Don't bet on cloning to cure

Ian Wilmut says that if he had "to bet money," he'd bet on reprogramming adult - the patient's own stem cells.

Joining the cloning experts in the race are scientists who are looking for new ways to "reprogram" DNA, or make it young again without fusing it into an egg. They think it may be possible, for example, to bathe adult cells in the right chemicals and produce stem cells.

"In my view, it is difficult to predict which will come first but I think we need to try both," Wilmut said Tuesday. "If I had to bet money, I would probably bet on reprogramming" rather than cloning.

The science of reprogramming, he said, is moving quickly, and scientists working in the field don't have to deal with the myriad obstacles facing cloning.

The statement was made in Connecticut, at "StemCONN 07," an appropriate name that has more to do with the unethical cloning and destruction of human embryos than with the name of the State hosting the conference. Press releases, so far, attempt to focus on therapies from embryonic stem cell research - which, of course, can only benefit patients if their own cloned twin is used and destroyed in the process.

In another article in the Harford, Connecticut Courant, cloning is described as a goal, evidently, in spite of it's futility:

Wilmut and other scientists want to obtain personalized embryonic cells by fusing DNA from, say, a skin cell into an egg with its own nucleus removed. The resulting cells could be used to study a host of difficult-to-research diseases and in theory could be used to repair damaged tissue in many ailments.

However, a third article on the convention points out that

Researchers who received Connecticut's first batch of stem cell grants were among the scientists who presented their work at StemConn07.

Some of that work involves reprogramming the DNA of adult cells to produce embryonic stem cells tailored to a particular organism. This would have potentially huge implications for using a patient's own cells to repair damaged tissue without fear of rejection.

Success would quiet ethical objections to research that creates and/or destroys human embryos. Questions surrounding these techniques have resulted in a freeze on federal funding for work on stem cells created after Aug. 9, 2001.

Well, if tax money is to be used on stem cell research, they're betting a limited supply of funds in the hope of achieving cures and treatments for Texans. I agree with Dr. Wilmut in this case - the best bet is not cloning or somatic cell nuclear transfer (SCNT). It's research into non-embryonic stem cells, in order to reprogram them to make the cells each of us might need, when and where we need them.

The Courant reporter doesn't quite "get it," though. He seems to believe that the goal of "reprogramming" is to use "generic embryonic stem cells" to produce the necessary cells. The research that has been published so far indicates that the most significant factor in regeneration of stem cells from more differentiated or specialized cells is the "factors," environmental cues and conditions that stimulate and recruit the patient's own latent or limited stem cells.

The Nonsense of the Market for Eggs -

The New England Journal of Medicine has a free text and audio interview on the subject of women who donate/sell/give their oocytes or eggs for other women to become pregnant through in vitro fertilization (IVF) or for scientific research.

"Perspective: The Egg Trade — Making Sense of the Market for Human Oocytes" by Debora Spar (Free Full Text)

Audio interview with Debora Spar and Emily Galpern


Listening to the debate, the controversy - or the effort to discover and maintain a controversy - seems a bit strained. Elitist white women who are "pro-choice" when it comes to abortion of embryonic and fetal humans, and who say they do not object to embryonic stem cell research, itself - who wouldn't mind how many embryonic humans die as long as no adult woman is exploited - speaking of poor black women's right or risk in egg donation reminds me of a bioethics afternoon TV talk show.

If the right not to be created and killed is dependent on "choice," then so is the right not to be exploited or even enslaved. If compassion for already born children and adults is really important, then why not use fetal stem cells (as has been proposed in nerve regeneration studies, the 8 week "embryos" were actually fetuses that had been aborted), paying women to abort or telling women that their babies died at birth in order to harvest the baby's embryonic stem cells (as has been done in the Ukraine), or harvesting the organs of prisoners, whether on death row or not (China and, possibly in South Carolina).

What is not mentioned in this article is the other hazard in the "sharing" of oocytes with other women or with researchers in return for a discount on her own in vitro fertilization costs. In the body, the oocyte only lives about a day after ovulation.

The fact is that the best chance for fertilization and in the limited success that has come with making human embryos with SCNT (those few that begin to divide at all) comes when the egg is used only an hour after it's removed from the body.

Therefore, any woman who "shares" her eggs with researchers will not have a chance to know whether or not any of the oocytes she did not "share" - the ones the technicians kept for fertilization for her - were actually fertilized, much less whether she was able to get pregnant herself.

