French surgeons have performed the world's first face transplant, a development which has provoked mixed reactions amongst their colleagues and bioethicists. The patient is a 38-year-old woman, Isabelle Dinoire, who lost her lips, chin and part of her nose when she was savaged by her own dog.
Because of the dangers of transplant failure and psychological damage, doctors have been reluctant to perform this sort of operation, although a number of medical centres around the world have plans to do so. Unlike the heroes of Hollywood's saga of face transplant surgery, Face/Off, patients will probably end up with faces which are unlike their own or their donor's.
American surgeons were upset on several counts. First, the operation involved not one but two novel procedures: transplanting facial tissue and transplanting bone marrow stem cells from the donor to prevent rejection. Now, they say, if the experiment fails, it will be difficult to determine which technique was responsible. Second, the French doctors made no attempt to reconstruct the patient's face using conventional techniques -- although the French team said that this was impossible in this woman's case.
Third, the woman may not be emotionally stable. The London Times claimed that she had been unconscious after a suicide attempt when the dog attacked her, a detail denied by her doctors. Another factor is that the donor had committed suicide. American surgeons say that they would only perform such an operation on a person who is psychologically very resilient. Finally, the woman's name has been leaked to the media, which has already published before and after photos. Psychologically, this could be quite destabilising for the patient.
"We want for this to go well," Dr Maria Siemionow, of the Cleveland Clinic, told the New York Times. "But if it does, then I am afraid everyone will forget that the ethics were not proper here. And if it does not, then they will be blaming the transplant procedure, but not the ethics behind it." ~ New York Times, Dec 6; London Times, Dec 1; Sunday Times, Dec 5
HWANG UPROAR CONTINUES
The ripples from the humbling of Korea's most eminent scientist continue to spread. In an editorial the New York Times has warned that Hwang Woo-suk has tarnished his reputation as the world's most proficient embryonic stem cell scientist.
The key unresolved issue is whether lying about egg donations suggests that the Korean team may have lied about its scientific results. So far there is no evidence of that. Indeed, American collaborators and observers remain confident that the team's achievements were real," it said. "But science is an enterprise that relies heavily on trust. The Koreans should not be surprised if their next scientific breakthrough is greeted with extreme caution."
In fact, an investigative TV show in Korea, "PD Diary", has been asking whether Hwang faked his scientific results. According to newspaper reports, it was told by one of his researchers that he obtained stem cells from frozen IVF embryos and passed them off as cloned embryos. Tests of the stem cell samples by an independent institute were surprisingly ambiguous.
However, now "PD Diary" has been caught up in a scandal of its own -- it has been forced to apologise for violating journalistic ethics by browbeating the researchers it interviewed by threatening them with exposing their involvement in Hwang's allegedly sham research. Its network, Munhwa Broadcasting Corporation, is reeling from an avalanche of criticism in Korea. Even the nation's president, Roh Moo- hyun, has called for an end to the controversy.
Whether or not these charges are true, the ripples may splash the journal which originally published the research. The editor of Science, Donald Kennedy, has announced that Hwang recently informed him of problems with the original articles. At this stage, he says, they do not appear to be serious.
The Korea Herald interviewed Robert Laughlin, the president of the Korea Advanced Institute of Science and Technology and an American Nobel laureate for physics in 1998. Laughlin severely criticised its editorial policy. "Science magazine has a reputation of manipulating peer review to favour papers it likes," he said. "This is a side effect of its being a business -- one that desperately needs more headlines -- grabbing work such as Dr Hwang's to see its product."
He went on to say that "I don't think the editorial judgements of Science are nearly as good as it claims. I personally found their judgements in physics so consistently political that I stopped publishing with them."
Sentiment in Korea is running strongly in favour of Professor Hwang. One thousand women have volunteered to donate eggs for his stem cell program. The media there have started to fling mud at Hwang's former colleague, Gerald Schatten, at the University of Pittsburgh, the original whistleblower. The JoongAng Ilbo has reported that Schatten resigned after Hwang refused to give him half of the patent rights for therapeutic cloning and to make him chairman of the World Stem Cell Foundation. None of this has been confirmed. ~ New York Times, Dec 4; Korea Herald
STOP FIRST COUSIN MARRIAGES, SAYS BRITISH MP
A government campaign is needed to make British Pakistanis aware of the medical risks of cousin marriages, says a Labour MP. Ann Cryer says that "as we address problems of smoking, drinking, obesity, we say it's a public health issue, and therefore we all have to get involved with it in persuading people to adopt a different lifestyle." The Asian community, she argues, "must look outside the family for husbands and wives for their young people."
According to the BBC, British Pakistanis are 13 times more likely to have children with genetic disorders like deafness and cerebral palsy than the general population. However, Dr Aamra Darr, of the University of Leeds, comments that "altering a whole community's marriage pattern is an inadequate and superficial response to a serious health issue". She points out in BioNews that 20% of the world's population live in communities which prefer cousin marriages and that 8.5% of all births are from such unions. ~ BBC Newsnight, Nov 16; BioNews 337
TRADE IN PRISONERS' ORGANS EXISTS, CHINA ADMITS, AT LAST
Chinese authorities have admitted for the fist time that organs from executed prisoners are being sold to ailing foreigners. According to the London Times, Huang Jiefu, the Deputy Health Minister, says that the practice is widespread and must be regulated more consistently. We want to push for regulations on organ tranplants to standardise the management of the supply of organs from executed prisoners and tidy up the medical market," Mr Huang told Caijing magazine.
