GESTIÓN EN SALUD PÚBLICA: BioEdge: Is the California Institute for Regenerative Medicine worth it?

domingo, 9 de septiembre de 2018

BioEdge: Is the California Institute for Regenerative Medicine worth it?

BioEdge: Is the California Institute for Regenerative Medicine worth it?

Bioedge

Is the California Institute for Regenerative Medicine worth it?

by Michael Cook | 8 Sep 2018 |

In 2004 California voted 59% to 41% for Proposition 71, an amendment to the state constitution which would create the California Institute for Regenerative Medicine through a US$3 billion bond issue. Interest added another $3 billion to the bill. Now the CIRM’s funding has nearly run out and its supporters plan to ask voters to authorise another $5 billion in funding in 2020.

The San Francisco Chronicle has reviewed the record of the CIRM’s research in a special feature. Without committing itself, the newspaper suggests that renewing the CIRM’s contract with voters might not be a good investment.

First of all: the promise. Back in 2004 supporters of Prop 71claimed that “Nearly half of all families in California could benefit from stem cell treatments Prop. 71 would help create. One study it commissioned found that new, life-changing therapies could emerge in just a few years. And Prop. 71 would pay off financially, the campaign claimed, creating thousands of jobs and potentially returning the state's investment more than seven times over.”

Second: the reality. Californians were voting for quick cures, not training scientists, new research buildings or basic science. What happened is something different.

“No federally approved treatments have been produced. And without marketable therapies, the public is still far from reaping the up to $91 billion in health care savings by 2040 the campaign predicted.
“CIRM has funded nearly 50 clinical trials, but just four have been completed, meaning scientists enrolled all the patients they said they would and finished compiling data. One of those trials was an observational study that tested no new therapy. The others involved treatments that are still years, at best, from reaching the market.
“The state, once told to expect as much as $1.1 billion in royalties from CIRM-backed discoveries within 35 years, so far has received just a tiny fraction of that amount: a single payment of $190,000 from the City of Hope medical research center in Los Angeles County.”

In fact, soon after the campaign the CIRM issued a report which attempted to hose down the fires of hope about cures for dread diseases.

“The field of embryonic stem cell research was still young, the report warned. The road to marketing new therapies would be long and expensive. Most research never reaches human clinical trials, it explained, and most of those trials fail. Potential treatments for just a handful of diseases might be tested, and it was doubtful that a single approved therapy would be developed from the state’s investment.”

The toxic combination of generating unrealistic hope and the failure of reputable researchers at the CIRM to deliver proven cures has led to an unexpected result: a proliferation of clinics offering unproven, and sometimes dangerous, therapies.

But Robert Klein, the man who led the campaign for Prop 71 in 2004 and the CIRM’s chairman for its first seven years, is not daunted by the institute’s mixed record. He plans to campaign again in 2020. “In 2004 we had a vision of the future and data on animals,” he told the Chronicle. “In 2020, we will have patients who were paralyzed, patients who were blind, patients with cancer who will tell their story. The public will decide.”

Sunday, September 9, 2018

John Robertson was an American scholar in law and bioethics who died last year. He is best known for making a strong case for “procreative liberty”, whether procreation takes place naturally or with the help of technology. As a tribute to his influence, the current issue of the Journal of Law and the Biosciences contains several articles about this theory.

Robertson’s theme was that reproductive choices which do not harm the interests of others should not be subject to regulation or prohibition. In his best-known book, Children of Choice, published in 1996, he discussed abortion, IVF, surrogacy and pre-natal genetic modification. But time has moved on. The principle of effectively unconstrained “procreative liberty” is being used to justify other developments, some of which are discussed in the Journal, including unisex gestation.

What I found interesting was that Robertson, in a paper written not long before his death, agreed that a male pregnancy (after a womb transplant) could be ethically justified, but only if it were necessary for genetic reproduction. Even he wanted to draw a line somewhere.

However, the author of one of tribute essays questions this restriction. Enjoying the experience of gestation is reason enough, she says. (See below). I suppose that this raises the question of whether it is possible to draw any lines, anywhere, once we agree that reproductive rights should not be limited.