Liver cell regeneration and adult stem cells

Wesley Smith posted to his own blog and to Bioethics.com about the research out of Germany showing that patients' own bone marrow stem cells can be stimulated to regenerate (normal) liver stem cells and then liver tissue, allowing the regrowth of enough new liver that surgeons can remove the cancer. (UK Telegraph article here, the abstract at Radiology online here.)

The next day, we learned that White House Press spokesman, Tony Snow, has metastatic colon cancer in his liver. This post was prompted by a not-so-nice comment on one of the non-prolife, pro-embryonic-stem-cell-research blogs that we should promote embryonic stem cell research. There's a much kinder and informative post at the Cheerful Oncologist.

Mr. Snow's illness may help educate and save many lives, both embryonic and non-embryonic.

I hope that the hope of stem cell research will be spread including the good news that multiple studies concerning the fine-tuning of knowledge about the precise population of stem cells that are functioning to regenerate the liver, and I believe that there will soon be treatments using adult, but not embryonic stem cell treatements. The patients' own stem cells will be much easier to get past any Ethics Committee than any embryonic stem cells.

For more information try a "Pub Med" search on "liver regeneration." at "Entrez Pub Med." There are 20 or so promising articles on non-embryonic stem cell liver regeneration in the last month, including this one from the authoritative journal, Stem Cells, that appears to have identified the specific population of cells from the liver that serve to become liver stem cells and then functioning liver.

"Sheeple"

Scientists have reportedly engineered sheep with organs consisting of up to 15% human cells. A human's bone marrow stem cells are implanted in a developing sheep ( a fetal lamb), which then develops with the chimeric organs, such as livers, kidneys, etc.

The goal is to make multiple sheeple (I'm adapting this term from a derogatory slang comment for those people who will believe anything) for each patient, for back-ups in case organ donors are ever needed.

The concern with this research has always been the risk of inter-species viral infections that, like HIV and bird flu (actually every flu that we've had) will cross species to endanger the lives of many more humans than just the ones that receive the organ transplants.

There's a huge "yuck factor," here.

Government isn't the answer

I once told Edward Pelligrino, MD (who was advocating Government- funded health care ) that I don't have evidence that government is a good steward to carry out my duty to Jesus to care for the sick and poor.

Having spent 30 minutes in the post office on Thursday to pick up a box containing Tylenol samples I didn't order or want, I feel qualified once again to object to any movement toward Government health insurance, Government health care and don't forget the Government ID.

It's the fault of the Tylenol marketing department that there was a package at all. But, it's the fault - or nature - of government that made the process less efficient and very much less pleasant than it had to be.

Our post office has a number dispenser and a big, open space. At one time we could take the little package pickup notices to a special window. No longer. Just when everyone who wants to go Cancun or the Caribbean has to have a Passport, we have to stand in line with the people who legitimately need to have a large package weighed and postage charged. We can't even have the satisfaction of moving forward in the line, as was the case when there was a maze of counters to lean on.

Relapsing breast cancer

The Cheerful Oncologist has a post about the recurrence of Elizabeth (Mrs. John) Edwards' breast cancer. The comments from readers are wrenching -- with repeated remarks that, now, the survivors are afraid that their own cancer will return.

Having just gone through my mother's cancer and death - not due to the cancer, but from the effects of "para-neoplastic syndromes," due to the antibodies her body made against the cancer - I strongly urge the the Edwards family focus on their lives together.

Good for South Carolina

The South Carolina House of Representatives has passed a bill requiring the abortion clinic to offer to show the ultrasound of the unborn child - the fetus - to the mother before the abortion. The ultrasound is already being done and paid for by the mother, why shouldn't she be offered the opportunity to see what she's paying for?

Of course the pro-abortion delegates to the SC House and in the media and blogosphere object.

From Forbes.com on line:

Rep. Gilda Cobb-Hunter, a Democrat, said the new requirement is emotional blackmail for a woman who has already made an agonizing decision.

"You love them in the womb but once they get here, it's a different story," said Cobb-Hunter, a social worker. "You're sitting here passing judgment? Who gave you the right?"

Star Jones writes in her World Net Daily column on one pro-abortion advocate's comments:

According to NARAL Pro-Choice America President Nancy Keenan, "The women of South Carolina are fully capable of asking their doctor for information they need to make private, personal medical decisions. Politicians don't belong in the examining room."

Then, there are these from Blog.bioethics.net:

South Carolina law already requires the ultrasound, as well as doctor counseling of the age and development of the fetus, as well as alternatives to abortion. This is nothing more than a bald-faced attempt at intimidation and emotional manipulation of someone who is already in a vulnerable position.

