Tuesday, 11 April 2006

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BioEdge 199: Consent form for drug trial disaster flawed, say critics

THIS WEEK


bullet 
Consent form for drug trial disaster flawed, say critics
      Companies refuse to release document
bullet 
Political battle looming over eternal life
      Are "bio-conservatives" keeping us from living longer?
bullet 
Echoes of Hwang in possible Japanese fraud
      12 major papers faked
bullet 
Hwang debacle must not hold back research, says scientist
      It can't happen here, says US researcher
bullet 
Belgian politicians want euthanasia for kids
      ... but only if they want it, too
bullet 
Gene therapy success in Germany
      Optimism tempered by past failures
bullet 
Federal spending on embryonic stem cells increasing
      ... despite complaints from critics
bullet 
Him and her tummy tucks
      Cosmetic surgery increasing for couples
bullet 
Indian surrogate mothers working for overseas clients
      How else can we earn such money, women ask

HAPPY EASTER!
There will be no issue of BioEdge on Tuesday, April 18, because of the long weekend and because of preparations for BioEdge's 200th birthday celebration. The next issue is due April 25.

CONSENT FORM FOR DRUG TRIAL DISASTER FLAWED, SAY CRITICS

Although British authorities say that a drug trial which made six healthy young men violently ill was conducted properly, critics have savaged their informed consent form. The drug, TGN1412, was a monoclonal antibody, a promising type of treatment which has seldom been approved for humans.

Bioethicists claim that the document did not sufficiently inform participants of possible dangers and did not depict the treatment as a novel drug that could harm the body's immune system. The 13-page form also appealed to the subjects' need for money and threatened to withhold their £2,000 payment if they withdrew early.

The drug company "failed to adequately disclose the degree of uncertainty around a first-in-man trial," said Michael Goodyear, a Canadian cancer physician and research ethicist. "The risks were well known. They're not disclosed in the consent form."

Goodyear and two other medical ethicists assessed the study's risk- disclosure form for Bloomberg News. Parexel, a US company which conducts clinical trials for pharmaceutical companies, has declined requests to release the document. TeGenero, the small German biotech which designed the drug, says it did not have a copy. The bioethicists had several gripes, according to Bloomberg:

  • the financial penalties for not cooperating were daunting. "If you leave the study and exercise your right not to give a reason or are required to leave the study for non-compliance, no payment need be made to you," the document said. "That's very coercive language," says Greg Koski, 56, a physician and former head of the U.S. Office for Human Subject Protection.

  • the volunteers were not told that 75% of them would receive the drug. US bioethicist Arthur Caplan says he considers it a major" ethical violation to withhold the actual chance of receiving the drug. "The subjects needs to be able to say these aren't odds I want," he told Bloomberg.

  • the description of possible side effects was misleading. The consent form says that TGN1412 was designed to treat arthritis, other inflammatory illnesses and leukemia and that it had "no significant side effects" in animals. "I think it was misleading not to tell participants that that this drug was genetically engineered from hamster cells and that it was designed to alter their immune system," Goodyear commented. "Reasonable people would think twice before allowing an experimental drug to change their immune system."

  • the form mentioned the possibility of a "cytokine burst" which it described as "a hives-like allergic reaction". In fact, this is what damaged the men's immune system. "Since monoclonal antibodies are known to cause Cytokine Release Syndrome, which can be fatal, and Parexel was even planning for this, the subjects should have been warned," Goodyear says. "They might have decided the risk wasn't worth £2,000." ~ Bloomberg, Apr 10   

    POLITICAL BATTLE LOOMING OVER ETERNAL LIFE

    At 167, he will still be an ace. Immortality beckons, says Ronald Bailey, science editor of Reason, an influential American libertarian magazine, and the partisans of mortality are powerless to stop it. Writing in the London Times, he predicts a 20 to 40-year extension of the average life span by 2050. And by the end of the century he predicts five-generation picnics with great-great-great grandmas playing tennis at the age of 150. He looks forward to "human bodies and minds enhanced by advanced drugs and other biotherapies; the conquest of most infectious and degenerative diseases; and genetic science that allows parents to ensure that their children will have stronger immune systems, more athletic bodies and cleverer brains. Even the possibility of human immortality beckons."

    But there is a hitch: malign forces from the Dark Side are working to scupper Bailey's dream. "An extraordinary coalition of left-wing and right-wing bio-conservatives is resisting the biotechnological progress that could make it a reality. Forget Osama bin Laden and the so-called clash of civilisations. The defining political conflict of the 21st century will literally be the battle over life and death," he writes.

