BioEdge 232 -- Tuesday, 19 December 2006

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BioEdge 232: Therapeutic cloning oversold, says UK expert

THIS WEEK


bullet 
Therapeutic cloning oversold, says UK expert
      Will probably never lead to cures
bullet 
Dollars and cents of voluntary euthanasia
      Poverty can push people over the edge
bullet 
Hairy experiment
      Stem cells in follicles
bullet 
Dads not needed, says UK government
      Single women and lesbians to access IVF
bullet 
Expanding the pool of organ donors
      Donation after cardiac death needed, say doctors
bullet 
Primates needed for research, says UK researcher
      Closer to humans
bullet 
Korean come-back kid
      Hwang quietly toiling away with his research
bullet 
Kevorkian to be paroled
      I'll behave myself, says euthanasia doctor
bullet 
IN BRIEF: serial killers; another fake; blood substitute

HAPPY CHRISTMAS AND NEW YEAR TO ALL OUR READERS!


The next issue of BioEdge will appear on January 9.

THERAPEUTIC CLONING OVERSOLD, SAYS UK EXPERT

Therapeutic cloning will be useless in clinical medicine, says one of Britain's leading stem cell biologists. Professor Austin Smith, of the University of Cambridge, says that "Its prominence is out of proportion to the significance of what's being done, and there are real question marks about whether it has any utility at all."

Cloning research has been oversold to the public and has gained an unreasonably high profile. In fact, says Professor Smith, it has limited potential for treating disease and adds little to scientific understanding. In theory, it may be possible to treat people with cloned embryonic stem cells, but the technical barriers would be insurmountable in practice, he told the London Times.

Professor Smith is an unlikely sceptic, as he is one of the first scientists in the UK to be granted a licence to work on human embryonic stem cells. He is the new director of the Wellcome Trust Centre for Stem Cell Research at Cambridge and expressed his opinions at a function sponsored by Cambridge and the journal Nature to celebrate the 25th anniversary of stem cell research. He says that research on embryonic stem cells from "surplus" IVF embryos and on adult stem cells is less controversial and more likely to yield medical benefits. ~ London Times, Dec 18   

DOLLARS AND CENTS OF VOLUNTARY EUTHANASIA

Dollars-and-cents calculations have become part of the debate over assisted suicide and euthanasia, argues a British doctor in the journal Bioethics. Dr Miran Epstein says that bioethicists esteem autonomy so highly that any decision which patients make with full knowledge and full consent must be respected. By virtue of the fact that something has been freely chosen, it must be a legitimate decision, regardless of the reasoning behind it.

Bioethics "has been largely silent about [economic] pressures, when in fact it has been willing to legitimize individual and social end- of-life decisions even if they reflected such pressures," he says. Two reasons which are often cited in cases of assisted suicide, fear of becoming a burden on others and fear of loss of control and independence, may often be, fundamentally, economic considerations. Contemporary families are so busy and pressured by the "rat race" that they cannot afford the quality of care that the elderly deserve. And in fact, he says, 63% of the people who died in Oregon in 2000 under its assisted suicide law feared being a burden on their families.

Although Dr Epstein describes himself as a supporter of voluntary euthanasia, he admits that it is possible that "the meaning and the social role of a right to die with dignity depend foremost on the absence or presence of a positive right to live with dignity." Dame Mary Warnock, the UK's doyenne of bioethics, illustrates his point. She argued in 1994 that "if a patient herself argued that keeping her alive was also too expensive for society... and that this was at least part of what caused her to wish to die, then that reasoning must be accepted... Cost-benefit must be the criterion here; and we should not be ashamed to use it." ~ Bioethics, vol 21, no. 1, 2007   

HAIRY EXPERIMENT

Scratching your head over where to find versatile but non- controversial stem cells to replace the embryonic kind? Keep on scratching. Researchers at the Medical College of Wisconsin have found that stem cells in the bulge of hair follicles seem to be able to differentiate into many kinds of cells and can multiply rapidly. Their results have been published in the journal Stem Cells.