The thing that baffles me the most is, what? You're going to suddenly see an ultrasound image and decide that no, all the reasons you have for an abortion have flown out the window, and really it's a great time to be a mother, hooray? Are we suddenly going to see social services increase in funding? Are we going to have outstanding health care, job retraining, free and good state-sponsored child-sitting services? Is South Carolina going to suddenly take away every single obstacle that exists to bearing and caring for a child, so that the only barrier remaining is whether or not a woman thinks this is the right time for her, without consideration to financial/economic concerns?

And from a comment on that last:

Isn't this really a case of the state trying to persuade based on images. Images are often misleading--they often fail to portray facts because humans associate the images with particular notions, accurate or not. In the case of abortion, the image of a partially developed fetus may resemble the outline of a newborn child. But that fact alone does not mean that it is a newborn child. Yet for many, including many under-educated, images may conjure notions that do not portray fact.

Isn't it great to hear/read the same old "love them in the whom, but once they get here . . ." and "What gave you the right?" Not to mention that abortion is justified as long as there are any poor or "under-educated."

Ms. Jones answers the NARAL argument:

An increasing number of crisis-pregnancy centers now have ultrasound equipment that allows clients to see the child developing within them. Their experience shows that there is little question that this materially impacts the decision that women make. Centers report that anywhere from 62 percent up to 95 percent of women who had intended to abort changed their minds after seeing the images.

Assuming that these statistics are accurate, the question remains whether these young women changed their minds because their perceptions of the reality with which they were dealing changed, or because they were intimidated or emotionally blackmailed.

Intimidation or blackmail implies some kind of threat. What exactly might that threat be?

You might say that a young woman with a pregnancy she did not intend is emotionally vulnerable. I would agree with that.

It's exactly why statements from the NARAL universe that portray these young women ("fully capable of asking their doctor for information they need") as cool, sober and rational, calculating the equivalent of whether or not to have a wart removed or to get a Botox injection, are so ludicrous.

As any woman can tell you, instincts and intuition are powerful. These women are stressed because they know that suddenly the decision they have to make is not casual, that it is deeply meaningful and gravely important. Chances are, if they had the tools at their disposal to make a proper decision, they would not be in the situation they are in to begin with.

In South Carolina, as in the nation as a whole, about half the abortions that are performed are on women under 24. Around 17 percent are on women under age 19.

What kind of sense can it possibly make to suggest that a young woman, who we don't think is old enough to vote or go into a liquor store and buy beer, has the resources on her own to understand the implications of aborting a child? Is there some absence of proportion here?

A woman in her 40s may not remember who taught her math in high school, but she'll never forget the abortion she had. Why?

Knowledge comes to us through different paths. We hear and read words. But visual images are something else. Why, when we realize something we had been indifferent to or unaware of, do we say our "eyes were opened"?

More eyes are opening in our country today and realizing that freedom is not tantamount to meaninglessness.

When these young women see fingers, toes and a beating heart, they understand the emerging life within them. This is a profound moment of personal growth. It's what causes their change and opens the door to their own rebirth and a life with new possibilities.

I agree. What, exactly, do all those pro-abortion women mean when they say that women and girls about to undergo abortion are "vulnerable"?

It's not enough to say that seeing the fetus will cause emotional stress or trauma. She's bound to see an ultrasound ("US") of a fetus someday - either in a movie, a TV show or as part of her own or someone else's prenatal care for a future pregnancy - and she is just as likely to compare that US to the aborted fetus. If the US leads to emotional damage before the abortion, it's likely to cause emotional trauma after the abortion.

The US and the counseling are already necessary for medical reasons of improved staging and positioning which improve the care for the woman, herself. Why not use the US for the counseling while you're at it?

It's true that the pregnancy assistance centers ("anti-abortion" groups who counsel women against abortion and provide various resources related to pregnancy and motherhood) report that the women who see their fetus by US are more likely to decide against abortion. But these are women and girls who are already contemplating not aborting.

The same may or may not be true of the general population.

But if it is, then it seems to me an argument in favor of, not against, showing her the US, unless you find abortion inherently preferable to continuing the pregnancy.

The economic and social consequences are very real concerns, but should be a separate issue from the benefits of informed consent for the procedure of abortion.

Money for Babies?

There is a gut reaction, what Dr. Leon Kass has called a "yuck" factor, to the idea that a mother would trade her child for money, however the idea is framed.

