Talking stem cells on the GP show

30 January 2018
Talking stem cells on the GP show
Associate Professor Megan Munsie joined General Practitioner and medical educator Dr Sam Manger, to discuss stem cell research, potential therapeutic applications and challenges faced by patients looking for stem cell treatments and the role of GPs in helping their patients explore their options. 

A/Prof Munsie began the 60-minute podcast by explaining what stem cells are and the current medical applications, namely in bone marrow and blood stem cell transplants for haematological malignancies. 

Sam and Megan then discussed emerging applications include using tissue stem cells. Megan showcased the recent case where a young boy with a rare genetic skin disease had 80% of his skin surface replaced by sheets of skin grown in the lab from his own skin stem cell. These researchers were also able to combine genetic engineering to correct the defect in the sheets of skin prior to transplant. She also spoke of colleagues at University of NSW who are working with limbal stem cells from the eye to develop a new way to restore vision for patients whose vision is impaired due to damage to their cornea. 

They then went onto to discuss how pluripotent stem cells, created from embryos or made in the lab from a somatic cell, could be coaxed to form a required type of cell on demand and thereby replace damaged or non-functioning cells in a safe, efficient and cost-effective manner. The conversation between Megan and Sam then moved to describe what Mesenchymal Stem Cells (MSCs) are and the possible functions these cells might have in medicine in the future. 

Alongside this promise, Megan cautioned that we need to thoroughly demonstrate that new interventions using stem cells or cells derived from them, no matter the source, do not cause further harm to the patient but genuine benefit over other possible therapies, and that will need rigorous evaluation in clinical trials. 

She then went on to discuss that there are a number of ‘stem cell clinics’ overseas and in Australia claiming to offer treatment for a myriad of conditions at significant price. In Australia, the clinics are predominantly claiming to use MSCs, most often derived from fat, which are injected directly into joints or intravenously depending on the ailment. These practices are sold prior to being evaluated in clinical trials and Megan cautioned about the over-promise embedded in the marketing of these treatments, “MSCs have great promise, but whether they are able to deliver on this promise is yet to be seen” warns A/Prof Munsie. 

“Patients are often told there are no risks associated with such stem cell treatments, as the cells originate from the patient themselves, thereby making them “natural”. Is this true?” asks Dr Manger. 

Megan responded by discussing concern about information provided by the clinic selling the treatment, particularly around risks to health and expectation of benefit, and the manipulation of patients’ hopes for improvement. When it comes to possible stem cell applications just because the cells are from the patient doesn’t automatically make them safe. It matters how the cells are obtained, how they are prepared, where they are transplanted and what function they are expected to perform. More clinical research is also required to demonstrate benefit. 

However, by marketing directly to the patient and positioning their onsite doctor as a “stem cell specialist”, which is not a recognised speciality, the clinics effectively cashing in on the hopes of patients seeking a solution to their suffering. The interventions are expensive - between $10,000 and $100,000 per procedure – and the number of clinics in Australia marketing ‘stem cell’ treatment has grown from two to over 50 in the last seven years. Megan noted that the Therapeutics Goods Administration has recently announced that regulatory changes will be introduced in 2018 to increase the standards required and provide greater safeguards to patients and to the stem cell industry. 

Sam finished with an ethical question: if patients accept that the treatment is experimental and are aware of the risks, aren’t they entitled to try the treatment?

Megan agreed that patient choice should be respected but challenges the idea of informed consent; patients often do not seek out independent advice after speaking with a stem cell clinical sales person. They are simply delighted to be speaking with someone who is offering them a treatment, a hope of improvement. 

Megan and Sam then discussed the role GPs can play to assist their patients and their families who may be contemplating stem cell treatment. Megan acknowledged that GP’s face the challenge of perhaps not having the knowledge or time to explore the stem cell treatment field for that particular condition but maintains that it is important for primary health carers to have the conversation about the hype and risks around unproven treatments.
There are several resources (listed below) to help start this conversation. “We shouldn’t lose our enthusiasm for stem cell research but be conscious that there are limitations. It is important to see stem cells in the context of medical research and all its challenges”. 

Associate Professor Megan Munsie is the Head of the Education, Ethics, Law & Community Awareness Unit at Stem Cells Australia, and the Deputy Director for the Centre for Stem Cell Systems at The University of Melbourne. 

For more information:
Listen to the podcast.