The lead scientist, Dr. Maya Sieber-Blum, says: "We see the potential for cell replacement therapy in which patients can be their own donors, which would avoid ethical issues and reduce the possibility of tissue incompatibility." Her colleagues have done some preliminary research on mice with spinal cord injuries. These cells, called epidermal neural crest stem cells, grafted into the spine and survived. ~ physorg.com   

DADS NOT NEEDED, SAYS UK GOVERNMENT

Fathers will not be required for IVF children under a proposed shake- up of Britain's fertility legislation. The Blair Government feels that a revision is needed because of changing social mores and the galloping pace of developments in reproductive technology. Its most controversial provision will allow single women and lesbians to access IVF. Both would be recognised as the parents.

Outspoken Liberal Democrat MP Evan Harris welcomed the proposal. He said the existing act was "unjustifiable, discriminatory and vindictive. It was also unsustainable in human rights and equality terms. The evidence suggests children do very well brought up by lesbian couples and solo parents, so good riddance."

Dr Calum MacKellar, of the Scottish Council on Human Bioethics disputed this: "It is possible that these children may only become aware of any psychological problems when they become adults or consider having children of their own."

Doing away with Dad is only one of 25 proposals to be presented to Parliament. Public health minister Caroline Flint has suggested a raft of changes. Some of these are designed to deal with awkward cases which have arisen over the past few years. These include: a one-year cooling off period after one of the partners wants embryos destroyed; extending the mandatory period for storing embryos from five to ten years; allowing screening of embryos for medical conditions and saviour siblings; gamete donor access to some information about their children; allowing donor-conceived children to find their siblings; and the creation of some hybrid embryos.

"A greater range of persons" will be able become legal parents of IVF children. Presumably this will allow homosexual couples to become parents without having to adopt a child. It is not clear from the information released by the government whether the range will be extended numerically as well to allow 3 or 4 people to become legal parents.

Although the tone of the recommendations is generally permissive, the Government does plan to ban sex selection for family balancing. This provoked an angry response from Guardian journalist Sarah Ebner: "I know of numerous families with two or three sons or daughters who would like to have another child, but only if they know it will be of the other sex... We're facing a demographic disaster in this country and need all the children we can produce." ~ Guardian, Dec 14; London Times, Dec 15   

EXPANDING THE POOL OF ORGAN DONORS

With 94,000 Americans on an ever-lengthening list of candidates for organ donation, transplant surgeons are eager to expand the pool of potential donors. An op-ed in the New York Times contends that one way is donation after cardiac death.

"The propriety of donation after cardiac death is so well established and its potential to ease organ shortages is so great that the Health Resources and Services Administration has deemed it an important goal for the nation," writes Dr Francis L. Delmonico, the medical director of the New England Organ Bank.

Since it is a fundamental ethical rule that patients must be dead before their organs are transplanted, the problem is defining when they actually die. The normal criterion is strict: brain death, even in the brain stem. In other words, no brain function at all. This is less common than cardiac death which occurs when a person's heart stops beating. Lungs, livers and kidneys remain viable after cardiac death.

Normally brain-dead patients have been on a ventilator, with their hearts still beating, until the moment of transplant. This gives the organs a better chance of survival. But many patients die without being on a ventilator. When their heart stops, their organs begin to deteriorate immediately. The contentious issue is how long doctors should wait before removing organs. The standard interval is five minutes. Apparently there has never been a documented case of heart resuming after two minutes.

In the US, the Joint Commission on Accreditation of Healthcare Organizations will require hospitals to enable the practice from next year. However, some doctors are uneasy about removing organs too soon after the heart stops and many hospitals will take advantage of an opt-out clause. Dr Delmonico worries that their scruples could cause lives to be lost unnecessarily. ~ New York Times, Dec 15   

PRIMATES NEEDED FOR RESEARCH, SAYS UK RESEARCHER

Four centres of excellence should be established to carry out experiments on primates because they are essential for medical research, claim UK experts in an independent report. "We felt there was a strong moral scientific case" for their use in research, says medical scientist Sir David Weatherall.

