News focus piece on bad medical practices in china

1. A4 Tuesday, May 17, 2011
FOCUS
It’s a stem-cell therapy untested and unproven for many incurable
`
diseases, but in the mainland’s little-regulated system, hospitals are
cashing in on the last-chance hopes of the desperate and the dying
Medicine’s
wild east
Illustration: Stephen Case
......................................................
Aborted fetuses
fore, it’s impossible for a single adult after receiving two stem-cell treat- make these connections,” the ISSCR tuses are being injected directly into
Fiona Tam in Qingdao
somatic stem-cell type to treat multi- ments in Mexico in 2009 and 2010. His said. “We are still learning about how patients’ brains and spines. Similar
fiona.tam@scmp.com
ple unrelated diseases such as diabe- body became softer and more elastic, to direct stem cells to become the fetal-cell treatments are given at the
tes and Parkinson’s disease. and he was able to sleep and eat bet- right cell type, to grow only as much as Naval General Hospital of PLA, the
the likely source
The Singaporean doctor has ALS, the Stanford Stem Cell & Regenerative ter, after those treatments, she said. we need them to.” General Hospital of Chinese People’s
incurable degenerative disease of the Medicine Institute director Irving She was hoping for even better results Although it is now possible to re- Armed Police Forces, Peking Univer-
nervous system. He tried the drug Weissman , told reporters last year on the mainland, as other parents had program adult somatic cells to act like sity Health Science Centre and many
with the best chance of slowing the that stem cells from umbilical cords told her that the country had leapt embryonic stem cells (induced pluri- other public hospitals.
of stem cells
weakening of his muscles, the com- did have a very limited capacity to ahead in stem-cell therapies. potent stem cells, iPSCs), the main- In two articles in the Second Mili-
promising of his respiratory system, make scar, bone and fat. “But they “China has a big reputation in land’s stem-cell therapy centres tary Medical University’s journal,
the steady onset of death. But he is don’t make brain, they don’t make stem-cell treatment and is the place aren’t capable of doing it. Tian Zengmin, the naval hospital’s
allergic. He figured he had only one blood, they don’t make heart, they to be because you can actually see the neurologist, detailed how they culti-
hope left. don’t make skeletal muscle, despite improvement,” she said. “It takes a A family in mourning vated fetal brain cells taken from five-
Dr Poon Lee Kwee, 61, joined the what various people claim,” he said. decade for the FDA [US Food and to 11-week-old fetuses to treat Parkin- Hospitals often sell fetal tissue to labs for research or
droves of foreigners now flocking to The injections’ maker, Shenzhen- Drug Administration] to approve The Singaporean doctor is lucky he son’s disease and cerebellum atro-
mainland hospitals for stem-cell based Beike Bio-Technology says the something and the Americans can’t didn’t feel severe side effects after the phy. The central government funds treatment, without the mother’s knowledge
treatments — therapies that are un- treatments are offered by more than wait.” six injections. Tian’s research.
tested and unproven, but in the main- 50 mainland hospitals. Chairman Hu With stem cells directly implanted A 30-year-old man from Jinhua A Shanghai father who paid 18,000
...................................................... The country’s lax system of ethical
Fiona Tam in Beijing
land’s little-regulated climate, are of- Xiang said its stem cells, mainly ex- into the boy’s brain, Hansard hopes city in Zhejiang who tried to cure his yuan for a treatment for his son with and regulatory oversight and respect
fiona.tam@scmp.com
fered far more freely than in the US tracted from umbilical cord blood, the boy will finally learn how to make cerebral infarction with stem cells cerebral palsy said he believed all hos- to privacy enable doctors to remove
and other Western countries. had been injected into more than normal movements and reactions. died four days after receiving two in- pital-provided cells were taken from fetal cells and tissues without inform-
Seven months after being diag- 10,000 foreign patients from 70 coun- What Hansard and Poon didn’t jections from the No. 455 Hospital of induced abortion. “Otherwise you Research projects using embryonic ing the mothers.
nosed with amyotrophic lateral scle- tries. He said only 2.8 per cent of pa- PLA in Shanghai in July. The victim’s never know whether the cells from and fetal stem cells are ethically con- Ding Yu, who specialises in wom-
rosis (ALS), the general practitioner tients had slight side effects such as elder brother, Hong Chun, said he spontaneous abortion are good troversial in the West and have gener- en’s rights and is a researcher from
paid the equivalent of HK$155,420 for fever or headache. Hu refused, how- had seen the injections’ packing at the enough to repair injuries,” he said. ated plenty of public debate, but in the School of Sociology and Anthro-
a month-long therapy in Guangzhou ever, to disclose a success rate. hospital. Wernig said it made much more China there is little discussion and pology at Sun Yat-Sen University,
in March. Poon received six injections
of mesenchymal stem cells (MSCs), a
Hua Qing, Beike’s coordinator in
the Guangdong hospital, concedes
Although scientific “It was made in Shenzhen and the
hospital told me that they purchased
sense medically to use fetal brain tis-
sue than MSCs to repair neural inju-
public opinion seems to be largely
positive.
said: “Very few Chinese have ethical
concern over abortion after three
kind of adult stem cell from umbilical- the injection can’t actually cure seri- progress is being each injection for 300 yuan from the ries, because the fetal brain actually The country’s particular situa- decades of the ‘one-child policy’ and
cord blood at Guangdong Provincial ous diseases, but can “improve” pa- manufacturer,” he said, adding that contains neural stem cells. He said tions, however, further complicates forced abortions. Most of them take
Hospital of Traditional Chinese tients’ conditions to some degree. made at amazing he had received anonymous calls there were some clinical trials using the picture. Most mainland stem-cell abortion as common phenomena
Medicine.
