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Editorial: Stem cells: hope or hype?

Official warnings about the new medical treatment echo concerns about safety and ethics

Published on August 7, 2007

The Food and Drug Administration issued a statement last month to warn chronically-ill patients against seeking stem-cell therapies from medical service providers. Certain providers of such therapies claim that injecting the cells offers beneficial effects in the treatment of diseases and other medical conditions ranging from spinal cord injury and diabetes to Parkinson's disease and myocardial infarction. The FDA said that although research into the possible use of stem cells for medical treatment - particularly for chronic and often irreversible diseases and conditions - had made headway in the past few years, there was still insufficient evidence to support the hypothesis that stem cells can be manipulated to form different types of tissue.

At present, the promise of a major breakthrough in healthcare offered by stem cell research has yet to be realised. Members of the public should heed the warnings issued by the public health authorities that the injection of stem cells could put patients in danger.

Despite all this, some healthcare providers in Thailand, as well as in other countries, have advertised their stem-cell treatment services in the mass media. They are openly targeting vulnerable and chronically-ill patients as well as healthy individuals looking for frivolous treatments to reverse the ageing process.

The problem is that certain of these advertisements appear to have been endorsed by some medical doctors, which can easily mislead members of the public regarding the efficacy and safety of such treatments and procedures. These medical practitioners charge huge sums of money, often hundreds of thousands of baht, for stem-cell treatments. But as yet there is no firm proof that these treatments offer any medical benefits. They may also put the patients at risk.

The FDA should consider taking action against stem-cell treatment providers for putting out advertisements that tend to overstate the benefits of therapies, or give false hope to people with chronic illnesses. At the same time, the Medical Council of Thailand, the governing body of doctors, should impose disciplinary action against members of the medical profession who are involved in such schemes.

In the absence of established standards in terms of quality of stem-cell materials and the safety of medical procedures and treatments in which stem cells are used, the FDA still does not recognise or endorse this type of treatment. This is also true of most public health authorities around the world.

Aside from the efficacy and safety of stem-cell treatment, a more important issue is medical ethics. The Medical Council has a duty to impose controls on hospitals and clinics offering stem-cell treatments to make sure that they conform to medical ethics. At present, there is no law or regulation governing stem-cell research and treatments. A government committee, comprising top medical experts and legal professionals, is in the process of drawing up regulations on stem-cell research and treatments. Some of the most difficult questions are about the sources of stem cells used in these treatments.

Stem cells can be obtained from an adult's peripheral blood, tissue or bone marrow, or from the blood cells of a placenta, or embryonic stem cells from either blastocysts or foetal tissues. However, embryonic stem cells are recognised as the most useful and versatile as far as stem-cell treatment is concerned. Unlike adult stem cells, which pose no controversial questions, the use of embryonic stem cells continues to raise ethical issues. For example: Can the medical advance brought about by stem-cell treatments justify a trade in human embryonic stem cells, or cloning of humans in order to harvest embryonic stem cells from blastocysts or foetal tissues?

It will not be easy to draw up laws and regulations to control stem-cell treatments. The biggest challenge is how to control and verify the sourcing of stem cells so the authorities can decide whether to allow them to be used as legitimate biomedical materials for treatments. There will also be questions about equitable access. Should such treatments be made available only to the rich or should they be made universally available to all who have medical needs?

Thailand as a society still has time to decide how best to strike a delicate balance between embracing the biggest trend in today's fast-paced medical advancements and an ethical standard and public consciousness that everyone can live with.

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