Stem Cells ‘Sited’

There is a new web site up giving some basic information about stem cell research. The information is basic, but for those who have no science background, it is probably a good start.

Even though the site claims to be absolutely neutral on the issue of stem cell research, it does make one major assumption, that stem cell research, either on embryonic or adult stem cells- will eventually lead somewhere. Also note the language involved in the site is also inherently pro-science. For example the site prefers to use the more talking-point acceptable adjectives unlimited and limited as opposed to embryonic and adult. Is that bad? No. Is it neutral. No again.

Do I think stem cell research is inherently unethical? No. The unethical part of the discussion is the disingenuous arguments coming from the anti-choice, religious right trying to claim that unused embryos created during in-vitro fertilization are the moral equivalent of a 5 year old child. These people leave a slime trail.

On the other hand, I have long since lost the ability to believe that scientific progress is either good or inevitable.

For example look at today’s article in the New York Times about one of the main pharmaceutical companies cancelling trials of a new heart medicine.

The news came to Pfizer’s chief scientist, Dr. John L. LaMattina, as he was showering at 7 a.m. Saturday: the company’s most promising experimental drug, intended to treat heart disease, actually caused an increase in deaths and heart problems. Eighty-two people had died so far in a clinical trial, versus 51 people in the same trial who had not taken it.

Scrutiny of Other Heart Drugs Could Grow After Failed Trial (December 4, 2006) Within hours, Pfizer, the world’s largest drug maker, told more than 100 trial investigators to stop giving patients the drug, called torcetrapib. Shortly after 9 p.m. Saturday, Pfizer announced that it had pulled the plug on the medicine entirely, turning the company’s nearly $1 billion investment in it into a total loss.

The abrupt decision to discontinue torcetrapib was a shocking disappointment for Pfizer and for people who suffer from heart disease. The drug, which has been in development since the early 1990s, raises so-called good cholesterol, and cardiologists had hoped it would reduce the buildup of plaques in blood vessels that can cause heart attacks. Just last Thursday, Pfizer’s chief executive, Jeffrey B. Kindler, said publicly that the drug could be among the most important new developments for heart disease in decades and that the company hoped to get Food and Drug Administration approval for it in 2007.

We’ll leave the fact that the headline – “End of Drug Trial Is a Big Loss for Pfizer and Heart Patients” – alone is an abomination and inherently assumes heart patients would have benefited more from medication than from improved diets and permanent mobility training. The fact that Pfizer is forced to stop trying to produce a drug which demonstrably didn’t work is just that – a fact. It is a big loss for Pfizer, the investors will be sorely missing the 1 billion dollar investment. But that is the kind of thing that is at stake here. Not making people healthier.

But what was Pfizer trying to produce? A drug that is supposed to turn bad cholesterol into good cholesterol. According to the Weight-control Information Network, half of America is overweight and a third are obese. Do I really believe those exact numbers? No, not really. Oh the values are correct, but I don’t think that all overweight people need to fit some fantasy number designed to make statistical analysis easier. On the other hand the trend is obvious. Pfizer knows that one way to make money is to allow people to eat what they want and be able to reduce heart problems. The NIH is trying to get people to stop eating what they want. Pfizer ran up against a scientific wall after investing about a billion dollars in a lifestyle drug. Lot’s of very intelligent, caring people hoped the drug would work, that it would be effective. They found the path led nowhere. Perhaps because the hypotheses – good and bad cholesterol instead of good eating habits and exercise -is a path leading to failure.

Do I think stem cell research is a canard? Is it something that is cynically being pushed as a possible wonder cure, a new lifestyle drug? No. But the possible advantages and the possible side effects are so unknown, so impossible to estimate that the noise being generated to do further research, to be the first to get the money making patent, honestly makes me ill.

Researchers can’t predict if a certain line of research will pan out. Basic scientific research is just that – basic. There are failures and successes. Some hypothesis will pan out – others will fail. But to turn the issue into talking points. To speak of limited and unlimited cells is also disingenuous. Unfortunately to be able to do the basic science, to convince an increasingly fundamentalist American public, the misdirection is probably necessary. But don’t forget that it is ultimately big money that wants the research to be done.