The treatment has undergone no
That claim isn’t based on medical
data, but on patients’ testimonials —
speeds, we need to from Guangdong threatening him
not to expose the malpractice.
fetal brain tissue, in particular in pa-
tients with Parkinson’s disease.
researchers will not say publicly
where the fetal tissue they used for
and never link this with human rights
or a fetus’ right to life.”
clinical trials, yet the hospital’s web- something that the International So- distinguish facts Yu Shuangfeng, 68, is among 21 “[But] the success rate was very study or treatment comes from. A On the mainland, fetal stem cells
site claims that a wide range of condi- ciety for Stem Cell Research (ISSCR) mainland patients who have sued the limited and led to uncontrollable se- close reading of mainland journals and tissue from abortion clinics have
tions considered incurable by other warns others to be wary of. from hype military hospital for fraud. Yu said she vere side effects,” he said. “Scientists however, show that many cells used become a steady source for mainland
means are now treatable with its revo- A month after getting the treat- nearly died of strong side effects, in- are trying to find out why the trans- for the research are coming from hospitals in treating patients for vari-
STEM-CELL EXPERT PROFESSOR RONALD LI
lutionary stem-cell therapy — from ments, Poon said he felt no substan- cluding fever, after paying 70,000 plants did not lead to the desired induced abortions. The cells harvest- ous diseases as early as 2000, as well
the fatal ALS, cerebral palsy, autism, tial improvement or difference. He yuan for two injections last year. Her effect. Once there is a better under- ed from fetuses range in age from five as stem-cell laboratories for research.
Parkinson’s disease, spinal-cord inju- said he would wait three months be- know is that manufacturing one MSC diabetes has never been cured. In- standing of the process such a trans- weeks to six months. Mainland media revealed that a
ries, and optic-nerve disorder to foot fore deciding if it had helped. injection can cost as little as 300 yuan stead, it worsened. plant could become possible.’’ The mainland’s draconian popu- Liaoning woman who chose a sex-
ulcers caused by diabetes. (HK$359). And these cells could never Han Zhongchao, director of Na- Professor Ronald Li, director of lation “one child” policy has ensured, selective abortion in Xian in
But there is no convincing evi- Foreigners flock to mainland cure Poon’s disease. tional Research Centre for Stem Cell Hong Kong University’s Stem Cell although unintentionally, that the June last year discovered that her six-
dence published in any reputable In theory, only neural stem cells Engineering and Technology, said the and Regenerative Medicine Consor- supply would be limitless. month-old fetus was sold to a local
journal to support MSCs as a treat- Despite the lack of a credible track from the brain that can give rise to mainland’s military hospitals, which tium, said that although stem-cell Many Chinese mothers-to-be are medical company called Shaanxi
ment for diseases like these, said Ma- record, the lure of a long-shot cure is nerve cells and two categories of non- weren’t under the administration of therapy could fundamentally change forced to terminate their pregnan- Alerfu Activ Tissue Engineering Co,
rius Wernig of Stanford University in drawing anxious Western patients to neuronal cells are the right type of the Health Ministry, were the first to medicine, almost all treatments being cies, regardless of the stage at which
California. mainland hospitals for treatments stem cells to treat Poon’s ALS. But offer stem cell treatments. Many developed were still in the experi- they are, under this policy. Author-
For the hospital’s claims to come costing up to HK$233,000 a month. most mainland stem-cell therapy small hospitals eyed the lucrative mental stage or clinical trials, except ities exert pressure to abort by impos-
true “would be a miracle”, Wernig, The stem-cell surgery of the little- centres provide only MSCs, which are business and launched their stem- bone-marrow transplants. ing heavy fines on would-be parents,
principal investigator at Stanford’s known Qingdao Chengyang People’s easy and cheap to produce. cell centres after that. “Many hospitals and centres have dismissing them from jobs, and re-
Institute of Stem Cell Biology and Re-
generative Medicine, said.
Unlike embryonic stem cells —
which in theory give rise to all the
body’s stem-cell types — tissue-spe-
Hospital is so popular an entire floor
at the top of its complex has been re-
made into luxurious suites for foreign
patients, who fly tens of thousands of
kilometresfor the treatment. The hos-
Even if Poon had been given the
right cells, there are still many barriers
to the development of successful
stem-cell therapies. Among them:
getting the cells to behave in the de-
“But all of these stem cell therapies
are still at the research stage, and
none of them has been approved by
domestic health watchdog as effec-
tive treatment,” Chinese Academy of
obviously overstated their stem cell
treatments, with very bold claims,” Li
said. “Too much hype is going to jeo-
pardise a paradigm-shifting field. Al-
though progress is being made at
fusing residency permits and social
protections such as education and
medical services for the children.
