An end to the stem cell ‘hammer’ and ‘nail’By Rafael Castillo M.D.
Philippine Daily Inquirer
A saying goes—if you’re a hammer, you see everything as a nail.
This may symbolize what’s happening to our practice of stem cell medicine in our country. Because of the media hype focusing on testimonials of celebrities on supposed spectacular healing or rejuvenation, stem cell practitioners coming from various medical practices have suddenly become overenthusiastic of the things stem cells could do for their patients. In every Tom, Dick and Harry, one or another indication for stem cell therapy can be seen at the end of a 5-minute consultation. It has been estimated that nine out of 10 Filipino patients administered stem cell treatment receive it for unproven and still experimental indications.
A neurosurgeon colleague asked the young doctor-son of a patient (who appeared to be fresh out of medical school) what his line of practice was, and he confidently replied that he administers stem cell medicine. When told that it seems to be a pretty complicated specialty, he answered without batting an eyelash that it’s not.
All of a sudden, a few hundred physicians from several specialties—internists, oncologists, surgeons, neurologists, dermatologists, OB-gynecologists, family medicine and practically all others—have seemingly converged to make stem cell medicine their specialty or subspecialty. I know that the doctors mean well. Most of them (including those who sent me angry SMS or e-mail messages after reading the first part of this column last week) sincerely believe they could offer something short of miraculous healing for their patients.
Not hammers at all
I don’t doubt their well-meaning intentions but they just have to stop acting like a hammer, finding everything like a nail—judging practically everyone who comes to them as a potential stem cell treatment candidate. In fact, many colleagues who practice stem cell medicine should realize they’re not hammers at all. They should be honest enough to admit that they do not possess the competence to administer such a complicated therapy to their patients.
Being interested in stem cell medicine and considering oneself as an eager student wanting to learn more about this promising experimental form of treatment is good. But thinking that one can be good enough to administer it to patients after observing how others do it several times is definitely betraying one’s sworn duty as a physician—to make patients well and not to administer anything that can potentially cause him or her more harm than good.
When I was a medical student at the University of Santo Tomas, every morning I would be reminded by the sculpted Latin phrase on the façade of the Medicine Building which said, “Primum non nocere (First, do no harm).” This is one of the principal precepts of medical ethics that all medical practitioners pledge to adhere to.
Authorities on medical ethics always refer to it in advising how one should be guided when confronted with a dilemma on using unproven experimental therapies. They would counsel that “given an existing problem, it may be better not to do something, or even to do nothing, than to risk causing more harm than good.”
Physicians and other healthcare providers are always reminded that they must prioritize their patients’ safety first, and diligently consider the possible harm that any intervention might do to their patients. This fundamental principle stands out when one looks at the prevailing inappropriate use and abuse of stem cell therapy.
Clearly, there’s no question that the practice of stem cell medicine has to be strictly regulated, for the sake not only of patients but also of the doctors, who might get into legal trouble if their patients experience severe adverse reactions. Many authorities including esteemed national scientists like Dr. Ernesto Domingo are worried about the perilous state of stem cell practice in the country. It’s like a main highway with so many drivers trying to beat the red light, seemingly unmindful of the risk they’re exposing their passengers and themselves to.
But I see a bright light at the end of the tunnel. The Philippine College of Physicians and around 30 other medical organizations have spearheaded moves to wake up the public from the magical trance they have been put, with unfounded hopes of healing and rejuvenation from stem cells. The Department of Health (DOH) and the Philippine Food and Drug Administration (PhilFDA) have also committed to do their part, and have taken into consideration all the recommendations of the medical societies in revising the guidelines they have issued earlier this year.
I learned from some sources that soon, Health Secretary Ike Ona and PhilFDA Director Kenneth Hartigan-Go will already come with the updated guidelines and policies to weed out the irrational use of stem cell treatment in the country. They’re just making sure that all legal bases are covered. After all, it’s not that simple to close down unaccredited establishments that have been dispensing different types of stem cell therapies in the country. Even violators have to be given due process.
I had the chance to communicate by phone or e-mail with the leaders of both sides—Secretary Ona and director Hartigan-Go, respectively, for the DOH/PhilFDA side and Dr. Tony Leachon, the PCP vice president and spokesperson, for the medical alliance. There may not be a 100-percent meeting of minds but both sides have agreed to maintain open lines of communication, and to cooperate in working for the common goal of rationalizing stem cell medicine in the country.
Both sides now realize that they need to be allies, rather than foes, in resolving this problem. It is to be remembered that this same alliance of doctors from all specialties were among the staunchest allies of the DOH in pushing for the Sin Tax and Reproductive Health Laws. The DOH and the medical alliance make a potent combination that can move legislative mountains and other seemingly impossible public health problems. I have no doubt that this same alliance can put the current stem cell issue to rest.
However, everyone must be part of the solution to the problem. The public, the big medical centers and the doctors administering stem cells should also form part of the solution. Everyone should adhere to whatever revised guidelines the DOH/PhilFDA will issue, and follow other self-policing measures that will ensure the safety and protect the best interest of all patients.
I believe that soon, there will be no more stem cell “hammers” driving all sorts of “nails” through any kind of “wood” in this country.