Tackling stem cell tourism: a comment by Matthew D. Griffin

2 Ago 2011

Stem cell therapy is moving steadily toward worldwide clinical application for a broad range of inherited and acquired diseases. In countries where biomedical research progress is both widely publicised and tightly regulated, it is understandable for those who stand to benefit from the regenerative potential of stem cell therapies to seek more rapid access to treatments. This situation is conducive to practitioners operating under lax regulatory conditions offering treatment to patients travelling from overseas. Indeed, there is good evidence that stem cell therapies are an important driver of medical tourism and good reason to believe that some patients who travel for stem cell therapy are receiving ineffective or harmful interventions.



A timely call for action
Zubin Master and David Resnik [1]  provide a timely and provocative call for more active involvement of the scientific community in preventing stem cell tourism and its damaging effects on individual patients, as well as on the field in general. You can read a short summary of their proposal in our introduction. In making their recommendations, Master and Resnik point out the inherent social responsibility involved in conducting stem cell research. They also highlight the limited effectiveness of other strategies for discouraging medical tourism, such as legal barriers and education of patients and their physicians regarding the risks involved in travelling for unproven medical interventions. On reading the article in EMBO Reports, I find myself strongly agreeing with the authors’ core recommendations. I certainly concur that counter-arguments such as the erosion of scientific openness and the burden of work involved in generating a legal framework for resource sharing hold little sway when weighed against the well-being of vulnerable patients.

"A key point touched on by Master and Resnik is the value of an agreed set of ethical guidelines generated through consensus"

Organ transplantation provides a useful example
A key point touched on by Master and Resnik is the value of an agreed set of ethical guidelines generated through consensus by representative scientific societies operating across international boundaries. In this regard, the stem cell scientific community would do well to examine the efforts made in recent years to limit exploitative medical tourism in the closely-related field of organ transplantation.

In 2008, a summit convened jointly by two international societies (The Transplantation Society and the International Society of Nephrology) to discuss rising concerns about abusive practices in organ transplantation worldwide resulted in the Declaration of Istanbul on Organ Trafficking and Transplant Tourism [2] . This effort carried an inherent risk of polarising representatives from wealthy and developing nations, or of simply being ineffectual. However, the Declaration has since been ratified by other important national and international societies and has served as a nucleus for a wider range of efforts to reduce and marginalize unethical practices [3] . There are some specific elements to this process in organ transplantation that may be of relevance to the challenge of acting against stem cell tourism. These include:

  1. Participation of multiple international societies
  2. Inclusion in discussions of a broad range of stakeholders from all countries involved: scientists, clinicians, government and social agencies, legal and ethical professionals
  3. A focus on accurately describing and defining unethical practices
  4. Generation of clear proposals for policies and prohibitions against these practices
  5. Initiation of an ongoing international process to disseminate the recommendations and to pressurise government to enact and enforce laws [4].

Other useful actions
In addition to such highly-coordinated international efforts, individual scientists, scientific journals, representative societies and funding bodies can also promote reform in other ways. These could include actively conducting research into the outcomes of stem cell tourism, refusing or cancelling membership of those involved in unregulated clinical use of stem cells and insisting on evidence that ethical guidelines have been followed as a prerequisite for receiving funding or for presenting and publishing stem cell-related studies [2].

"The recommendations of Master and Resnik regarding sharing of stem cell lines and related reagents deserve careful consideration by individual scientists"

Many researchers are already actively involved in coordinated efforts to inform the public about risks of stem cell tourism and to prevent unethical clinical use of stem cells [5]. The recommendations of Master and Resnik regarding sharing of stem cell lines and related reagents deserve careful consideration by individual scientists. As pointed out by Robin Lovell-Badge is his own response to their commentary, it is unclear whether more rigorous pursuit of MTAs would significantly impact the problem of fraudulent stem cell clinics. Nevertheless, unquestioned sharing of research materials and protocols may well be one piece of the puzzle and it is an area over which scientists have personal control.

Undoubtedly, other initiatives will be required and there is a real need for more accurate data on the range of regulated and unregulated clinical stem cell activities being conducted around the globe. The recent positive developments in organ transplantation suggest that the community of stem cell scientists and their representative bodies should consider joining forces with colleagues in clinical, legal and political spheres to engage respectfully on the issue of medical tourism with their counterparts in countries where unethical practices are suspected.  

Related links

References (Journal subscriptions may be required)
[1] Zubin Master and David B. Resnik, Stem cell tourism and scientific responsibility, EMBO reports advance online publication 29 July 2011; doi:10.1038/embor.2011.156.
[2] Steering Committee of the Istanbul Summit, Organ trafficking and transplant tourism and commercialism: the Declaration of Istanbul, Lancet 2008 372:5-6.
[3] Reed AI et al. The Declaration of Istanbul: Review and commentary by the American Society of Transplant Surgeons Ethics Committee and Executive Committee, Am J Transplant 2009 9:2466-9.
[4] Honey K. Putting a stop to organ trafficking and tourism, J Clin Invest 2009 119:425.
[5] Mitka M. Troubled by "stem cell tourism" claims, group launches web-based guidance, JAMA 2010 304:1315-6.

Such and interesting topic. I

Such and interesting topic. I wonder what will become of this research after a year or two.

stem cell tourism

We cannot blame patients for going to countries where stem cell therapies are offered.  When terminally ill or when afflicted with a progressive disease for which there are no cures, you and I too might consider such therapies, even if not proven to be well substantiated.  Let us look back in time and make a guess of the money so far spent in finding cures.  In the last ten years how many cures were we able to find? When medical research is stalled and most of the diseases other than infectious diseases cannot be cured, we cannot expect patients to be confined to fate. Scientific community knows quite well that embryonic stem cell research is stalled and any translation of adult stem cell research would take several years. Stem cells are simply unspecialized cells and embryonic stem cells are mostly made from discarded embryos.  The public has less knowledge of the specifics and they stick to their religious dogmas, making research in this area very difficult to be funded. To add fuel to fire, when trials such as that of Geron are getting cancelled midway, it may be logical to think that developing countries with less research regulations are ideal places to conduct such research.