After the abortion, the hospital
often sells the fetal tissue to other
1,116
The number of stem-cell papers
cific stem cells such as MSCs are lim- pital even hired two full-time transla- sired way. “To treat many neurologi- Science academician Wu Zuze was amazing speeds, we need to distin- hospitals or laboratories for stem-cell published in international peer-
ited in their potential and largely tors and a private driver to cater to cal conditions the cells we implant quoted by Century Weekly magazine. guish facts from hype. The field needs research or treatment, without the reviewed journals in 2008
make the cell types found in the tissue those who can’t speak Chinese. will need to grow into specific types of The therapies may be unproved. time and space to grow and mature, mother’s knowledge. from China, ranking it fifth
from which they are derived, accord- Lori Hansard, of Houston, Texas, neurons, and to work they will also But some doctors are using them with before stem cells can be turned into “Generally, surgeons in the main- in the world
ing to the US-based International So- brought her 14-year-old son with ce- have to know which other neurons to abandon. In Beijing’s military hospi- clinical and other applications – it will land are very likely to use aborted fe-
ciety for Stem Cell Research. There- rebral palsy to Qingdao last month make connections with and how to tals, cells cultivated from aborted fe- happen, but not right away.” tuses in medical experiments and
treatments without informing the which focuses on producing artificial
mother-to-be,” Liu said, “while many skin and cornea. Three maternity as-
Stem cells for therapy
Stem cells are generally early stage cells that can continuously replicate and differentiate into other specialised cells.
China hopes to build an mothers-to-be are also not aware of
their rights on aborted fetuses, and
some surgeons may take advantage
sistants who sold the fetus soon after
the abortion were fired by the hospi-
tal after a police investigation.
Scientists hope these can be used to replace damaged tissues in patients. There are two main categories of stem cells:
Embryonic stem cells Egg is fertilised Adult stem cells
advantage in cell studies of this.”
An Yimeng, director of the stem-
cell transplant department at Bei-
There are growing concerns on
the mainland, though. Liu Hongbo, a
noted newspaper columnist based in
Stem cells can be extracted jing’s General Hospital of the Chinese Wuhan , said an unborn child
Stem cells created can ...................................................... yuan for developing potential treat- People’s Armed Police Forces, told arguably had as much right to live as
from umbilical cord blood, and Fiona Tam
develop into more than The fertilised egg certain other sources. These ments for heart disease, liver failure, People’s Daily that mainland hospi- the terminally ill child who used its
250 specialised cell begins to divide may be limited to producing Parkinson’s disease and repair of tals had been using fetal brains to cells. But Chinese legislators only re-
types in the body only certain types of cells China is making some large invest- neural conditions. treat patients since the 1980s, and a gard babies, not fetuses, as human.
ments in stem-cell research and By contrast, the US National Insti- huge number of patients received “Chinese authorities believe fe-
Two-cell medicine. tute of Health will spend US$125 mil- similar treatments during the past tuses are just a possibility of life, and
embryo Nerve cells
Without the shackles of ethical lion on human embryonic cell three decades. abortion is legal and well accepted by
qualms or government regulations, research. An’s hospital alone has treated the public,” Liu said.
Four-cell embryo leaders see stem-cell research as an It will, however, spend another nearly 4,000 patients with its neural But neurologist Ben Barres, chair
Skin cells area in which the country’s biotech- US$1.7 billion to understand the stem cells since 2003, including for- of the neurobiology department at
nology industry might outpace the basic mechanism of stem cells and to eign patients from 20 countries. Stanford University School of Medi-
Inner West. do non-human and non-embryonic In Shenzhen, a public hospital ob- cine, said he saw nothing wrong with
cell mass
Beijing announced early this stem cell research – matters of less stetrician said that in most cases, a using cells or tissue from a fetus that
Muscle cells month that the 973 State Develop- interest to Beijing. mother-to-be will leave the aborted was being discarded in any case.
ment Programme for Key Basic Re- Rather than basic research, Chi- fetus or stillbirth baby to the hospital “Personally,” Barres said, “I don’t
search would invest 1.6 billion yuan nese scientists are eager to focus on as medical residue. The fetuses will think there is an ethical problem with
Eight-cell Blastocyst Undifferentiated Partly (HK$1.9 billion) in stem-cell research humans’ mesenchymal stem cells be sold. And so will the placentas, to using tissue from aborted fetuses [tis-
embryo Mostly hollow sphere stem cells differentiated and five other fields this year. (MSCs) and the clinical uses for stem pharmaceutical factories or individ- sue that would otherwise be thrown
composed of up to 100 cells Cultured in nutrient-rich liquid stem cells Specialised cells Also, the 863 State Hi-Tech Devel- cells. Just one per cent of the US re- uals who believe them rich in nutri- in the garbage] to help patients.”
Sources: US National Academy of Sciences, US National Institutes of Health, Reuters SCMP opment Plan will allocate 130 million search budget is allocated to MSCs. ents and suitable to eat.