He led an independent working group that carried out an 18-month study of how non-human primates such as marmosets, tamarins and macaques are used in research. "We are not calling for an expansion in non-human primate research," Sir David said. "Focusing research at specialised centres would have huge scientific and welfare benefits. There is a scientific case for careful, meticulously- regulated non-human primate research, at least for the foreseeable future, provided it is the only way of solving important scientific or medical questions and high standards of welfare are maintained."

Although animal welfare groups immediately slammed the report, Sir David insisted that non-human primates are the only way to ensure that medications are safe and effective before they are tested on people. Rodents and other animals are too different to human beings to provide relevant information.

The journal Nature urged scientists to take a nuanced view of the use of animals in medical research. According to an anonymous poll it conducted, about three-quarters of scientists felt that animal research was essential to progress. However, some expressed misgivings about their work. ~ London Telegraph, Dec 14; Nature, Dec 14   

KOREAN COME-BACK KID

Disgraced stem cell researcher Hwang Woo-suk is making a quiet return to scientific research, even though he is still in the middle of a trial over faked articles in Science, embezzlement and bioethics violations. With the help of an unknown financial backer, he has shifted to a new lab about 50 kilometres south of Seoul and is working on animal cloning with the help of about 30 researchers. He hopes to return to human therapeutic cloning eventually.

Koreans are split over Hwang. Some feel that he is a victim and that the real culprit is his former associate Kim Sun-jong. Others think that he was brought down by American researchers who were jealous of his success. Professor Park Se-pill, of Cheju National University, does not agree with either theory, but admires his competence and want to see him back in the lab. "Hwang and his men have unrivalled technologies for cloning," he told the Korea Times. "Korea should not scrap that know-how for the benefit of the country and the world." ~ Korea Times, Dec 12   

KEVORKIAN TO BE PAROLED

Convicted murderer and euthanasia activist Jack Kevorkian has been granted parole. He has promised not to participate in any more assisted suicides. Kevorkian was convicted in 1999 in Michigan of second-degree murder after helping a man with Lou Gehrig's disease to die -- a death which he videotaped and screened on the CBS show 60 Minutes. He claims to have helped at least 130 people to die.

"You can put any conditions you want on me," he told the parole board. "I'm not going to do it again. Anything that will bring me back to prison I will avoid. Prison is not a place to live." However, he will continue to press for the legalisation of assisted suicide. Kevorkian has served 8 years of a 10 to 25-year sentence; his parole begins in June. ~ Detroit Free Press, Dec 14   

IN BRIEF: serial killers; another fake; blood substitute

Serial killers: At least 90 health care professionals have been prosecuted for killing more than 2,000 patients since 1970, according to a study in the Journal of Forensic Sciences. They occurred in 20 different countries, primarily in the US and Europe. ~ infozine, Dec 14

Another fake: An important paper in the respected journal Cell has been challenged over image manipulation. A group at National Chung Hsing University, in Taiwan, published the paper in the October 20 issue. However, anonymous sleuths have alleged that certain images had been manipulated. The lead author, Ban-Yang Chang, has denied it, but his university has advised him to retract the article. Now the sleuths have challenged another of his papers in the Journal of Biological Chemistry. ~ Science, Dec 15

Blood substitute: The US Food and Drug Administration has failed to approve a blood substitute, Hemopure, which the Navy says could save many lives. The Navy wants to test it on 1,100 trauma victims in emergency situations without obtaining informed consent. However the FDA says that such trials must give victims some benefit, not just minimise the harm done to them. In this case, it says, the benefits do not outweigh the risks. While a blood substitute which will maintain blood pressure and is compatible with all blood types is a good idea, it has a chequered history. Twenty patients tested with a similar product in 1998 died. ~ AP, Dec 14   

  

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Australasian Bioethics Information
ISSN 1446-2117
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BioEdge editor: Michael Cook
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