ABC news picked up another news item, this time from my hometown. Our local Chamber of Commerce owns the copyright to the title of "Texan of the Year" and makes the award at our "Legislative Conference" every spring. The event is pretty big as far as State politics go, so there are usually quite a few of our Legislators present. I do my best not to miss it, but had to work yesterday, so I missed seeing our Governor, Rick Perry honored.

I also missed my chance to hear Senator Dan Patrick make the case for his proposal to pay women $500 if they will choose to carry their babies to term and put them up for adoption rather than have an abortion.

I'm all for supporting women who have chosen life for their child, and for individual support of local charities and outreach, as well as public policy that blatantly and unequivocally favors life over abortion. However, something doesn't feel right about this cash money for babies deal.

At the very least, the proposal appears to favor adoption over keeping your own child to raise, at least as much as it favors adoption over abortion - possibly more.

I find it difficult to believe that a woman or girl will continue a pregnancy for the promise of $500 in 8 months or so, after the birth and after signing the rights of the child away. However, I can see desperate or depressed women and girls who have just given birth deciding that they can't handle motherhood and considering the right-now $500. I'm also afraid that predators will find ways to take advantage of these mommas and the would-be adoptive parents.

My feminist side - my matriarchal/sisterhood side - is stirred to thoughts of "Just like a man!" (The Libertarian/Republican side is certain that the money could be spent more wisely.)

Frankly, I'm a little insulted by the implication that $500 will override the heartache, confusion and crisis that brings a woman or girl to the point of believing she has to make a choice between her child and her life, her future, her education or (all too often) the support of the man who got her pregnant or the family who should protect her most of all. These problems are not that cheap, and the currency is not money.

First, if you're going to spend the money (sorry, Republican/Libertarian), spend it to give girls more options before they put themselves at risk of an unwanted pregnancy. Education is directly associated with delayed childbirth. Unfortunately, delayed childbirth is also related to increased infertility.

All too often, the only resources on college campuses for pregnant women are abortion-referral services. (See Feminists for Life) How would it be if we enabled and supported mothers and mothers-to-be in school, work, and the home? We could provide campus housing for married students and families, more daycare and family-centered health care and social services in the universities and colleges, where we are already investing our State tax funds.

Or, as a last resort, you could add that $500 per pregnancy to the Medicaid and TANF funds.

Added: My husband (who donates at least that much each month to life-causes, even if you just count the time I could be working instead of going to Austin and blogging) just commented: It's strange that he'd talk about how priceless human life is, and then proceed to offer $500."

Cord Blood Cells: Godsend or Gimmick?

"There are people who are alive now who otherwise would've been dead if there hadn't been a mother who donated their cord blood."

If you know me and my granddaughter Roni, you know that my answer is "Godsend."

ABC News has a video news report from Good Morning America on the current status of cord blood use. Note that one of the cases discussed is for an "immune problem." This could be a lack of immune cells or one the treatments for Rheumatoid Arthritis, lupus, and other autoimmune problems that are in Phase I and Phase II trials.

I thought about editing out the negative remarks, but I've left the article intact. Be sure and read the last section, "Public Banking Could Save Many Lives."

ABC News
Umbilical Cord Cells: Godsend or Gimmick?
Stem Cells Offer Life-Saving Treatment, but Private Storage Remains Expensive

March 22, 2007— - For most of us, our connection to an umbilical cord lasts only during our first few seconds of life.

However, for a growing number of people, umbilical cords represent a crucial lifeline even in adulthood.

Take Rhonda Kottke, for instance. On Dec. 28, 2001, at the age of 29, her doctor diagnosed the Chicago woman with leukemia.

Her treatments ravaged her immune system to the extent that if it were not replaced, she would die.

Kottke's siblings were tested, but their bone marrow was not a close enough match to hers. It was then that her doctors suggested a different course of treatment altogether -- an infusion of stem cells obtained from an umbilical cord.

The transplant came six months after her diagnosis. Today, doctors say the graft likely saved Kottke's life.

"I'm doing great, knock on wood," she told ABC's "Good Morning America." "I have no signs of leukemia in my blood. I have no sign of cancer at all. I'm as healthy as anyone else."

Kottke received her transplant from a public cord cell bank. However, many private companies offer new parents the chance to freeze their child's cord cells for personal use -- that is, if the child or a family member needs them.

But as the trend of banking cord blood continues to grow, critics say those who bank umbilical cord cells at private banks will most likely never use it.

And with an initial price tag of more than $1,000 to store the cord blood -- and yearly storage fees in the hundreds of dollars -- the cost of this biological insurance policy may outweigh the actual benefits for most.

