cell work vs foreign stem cells. IE using yoru own stem cells to work on you vs using cord blood, embryonic, or sheep's stem cells.

I have read that any foreign stem cells seem to work- especially in the CHina examples at several China hospitals working on Parkinson's and neurological disorders. However after getting better for a while, the body finally figures out that the wrong dna is involved and systematically deconstructs what was onc constructed. The only hope I have heard about is with your own adult stem cells and the results are still mixed on that and mostly anecdotal.

Anonymous said...

If thousands of people in China are receiving umbilical stem cells without rejection perhaps there is something we're missing here in the west about cells in that crazy little cord.

This also showed up today--

And even pharmaceuticals wear off. They don't seem to be claiming cures--only improving quality of life. And maybe we're too focused on the lab rather than suffering people.

Anonymous said...

Your saying this is not possible but children who were blind are seeing light and objects. Parents of blind children are going to get this done because it works better than there other option and not worry that your Bush lab has not figured out why. When you do you will say you discovered it patent it and charge even more money than they do. 20,000 is spent faster in any US hospital in a single day. The blind see and you say impossible. Maybe just jealous.

Anonymous said...

Even if this stuff works US doctors can't admit it until after their own clinical trials are done. While we wait for them to kill some rabbits the rest of the world seems to be moving ahead. There are too many studies mid-stream finding this stuff works to keep our heads stuck in the sand. For all our sakes let's hope China doesn't tie themselves up in the same knots we've got over here. Medical progress takes science and guts. Literally.

As Anon points out, drugs wear off too. If little girls are getting injections without rejection we need to check our own notes again to see what we missed. The patients in China aren't dropping dead. Let's not be so hasty to cry foul. For your twenty grand you could do a lot worse than a sore back and some mosquito bites. Western medicine has plenty of surgeries that have low chances of success. We still do them.

They can't read blogs. We can't get stem cell treatment. No country is perfect.

Kamel said...

Anon (1),
On what basis do you make the claim that the cells aren't being rejected? What do you mean by "even pharmaceuticals wear off"? Do you mean people become resistant, or that they can require continual use?

You'll notice I don't say it's not possible, but I do think it's improbable. In fact I explicitly say that it may have future promise, and my point 1 addresses the situation where the treatment does work. My issue is, as I said, putting the cart before the horse: Charging large amounts of money for untested treatments with no evidence of safety and no evidence that they'll work(anecdotes are not data). I've written before that there are reasons a treatment might seem to work, which is why controlled study is needed before claims are made.

I don't think anybody is expecting people to drop dead from this treatment. That's just a strawman. But there is, for example, a cancer risk and how long have these patients been followed to see if that's the case. I'm not crying foul because it's unsafe per se, I'm crying foul because it's untested and we don't know if it's safe (among other complaints, like ethical considerations). Western medicine may have surgeries with a low chance of success, but in those cases we *know* the chance of success, as well as the associated risks so informed decisions can be made. In the situation we're talking about, both of those factors are unknowns - but they could be known with proper study. What's worse is that the treatments are being given to young children who cannot give informed consent.

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