Stem Cell Magic: When will stem cells really provide medical cures

Wow. Stem cells are hot. Dr. Science has been inundated with questions about them – more specifically about what stem cells will do, and when.

Stem Cells have been getting a lot of really good press lately. Once we figure out how they work, we’ll be able to re-grow and replace any damaged tissue, organ, bit or piece of our bodies that may get damaged or just plain wear out. Been eating McDonald’s french fries every day for the past 50 years? No problem, just grow a whole new set of clean wide-open arteries, and a new heart while you’re at it. Been gnawing on aluminum, and you’re bumming about not being able to remember anything? Just grow a new alzheimers free brain. Stem cells will make it all possible.

Well dear readers, unfortunately the hype is about as good as Bush’s hype about WMDs. In other words, its fantasy. Don’t get me wrong, stem cells do have a lot of potential for medical treatments and therapies that can (and probably will) make a huge difference in treating a number of types of diseases and disorders. However, they are not manna from heaven. Stem cells have the potential to be a part of a treatment – to date there is very little actual stem therapy that actually does anything. There are a lot of reasons for this.

First of all, even if a scientist came up with a stem cell treatment today it would take 15 to 20 years to get through FDA approval. A fine example of this is a medical procedure that has been done in Europe for about 15 years. A very common injury among adults is damage to the discs in the lower back. In severe cases, this can lead to loss of function in the legs. In Europe, for extreme cases, doctors have been replacing the damaged disc with a synthetic disc – often as many as three or four discs are replaced in the same patient. They have been using these synthetic discs for about fifteen years, with pretty good success rates. In America, the synthetic discs were approved by the FDA this past January (Yep, Jan 2007) – but only for single disc replacements – not for multiples. That means that for the past 15 years, Europeans have had a therapy available that can cure crippling back injuries, but in the USA, you have been stuck with the same technology we used in the 60s. Today, you can actually get a single disc replaced inthe US, but not more than 1. Why is the US so far behind Europe? You’d need to talk to the FDA, but my guess is that no US company is set up to make a ton of money off the synthetic discs – in fact, many would lose money as their archaic products are pushed aside by the new technology. In any case, new treatments take a really long time to get approved by the FDA. (If you are rich, and can pay cash for the treatments, you can just go to Europe and get it done there, but no US insurance company will pay for it).

Second, stem cell research is just that: research. It is very common for scientists to work on new areas and emergent fields for decades before any potential treatments surface. Work that I did on brain anatomy in the late 80’s has only recently entered the scientific mainstream, and it will probably be decades before the results of today’s work has any relevance to any medical treatment. We’re still in the very early phases of figuring out how the brain is put together and works. Stem cell research is in the same situation. We’ve done enough research on stem cells to know that they could be really amazing things, and will probably provide truly major changes to how we think of medicine. But not yet.

There are areas where stem cell research has potential to move fairly quickly – meaning that there may be treatments available in the next decade or two. One of the most promising is AIDS research. This is going to sound really horrible, but AIDS patients have shown a strong willingness to be human guinea pigs. They often clamour to test treatments that are nowhere near being ready for testing on humans. As an ethicist this is a tough nut. These people are terminally ill, know they are going to die, and are often willing to grasp at any straw – no matter how thin – in an effort to put off their demise. There is a similar tendency in certain populations of cancer patients. Ethics aside, the fact that these people are willing to circumvent the normal (and very time consuming) processes to ensure the safety and reliability of these treatments has the potential to greatly accelerate the advancement of the treatments. The “premature human testing” of these treatments can quickly indicate what options are worth pursuing, what are not, and occasionally, new and unanticiapted benefits of them. As an individual, I am not willing to discuss the ethics of this type of testing. My research has never included human subjects, and I have not spent the time contemplating all of the dillemmas these issues bring up. In any case, stem cells are currently very strong contenders in treatment of aids and certain types of cancer.

It is also important to keep in mind that there have been many examples in medical history where things that have started out looking like a panacea have turned out to be useful, but not cure-alls. Antibiotics were the magic bullets of the 20th century. from Sulfa drugs to the myriad of natural and synthetic antibiotics we have today, antibiotics have been credited with saving millions of lives. However, today we also know that careless use of antibiotics has kicked in darwinian evolution – we now have strains of bacteria that are completely immune to antibiotics. As a matter of fact, this is one of the fastest growing concerns in modern medicine. I’m not saying that stem cells are going to follow the same path, but it is important to keep things in perspective: There are no magic bullets. Stem cells may provide some treatments for certain conditions, but they are not going to make us immortal.

So, there’s the long and short of it: Stem cell research has a good way to go (I’m guessing 10 years at least) before we can realistically expect major treatment breakthroughs using them. Once we’ve made it that far, we’re looking at another decade or so (at least in the US) while the FDA does its thing and actually approves those treatments for use. Science moves slowly, and the Feds move even slower……

–Dr. Science

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