The need to get ‘first patent’ and not ‘first patient’ is at the heart stem of the issue.

(Hat Tip: Toby Barlow/Huffington Post for the stem cell website.)

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8 comments so far

  1. […] To bookend my last post, I present the article  from Sunday’s Washington Post. This is about a scientist in Texas who could get up to $75 million dollars to continue his investigations into a cause for what is know as the Gulf War Syndrome. Fifteen years after the end of the 1991 war with Iraq, a Texas researcher is in line to get as much as $75 million in federal funding to press his studies of “Gulf War syndrome,” even though most other scientists long ago discounted his theories. […]

  2. Darmok on

    No, the headline assumes no such thing; that one promising avenue of treatment is eliminated can be disappointing without any implication that it would be superior to other treatments. While pharmaceutical agents do benefit the manufacturing company, they provide benefits to patients as well; I do not understand the source for your animosity or your claim that making people healthier is not at stake. It is.

    Could you explain your claim that “hypotheses – good and bad cholesterol instead of good eating habits and exercise -is a path leading to failure”? First, medication is a complement to, not a replacement for, lifestyle changes. It does not mean we cannot pursue both avenues. Furthermore, studies have quite clearly shown that increased LDL levels (bad cholesterol) and decreased HDL levels (good cholesterol) are associated with worse outcomes, independent of lifestyle. That is, even if two people eat the same diet and follow the same exercise pattern, if the LDL of one is higher, he will be at higher risk.

    Now studies have also shown that diet and exercise can lower LDL levels, and of course this is preferable to using medication. But neither is very effective at increasing HDL levels. In fact, there really is no good method, either lifestyle or medication, to increase HDL levels; we just know that they are associated with better health but we’re limited in our ability to modify them. That’s why a medication like this would be so useful.

  3. blc303 on

    Actually I perceive the rub to be here.

    First, medication is a complement to, not a replacement for, lifestyle changes.

    As I see it, the problem is less chemical than psychological. Lifestyle changes, including to a large part a complete change of eating habits, will only take place when less emphasis is placed on trying to medicate the problem away. You can’t tell me that there is some magical thing floating around causing Americans to become fatter and fatter, moving less and less and that heart desease is increasing due to something else. Americans have become accustomed not to want to pay a price for whatever they do. At the same time major corporations, big pharma offering medical solutions and big ‘health food/new age’ imagining herbal whatevers to long term behavioral problems.
    Second. The failure of this test is not a loss for heart patients because the drug wasn’t safe. I repeat – THE. DRUG. WASN’T. SAFE. A loss would be a denying people medication that was safe. That would be a loss. This is a hypothesis that didn’t pan out. A scientific success because Pfizer nixed the study, a win for those who didn’t die taking the medication.
    As it is heart patients are losing nothing but another medication that for some people was deadly. A medication that would have also likely been expensive feeding the habits of an overmedicated society.
    Will this type of therapy pan out to into something if genetic classification of heart patients becomes more available? Maybe. But for the moment the only big loser is Pfizer. Neither the patients nor the insurers will have a middle term loss.

  4. Teresa on

    I started to comment, but it got too long. I’m taking my ball and heading to my own backyard so I don’t trample on Ben’s carefully tended turf. Later today at http://www.anomalousdata.com

  5. […] The other day I posted ranted about stem cell research. Some people thought I hit “enough triggerpoints to start an all-out flame-war if he just had a couple thousand readers.” […]

  6. Darmok on

    I am unclear what point you are trying to make: it now seems that you are arguing that our healthcare system is too quick to medicate. That may be, but if that is your message, I don’t think your blog entry conveyed it very well. In addition, you seem to imply that lifestyle changes alone would produce a superior health outcome to medication alone. I don’t believe this is the case; in fact, not only are lifestyle modifications difficult to implement, even among those who can implement them, they do provide significant benefit but usually not as much as medication does. Or perhaps you wish to argue that regardless, we should focus on lifestyle changes. That is certainly your prerogative, though I would suggest that a better-structured entry more focused on this issue would be more effective, especially if you had some evidence to back up your claims.

    You are quibbling over the definition of “loss.” A promising potential treatment was what was lost. No, it is not a physical loss, not a loss of something was already present, but it is a loss nonetheless.

