Rejoinder on stem cell treatment

We’ve received quite a number of reactions regarding our article on stem cell therapy two weeks ago. Dr. Ramon Abarquez Jr., whose comments on the real status of this promising but still experimental form of therapy we extensively quoted in that column, told me he was politely confronted by several well-meaning colleagues who did not share his viewpoint.

We would just like to clarify that we’re definitely not against stem cell treatment. We share the enthusiasm of many about the amazing potential it has to treat, even cure some debilitating degenerative diseases like Parkinson’s disease, multiple sclerosis and severe heart failure. But, we do not share the “medical adventurism”  which a few unscrupulous  practitioners appear to be guilty of.

We cower apprehensively when some clinics hype it like a tried-and-tested rejuvenating potion which can make one look and feel 20 years younger. They present celebrities who seem to be more than eager to give their testimonials on the treatment, insinuating that the hefty sum they paid for it was well worth it.

More local data needed

We support all efforts to gain more local data on stem cell treatment. But this has to be done under several strict conditions. Firstly, all treatments for any specific indication must be done under a standardized protocol, approved by experts on this new field. This protocol must include an acceptable source for the stem cells, established as safe and with some evidence of reasonable effectiveness; the method of preparation of the stem cells; its mode and dose of administration or delivery to the patient; and objective monitoring parameters to detect any beneficial effect, as well as adverse side effects. If the protocol is standardized, all local data can be pooled together for a credible scientific study which can add to the universal pool of data on this field.

Secondly, there must be “full disclosure” to the patient on what they signed up for. Before they are made to sign the consent form, there must be leveling of expectations. The patients must be fully informed of the real status of the treatment,  and the potential benefits, as well as side effects. No superfluous or testimonial claims should be allowed, like assuring a diabetic with organ complications that he or she can do away with maintenance treatments for the disease and regain his/her heart, kidney and other organ functions back. All these must be written in plain, simple terms and the patient must be given the time to study all information and ask questions before proceeding with the treatment.

Lastly, the charges should not be exorbitant. In clinical trials, the subjects are usually given the medicines he or she is asked to try for free. This may not be possible with stem cell treatment, but it would be ideal if the patient is only asked to shoulder the actual cost of the stem cell preparation plus a reasonable mark-up fee for the institution or clinic and professional fees for the doctors and other members of the team. It should not be treated as a revenue undertaking. That’s why I’m personally not so keen in supporting moves to promote it as part of medical tourism. At the moment, the charges can run up to millions of pesos. For an unestablished field like stem cell therapy, this may sound like opportunism and it definitely leaves a bad taste in the mouth.

Potential alternative

One of the current indications being investigated by researchers in the United States is the use of stem cell treatment for patients with severe heart failure. Initial results of clinical trials suggest it is able to make patients—who can hardly tolerate minimal physical activities because of the failing heart—functional again and able to tolerate even moderately intensive physical activities. This means that it can be a potential alternative for heart transplantation. This gives hope to the thousands of Filipinos with really bad hearts.

Dr. Rogie Tangco, one of the country’s top interventional cardiologists, shared with us  a recent lecture by Dr. Rouel Roque, a cell biologist who had extensive experience in stem cell research in animals in his long stint at the University of Texas Health Sciences Center  Department of Anatomy and Cell Biology.  Dr. Roque is on the editorial board of several basic science journals including the World Journal of Stem Cells, and is a grant reviewer for Vascular Biology for the American Heart Association.

Dr. Roque lectured at the National Kidney Institute (NKTI) and Manila Doctors’ Hospital, and Dr. Tangco is excited that the protocol for stem cell treatment in severe heart failure can be done here. “The faculty at NKTI were stirred excited about this frontier in medicine,  it was doable!” wrote Dr. Tangco. “We have the technology at NKTI and just needed some reagents and perhaps a fellow or a faculty dedicated to studying the technology of growing cardiac stem cells.”

Most ideal source

Dr. Roque also recommends autologous stem cells, i.e. the patient himself is the donor of the stem cell, as the most ideal source of the stem cells. “This relieves the physician and the hospital of ethical baggage, as opposed to harvesting stem cells from unborn fetuses or from cloning of human cells,” Dr. Tangco said.

We hope that the NKTI and other medical centers with the capability for this technology can be part of this effort to take part in this promising frontier of treatment for severe heart failure and other indications of stem cell treatment. I understand Dr. Roque is willing to come back to the country as a Balik-scientist to spearhead this research undertaking on stem cell treatment if he could get a funding for it. This can be a good area for a government-private sector partnership.