    What Bailey is referring to is scepticism on both right and left (if those tags are appropriate) not just about whether immortality is feasible, but even if it is desirable. Daniel Callahan, a leading US bioethicist, has declared, "there is no known social good coming from the conquest of death". And Dr Leon Kass, former head of the President's Council on Bioethics, says, "the finitude of human life is a blessing for every human individual, whether he knows it or not".

    In Bailey's future, organs can be regenerated and "antisocial tendencies and crippling depression will all be managed by individual choice through biotech pharmaceuticals and even generic treatments". Fanciful as this vision may seem, it is being taken seriously and is even being described as a moral obligation in some circles. "The highest expression of human nature and dignity is to strive to overcome the limitations imposed on us by our genes, our evolution and our environment," writes Bailey. ~ London Times, Apr 8   

    ECHOES OF HWANG IN POSSIBLE JAPANESE FRAUD

    University of Tokyo The leading journal Nature is getting abundant experience in dealing with scientific fraud nowadays. Hard on the heels of an investigation into the cloning research of disgraced Korean stem cell scientist Hwang Woo-suk, Nature has discovered that several papers from a Japanese laboratory were probably faked.

    The problem came to light last year when the RNA Society of Japan asked Tokyo University to investigate a dozen papers from a lab run by biochemist Kazumari Taira, following complaints from other researchers. Taira and his co-author Hiroaki Kawasaki were unable to supply some data -- because of bad record-keeping and computer failure, Taira said. And then it appears that Kawasaki faked the data which he did supply. This was detected because he allegedly used software which was not available in 2003 when the experiment was conducted.

    Now the university has decided that there is a "high possibility" that a dozen papers on RNA technology from Taira's lab have been faked. According to a March 29 statement, the papers had "no reproducibility and no credibility". Taira has already asked that five of his papers be retracted, although Kawasaki has refused to do so. A university committee is to submit a report on the scandal this week. ~ Nature, Apr 6   

    HWANG DEBACLE MUST NOT HINDER RESEARCH, SAYS SCIENTIST

    The Hwang fraud must not hold back human embryonic stem cell research, insists a leading US researcher. Xiangzhong (Jerry) Yang, of the University of Connecticut, writes in Nature Biotechnology that "reconsidering our work because of a hoax in our field is unthinkable". Yang believes that the science behind hESC research is basically sound and that Korean debacle was "an individual case of the sort that can happen in any field of science".

    Furthermore, he says, Korea was uniquely vulnerable to this fraud because of Hwang's "rock star" status in the media and because whistleblowing is discouraged there. In the West, scientists do not enjoy such prestige and whistleblowing is common. "It is to be hoped that these events will not unduly affect future related ES cell research in Korea, Asia, the West or the rest of the world," he says.

    China-born Yang is one of the leading advocates of embryonic stem cell research in the US. Although he is dying of cancer, he is determined to see research in hESCs begin at the University of Connecticut. "Until you have a major disease, you don't understand how important this is," he told the Hartford Courant last year. However, his colleagues at UConn and nearby Yale were more cautious. I don't think we should make this large commitment because Jerry is driven by his health issues," said Dr Peter Deckers, director of the University's Health Center. ~ Nature Biotechnology, Apr; Hartford Courant, Sept 12, 2005   

    BELGIAN POLITICIANS WANT EUTHANASIA FOR KIDS

    Euthanasia for children under 18 appears to be gaining support in Belgium. Two years ago, a bill was introduced to extend the country's recent euthanasia legislation to minors. It was argued that terminally ill children and teenagers have as much right to choose when they want to die as adults. That initiative failed, but now the Flemish Socialist Party, a member of the coalition government, has called for an amendment to allow under-18s to choose euthanasia.

    Under the proposed rules, children would have to request death more than once, be terminally ill and be in constant pain. These provisions are similar to those already in place for adults.

    Euthanasia appears to be firmly established in Belgium. More than half of the newborn babies who died in the Dutch-speaking region of Belgium were helped on their way by doctors, according to an article in The Lancet last year. Euthanasia was legalised in Belgium in 2002. ~ Guardian, Apr 6   

    GENE THERAPY SUCCESS IN GERMANY

    In the first apparent success for gene therapy in adults, two German men have been cured of an genetic immune deficiency which made them vulnerable to life-threatening infections. A paper in Nature Medicine says that a 16-year-old and a 25-year-old had chronic granulomatous disease resulting from a defective gene on the maternal X chromosome. They were treated at a Frankfurt hospital with transfusions of genetically altered stem cells which carried the effective gene. Within 50 days, the men were free of chronic liver and lung infections.