The aim of new legislation, says Mr Huang, is to end the commercialisation of organ transplants. It will also improve China's image and give condemned prisoners a greater say in what happens to their bodies. There are no official figures on the number of official executions in China, but Amnesty International estimates that there are between 3,400 and 6,000. ~ London Times, Dec 3
NOSE CELLS MAY HELP SPINAL CORD INJURIES
After 20 years of preparation, a British researcher has announced that he will use adult stem cells to try to cure or at least help patients with spinal cord injury. Professor Geoffrey Raisman, of University College London, says that he will test the regenerative ability of cells from the nose on 10 patients in a pilot study. The first group will be mostly teenagers whose arm has been paralysed after a motorcycle accident when the nerves were pulled out of the spinal column. Animal trials have been very promising.
"I don't know that it will work, but I think it will work," Professor Raisman told the Guardian. "I have been patient. I didn't jump in the dark. I have grown through the research all these years. It was in 1985 I discovered the cells. It has taken 20 years before I felt we had the technology to apply this to people."
The cells will come from the patients themselves, not embryonic stem cells. This "will avoid the need to use embryonic tissue, to find donor individuals, foreign stem cells, the immune response or to use powerful designer drugs with unknown side-effects," he said.
Professor Raisman describes himself as a maverick researcher who took the unpopular path of using adult stem cells rather than drugs to heal nerve breaks. "What we're proposing could be carried out by any very modestly equipped hospital with neurosurgery. There are no patents. It makes it a very unpopular form of research. We're producing a procedure where the patient is their own cure. You can't patent a patient's own cells, thank God." ~ London Telegraph, Nov 30; Guardian, Nov 30
BACK TO THE CLONING DRAWING BOARD?
Therapeutic cloning has taken another body blow with a report in a leading journal that cloned embryos appear to be genetically normal, even though most cloned embryos develop abnormally. The implication is that scientists are still far from understanding the cloning process.
The findings also suggest that therapies from therapeutic cloning are not around the corner. "Even if cloned embryos are born, many are not normal and die prematurely," Wolf Reik, of the UK's Babraham Institute, told The Scientist magazine. "These late effects are not caused by early deficits in gene expression." At first embryonic stem cells may look normal, but problems may emerge later on. And Atsuo Ogura, of Japan's Riken Bioresource Center, remarked that this study clearly indicates that technical improvements cannot overcome the post-implantation problems of clones".
Despite this pessimism, the leading author of the article, Jerry Yang, of the University of Connecticut, still asserts that the findings are "good news for therapeutic cloning and bad news for reproductive cloning". ~ The Scientist, Nov 29; Hartford Courant, Nov 29
DUTCH TO FORMALISE BABY EUTHANASIA PROCEDURES
The Dutch government is to set up a commission to oversee the euthanasia of seriously ill newborns. The commission will be able to approve late abortions or killing newborns. Euthanasia will be possible if a child has no chance of survival and is suffering unbearably, if another doctor is consulted and if the parents agree. The Justice Minister and the Junior Health Minister say that the commission, which will begin work in mid-2006, will improve the transparency of infant euthanasia.
"We wanted to respond to the needs of doctors to create clarity in how to deal with ending the life of seriously suffering newborns as well as the legal consequences of late abortions," the ministers wrote in a letter to the Dutch parliament.
"The conventions, as well as the opinion of the commission, offer doctors the knowledge that cases will not just be seen from a legal perspective but also from a medical and ethical perspective... the uncertainty of doctors is being addressed." ~ Reuters AlertNet, Nov 29
CHANGE INFORMED CONSENT STANDARDS, SAYS US BIOETHICIST
With South Korean researchers under the hammer for allegedly lax informed consent procedures, it is interesting to note a strain of thought in the US which proposes giving the whole notion a radical shake-up.
One of the papers most cited by academics in the social sciences in November, according the ISI Essential Science Indicators, argues that we have a duty to participate in clinical research. Rosamund Rhodes, of Mount Sinai School of Medicine, in New York, says that the current standards inhibit research and therein oppose the advancement of medicine and the interests of patients".
Dr Rhodes's argument is that medical research is so beneficial to society that we all have a moral duty to do our "fair share". Consequently, she questions whether informed consent should be "the primary focus of research oversight". "Clinicians should invite or even urge patients to participate in research," she says, "and that patients who refuse to participate have to justify their refusal at least to themselves."
She acknowledges that this approach would radically alter the conduct of medical research. However, she concedes that "research conscription" is not possible at the moment because millions of American are uninsured and do not share in the benefits conferred by medical research. ~ ISI Essential Science Indicators, Nov
IN BRIEF: NZ euthanasia; IVF defects
New Zealand: Australian euthanasia activist Dr Philip Nitschke plans to move to New Zealand in January to carry on his campaign from Auckland. However, the Medical Council of New Zealand appears to be trying to block him by insisting that he must first register as a doctor there. Dr Nitschke's attempts to register in the past have failed. ~ Sydney Morning Herald, Nov 30
IVF defects: American IVF babies have a slightly higher risk of major birth defects, such as heart or muscle or skeletal defects, according to a University of Iowa study. Since nearly 1% of all American children are born with the help of IVF, this is a major health concern. Similar results have been found in other countries, but this is the first report from the US. ~ press release
ABI in the media
"We Have to Formulate Our Own Bioethics"
by Michael Cook, TechCentralStation, December 2
