Stem cell research could end the ravages of MS, juvenile diabetes and Parkinson's - but only if scientists concentrate on one illness at a time. Robin McKie reports on an agonising dilemma
Sunday September 7, 2003
Charlotte Stanwell has suffered from the ravages of juvenile diabetes since she was four. Destroyed by her own white blood cells, her pancreas no longer secretes insulin and her blood sugar levels have soared and plummeted for the past 26 years. Her eyes have needed major surgery and Charlotte's desire to have children has had to be tempered with the knowledge that her condition poses the risk of inflicting respiratory and other problems on any baby she might have. 'I have come to feel very mortal,' she says.
Such sentiments would be echoed by Chetan Shah, who was diagnosed with multiple sclerosis nine years ago at the age of 30. A doctor studying to be a consultant surgeon, Chetan had to abandon his studies and retire. His movements have since slowly deteriorated until, in July, he suffered a serious relapse. 'For the first time, I have to use a frame to help me walk,' he says.
And finally there is Sue Moore who, for the past nine years, has suffered from Parkinson's disease, a condition characterised by increasingly severe tremors and stiffness. 'The drugs that halted my problems no longer help me,' says Sue. 'I have three children and five grandchildren and I just want to know they are going to grow up in a world in which Parkinson's is no longer a threat to them.'
Startlingly, it is a prospect that may be realised within the next five to 10 years. For along with diabetes and multiple sclerosis, Parkinson's is now rated as one of the brightest hopes for benefiting from the revolutionary new technology of stem cell science. In each case, doctors believe it may become possible to use stem cells - which the body uses as sources to create new brain, skin, bone and other cells - to replace the damaged neurones or insulin-producing cells that are linked to these crippling conditions.
By hijacking the body's own cell development techniques, it may soon become possible to halt deadly illness in its tracks. Not surprisingly, stem cell science - the focus of a series of international meetings over the next few weeks - has been hailed as one of medicine's brightest hopes for the future.
But progress is only like to come at a price. Apart from opposition from anti-abortion campaigners, serious ethical decisions will have to be made.
In particular, doctors say that the best hope for making a breakthrough in stem cell science will be to concentrate resources on one condition. Research on others would then be slowed down. If the decision goes Parkinson's way, work on juvenile diabetes and MS would suffer as a result.
'IT IS A real ethical problem,' acknowledges Roger Pedersen, professor of regenerative medicine at Cambridge University. 'Juvenile diabetes, MS and Parkinson's are very serious diseases and are being studied carefully by stem cell workers. But really we cannot afford to divide up our efforts. We need to concentrate on one, make our breakthrough on it and then exploit the knowledge we have gained on other conditions. In the short term, that means slackening our effort for some patient groups.'
Like the Human Genome Project, which succeeded through the careful central management of research, thus preventing duplication of effort, stem cell science needs to be targeted precisely, says Sir George Radda, head of the Medical Research Council (MRC). 'There has to be some form of focus. We need to concentrate our resources carefully.'
Deciding between the slow degenerative symptoms of MS or Parkinson's, which start in adult life, or the lifetime of dis comfort and illness that accompanies juvenile diabetes, is likely to cause a great deal of soul-searching for scientists, and will form one of the pressing issues that will be debated at an international stem cell conference in London next week. Patient groups will be watching anxiously over the coming months.
Nor is this the only problem facing stem cell scientists, despite the vast promise of their work. Although given the green light in Britain, research in the field - which involves the use of embryonic material left over from IVF treatments - is still not approved in many European countries. In the next few weeks, controversial bids will be made by a consortium of countries led by Germany, Italy and Austria to have such research severely curtailed throughout the EU - including Britain. In addition, the United Nations will this month debate a motion to ban the creation of embryos for research.
It is a stark prospect, though British scientists remain hopeful their work will survive such onslaughts. 'It remains to be seen how these debates go,' said Dr Rob Buckle of the Medical Research Council.
'The European Commission's position on stem cell science is close to Britain's, so I am hopeful that they will be able to influence the debate. In addition, Britain does not automatically have to adopt a UN resolution, though we have been generally supportive of them in the past.'
MOST OF THIS international opposition stems from Catholic countries, as Prof Bob Goldstein, chief scientific officer of the Juvenile Diabetes Research Foundation, points out.
'People say opposition to stem cell science is religious. In fact, most religions have no objection to the use of material taken from an embryo, as they do not accept that a person's soul is created at conception or that it manifests itself shortly afterwards. They believe it appears much later in pregnancy, when limbs and organs have formed,' says Goldstein. 'Jews, Muslims and most others have no problems with stem cell science. It is just the Catholics and fundamental Protestants who object on behalf of all religions.'
These groups have had a striking and disproportionate impact on the world, however. In the face of powerful Christian objections, the US government has banned the creation of new embryonic stem cell lines in public - but strangely not private - laboratories in the US. The result has been to freeze several billion dollars of National Institutes of Health funds, money that could have been crucial in speeding up stem cell technology.
On the other hand, the withdrawal of US science has opened up the field for British scientists, who are now the leaders of an international stem cell research consortium which - despite EU and US opposition - offers to pave the way for treatments that could transform the suffering of many people, and in the near future.
Their work will be watched very closely, not least by Charlotte Stanwell, Sue Moore and Chetan Shah.
Ethics of genetics
Human Fertilisation and Embryology Act 1990
The human reproductive cloning bill (pdf file)
18.01.2002: Human cloning
Stem cell research
Human cloning: how it might be done
The human genome
Human cloning in links
Human fertilisation and embryology authority
Chief medical officer's advisory group on human cloning
Current patents list (pdf)
Human genome project
Pro Life Alliance
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