    The researchers warn that the results are still preliminary. "Each gene therapy with stem cells carries a certain risk of leukaemia," says Christof von Kalle, of the National Centre for Tumour Disease in Heidelberg. Gene therapy, though highly promising, has had a mixed history. In 1999 an American teenager died during a clinical trial. Three years later three French children developed leukaemia after treatment. Since 2002, all gene therapy trials in Germany were banned unless the patients were severely ill, had no other treatment option and were fully informed of the risks. ~ BMJ, Apr 8   

    FEDERAL SPENDING ON EMBRYONIC STEM CELLS INCREASING

    Despite complaints about the Bush Administration's restrictive policy on human embryonic stem cell research, the US government spent more than US$37 million on it last year. "There is a lot going on the US. The official story [of stem cell advocates] is how we are falling behind in tragedy and dismay. And I don't think that is the case," the co-director of the Human Embryonic Stem Cell Center at the University of California, San Francisco, told the Wall Street Journal. Last year the National Institutes of Health supported 154 research projects involving the stem cell lines created in 2001 which are allowable under Bush's rules.

    One focus of the NIH's grants has been courses in how to work with the cells. "This is not 'Joy of Cooking' type of science," says Garry Gibbons, of the Morehouse School of Medicine in Atlanta, who received a $110,000 grant. "It was definitely a learning curve for us."

    In some ways, the parsimony of the Bush Administration has been a boon for human embryonic stem cell researchers, as top universities have received millions in donations from its opponents. Harvard University's stem cell institute, for instance, has raised more than $30 million. ~ Wall Street Journal, Apr 4   

    HIM AND HER TUMMY TUCKS

    Ageing couples are having cosmetic surgery together as a way of bonding or of keeping their relationship alive, according to the Los Angeles Times. "Men are figuring out what women figured out decades ago, which is that like it or not, our appearance really matters," says David Sarwer, a psychologist at the University of Pennsylvania School of Medicine. "We see it not only in men's pursuit of cosmetic surgery but also in the growing number of health magazines and skin-care lines directed at men." Staying competitive on the job is another powerful motivation.

    Surgical togetherness is part of a growing trend for men. The number of cosmetic procedures on men has increased by 16% since 2000 -- not nearly as much as the 42% increase in women's procedures, but still significant. The spokesman for the American Society of Plastic Surgeons, New York-based Dr Darrick Antell, says that he has seen a 15% increase in couples in his own practice over the past two years.

    Cosmetic surgeons warn that appearance plays such an important role in relationships that procedures can be counterproductive. A spouse without surgery may begin to feel that their partner will dump them for someone younger. In any case, even doctors say that cosmetic surgery will not make people happier. "There is pretty conclusive evidence that cosmetic surgery does lead to an improvement in body image," says Sarwer. "But there is not much evidence that surgery improves self-esteem and quality of life, both of which derive from so much more than just the way we look." ~ Los Angeles Times, Apr 9   

    INDIAN SURROGATE MOTHERS WORKING FOR OVERSEAS CLIENTS

    Surrogacy has swollen into a US$449 million [sic] industry in India, according to a report in the Christian Science Monitor. Motherhood on the cheap is the main attraction for overseas couples. In the US, a baby from a surrogate mother might cost $45,000, while in India, the cost of paying both the mother and the broker ranges between $2,500 and $6,500.

    Doctors insisted to the Monitor that surrogacy was neither exploitative nor exclusively commercial. "This is not the same thing as donating a kidney [for money]," says Dr Nayna Patel, of Kaival Hospital in the down of Anand. There are no psychological consequences either. "Many surrogate mothers see this not as handing over' the baby, but as 'handing back' the baby, as the baby was never theirs to keep," she says.

    For the mothers, although they too speak about altruistic donation, money is clearly a motivation. "How else will us uneducated women earn this kind of money without doing anything immoral?" asks one of the surrogates at the Kaival Hospital. ~ Christian Science Monitor, Apr 3   

     

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    Australasian Bioethics Information
    ISSN 1446-2117
    Website:www.australasianbioethics.org
    BioEdge editor: Michael Cook
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