Desperately ill patients will often sign up for treatments that are still in developmental stages
02 October 2006
Dr. Richard Smith, former editor of the British Medical Journal for 20 years, has written a book which may be just what I need for Christmas presents for some of my friends who have unbridled confidence in any bit of medical information on which they can get their hands. Dr. Smith's book is entitled The Trouble with Medical Journals and is reported to contain much criticism of many articles published in them and the far too close association many of the authors of drug trials have with pharmaceutical companies.
About 10 years ago, the editor of The New England Journal of Medicine, Dr Marcia Angell, put, forward a policy for the journal of refusing publication of drug trials where the authors had more than a modest financial involvement with the pharmaceutical companies producing the drug under examination. She had to abandon the policy after about two years, as I recall, because she was unable to find a sufficient number of papers for the journal which fulfilled the criteria.
All this is profoundly depressing. Drugs are very expensive, costing more than 10 per cent of the Health Service bill in this country. If they are not really needed by those consuming them it is a waste of valuable finance. Worse still, there can be adverse side effects, some of them serious, which do not become apparent until the drugs are on general release. (This has caused such concern to the general public that we have set up a subcommittee of the Joint Oireachtas Committee on Health and Children to look into adverse side effects of prescribed drugs.)
Many journalists from the general media screen the medical journals and the headlines produced have a huge effect on the general public, especially if "cures" are announced.
If one has, or if a relation or friend has, a serious condition for which little hope of improvement has been given by what I will call mainstream medicine, grasping at a "cure" is understandable. While alternative treatments are usually those sought, sometimes glimmers of hope given by treatments which are really at a very early stage are seized on, too.
A good example of this is stem-cell therapy. On behalf of the Joint Oireachtas Committee on Health and Children, of which I am a member, a few years ago I went to a meeting in London on stem cells. It was soon obvious that some therapies would not be in use for years.
Regularly I read of Dr. Orla Hardiman of Beaumont Hospital and other neurologists answering questions regarding "cures" with stem cells for Parkinson's disease, multiple sclerosis, and other serious neurological conditions. All urge caution and emphasise that many of these "treatments" are only at an experimental stage. But advertisements for clinics with these treatments, be it in Rotterdam or Ukraine, must be so tempting if one is seriously ill.
On a recent TV documentary, a clinic in Rotterdam was investigated. Stem cells were being allegedly injected into patients although they had not been cleared for human use.
The ethical considerations with regard to stem cells are very important and in some cases controversial. Most discussion has featured embryonic stem cells, not just in this country but internationally, particularly in the United States of America where President Bush has put a moratorium on the use of federal funds for research in new stem cell lines from embryonic stem cells. Initially he had support from many Republican Senators and Congress persons-and Democrats as well I'm sure, but this position appears to be changing. It would be cynical of me to say that is because public opinion on embryonic stem cells has changed in the United States. Senator Bill Frist, a cardiac surgeon and Leader of the Republican Party in the Senate, was also against embryonic stem cell research when President Bush voiced his opposition but he has reversed his position. Senator Frist's brother and father are very much involved in the health care business and he would be well informed on progress being made in these areas. Apparently advances have been made in the treatment of Alzheimer's, Parkinson's disease and diabetes using embryonic stem cells which have been voluntarily donated and would otherwise have been destroyed. Bush's moratorium, of course, does not affect private or state funds in embryonic stem cell research.
It has been reported that Minister Dermot Ahern, when he last met Pope Benedict XVI, promised him that embryonic stem cell research will be banned in Ireland by the Government. The Pope's reaction is not known but he will know that the likelihood of anyone choosing Ireland to set up a facility is very low.
The Government could ban any therapies which may flow from such research being used by patients in Ireland.
The most effective line of action would be to tell the many, many pharmaceutical companies who make their wares in Ireland that the must leave our shores if they or any of their subsidiaries are involved in embryonic stem cell research anywhere in the world. This would show a willingness to make a sacrifice, a big sacrifice in view of the huge contribution the pharmaceutical firms make to our economy and employment here. The greatest potential for these stem cell lines seems to be in testing new drugs on them rather than on people. It seems to be the main area where progress is being made, not in the area of "cures".
Senator Mary Henry, MD