  7. blc303 on

    You might go check Teresa’s post which pretty much got the point. But I’ll try to make it slightly clearer here.

    I perceive the assumption that science will always solve problems to be a real danger. It is dangerous because it leads people to do stupid things, like eating too much or not doing something about global climate change; to do things that long term lifestyle adaptation would have solved.

    You say lifestyle change provides a significant benefit but not as much as medication. I disagree. You are correct in assuming, if someone has already become sick, medication supplemented by lifestyle changes is the appropriate course. My stand is that trying to implement lifestyle changes before people get sick is correct. If the cultural mindset insists that science will solve long term lifestyle problems, you will have major problems trying to get people to change ‘bad habits’. The idea is to change the ‘science solves’ to ‘science tests hypothesis which produces information and theories’ mindset. Start living healthier sooner (calorie taxes anyone?) and solve the problem before medication is necessary. Not a short term fix. A long term mindset.

    Is it a loss that cold fusion doesn’t work? It would have produced a cheap easy form of energy finally freeing humankind from the bondage of fossil fuels. It would have been great but I don’t consider the fact that it didn’t pan out to be a loss. Large scale matter transportation and reanimation after cryogenic storage would be cool. But that they probably will never be discovered isn’t a loss. It’s the way it is. Again, science is about testing hypothesis in order to generate information and theories. What works – works.

    The nixing of this study does not mean that either the medicated approach to correcting high cholesterol values won’t eventually be validated or even that this specific medication will never be used. You might also check my comment there about Thalidomide at the above link. While the individuals involved in researching this medication were often trying to help individuals, Pfizer was trying to generate capital. If Pfizer really wanted to ‘help’ mankind, why don’t they put $1 billion into a malaria medication for the third world? Because it doesn’t generate income; because the people with that problem, which kills far more people per year than heart disease in the US and Europe, don’t have enough money to make the $2 or $3 billion return on investment necessary to satisfy the stockholders.

    And yes, if you choose to say that my post was poorly structured and misleadingly worded, I don’t have a problem with that. I live to quibble.

  8. Darmok on

    I agree that science will not solve all our problems—I’m sorry; I did not see that in your original post. The “benefit” to which I was referring is a health benefit, measured in terms of increased lifespan and decreased illness, though of course there are other ways to define benefit. I also agree with you that lifestyle changes, in general, should be implemented before medication, if possible; I did not argue to the contrary. And I still strongly encourage patients who are on lipid-lowering agents to continue or increase lifestyle changes; not only do they do better, but often can get by with smaller doses or even get off the medication.

    In some ways, cold fusion not working is a loss, though the promise was never really there; it was never very likely.

    The reason that the failure of this drug specifically is disappointing is that it used a new mechanism (blocking an enzyme called cholesterol ester transfer protein that converts HDL to LDL). As I mentioned before, it is quite difficult to raise HDL levels, which studies have shown are associated with better cardiovascular risk. Exercise can play a minor role, but much of the variation appears to be genetic—Asians, in particular, tend to have low levels regardless of diet. Researchers have been trying for many years to find a way to help increase them; the best medication we previously had, niacin, only modestly raised levels and causes some unpleasant side effects. Targetting CETP seemed like a great way to help boost HDL and lower LDL.

    But obviously, the drug wasn’t successful. Not only did it fail to help, but it harmed. And not a different side effect (say, cancer, or infection), but increased the rate of heart attacks. This is disturbing; it suggests that perhaps elevated HDL levels aren’t as good as we thought, or perhaps that cholesterol metabolism is more convoluted than previously understood. It could be a failing of this particular drug, and perhaps others in this class will be more successful, but it is quite disappointing that this targeted therapy failed in this manner. That’s why this is a loss.

    It’s not that you write badly or anything, but when challenged, you keep bringing up new points, points which I do not contest. I don’t believe that Pfizer’s attempts to generate revenue are particularly relevant, and I didn’t mention them. The point you are making now, that lifestyle changes are more important than (and should come before) medication does not appear in your original post; rather, you write that the path of researching this sort of cholesterol modification will inevitably lead to failure. My arguments are with your original post, not with the reasonable statements you make in your comments.


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