Cord Blood a Versatile Tool

At birth, the umbilical cord is normally thrown away. But in the past few years, doctors have discovered that it is chock full of stem cells, which can be used to treat as many as 70 different diseases.

Treatments using cord blood cells are still relatively new; so far, only about 6,000 Americans have received cord blood transplants. Most commonly, the cells are used to regenerate the immune systems of patients who have received treatment for leukemia.

"Cord blood is an increasingly valuable alternative to bone marrow transplant," says Dr. Curt Freed, head of clinical pharmacology and toxicology at the University of Colorado School of Medicine.

However, researchers say that future applications could be far broader. But, though cord blood treatments appear promising, much of the science surrounding these treatments is still speculative.

"There may be technology developed in the future that allow patients and parents to find it useful in a clinical setting, but there is a lot of science needing to be performed before any of this stem cell hype becomes reality," says Bryon Petersen, associate professor of pathology at the University of Florida.

A Wise Investment?

Joshua D'Eramo's parents privately stored his umbilical cord blood when he was born. It was an expensive decision -- they paid their company $1,200 up front and $100 each year to store it.

"It's like an insurance policy," says his mother, Rena. "We get insurance for our cars, for a car accident and we may never need it, but it is comforting to know it is there if you do need it."

Today there are 25 private companies that will store a baby's cord blood for a fee. Like a bank account, it will be available exclusively to the family of the donor.

But the chances that anyone will ever need to make a withdrawal from such an "account" may be slim.

"There's nothing particularly wrong with doing that, but it's not very useful," says Dr. Cladd Stevens, medical director for the New York Blood Center's National Cord Blood Program.

"I think most of the professional organizations, the pediatric society and obstetric society, recognize that it's not very useful."

"A single individual has about a one-in-one-thousand chance of needing a bone marrow transplant in his or her lifetime, so banking does not make much sense as an insurance policy," Freed says. But, he adds, "In individual cases, such as a family member's illness that might be treated with cord blood, retaining cord blood could make sense."

Critics go one step further, saying that advertisements used by such private banks prey on the fears of new parents.

"I'm sure there are a certain amount of businesses and people with less than admirable scruples who take advantage of the public fears," Petersen says. "Those companies would blacken the eye of the business as a whole."

Public Banking Could Save Many Lives

Parents who choose not to seek the services of a private bank have another option as well -- they can donate the cord cells to a public bank, which will, in turn, donate them to those in need.

"We initially thought about private banking, and I think most parents that think about it probably do, because your first thought is 'oh, my God, what happens if something happens to my baby?'" says 35-year-old new mother Angie Bongaarts of Chicago.

But Bongaarts and her husband discussed the matter, and together they agreed that since they had no family history of leukemia, they would, instead, send their daughter's umbilical cord to a public bank.

"We figured that there was probably a better chance for the blood going for use for someone who did have a problem right now," she says.

Two-and-a-half months after they donated their baby's cord blood to a public bank, Bongaarts and her husband were notified that the cells were used to help a young man with an immune problem.

Bongaarts says the prospect that her daughter's cells may have saved someone's life was a special gift.

"I was euphoric," she says. "It's been nice to think back on for the past couple weeks, to know that we were able to do that for someone."

According to Stevens, Bongaarts' story is not unique.

"We estimate there are probably 10,000 patients around the world who have benefited from the fact that a mother donated her baby's cord blood for anybody who needed it," she says.

"There are people who are alive now who otherwise would've been dead if there hadn't been a mother who donated their cord blood."

Largely due to the success stories seen thus far with public cord cell banking, many experts say a fully stocked national registry of 150,000 samples -- a project currently in development -- could save many lives.

"With medical research progressing -- and if everyone donates cord blood to public banks -- then an excellent cell match should be available for those that need cell transplantation in the future," Freed says.

Public banking saved Kottke's life. And she says the impacts of the lifeline she received are overwhelming.

"It's absolutely the most amazing thing anyone has ever done for me," Kottke says. "I'm thankful every day."

For more information about donations, visit www.nationalcordbloodprogram.org

Copyright © 2007 ABC News Internet Ventures

HT: Bioethics.com

Video on Emilio Gonzales

Austin Texas' KVUE has several video news stories available on their website covering the story about Emilio Gonzales and the Texas Advance Directive Act.

The report is in error because it says that the hospital makes these decisions, when the law allows the doctor to do so, and the ethics committee only determines whether the doctor's decision is correct about "medically inappropriate care."

These may not be available for long:
"Medical Ethics vs. Futile Care" is available on this page. (I can't link to this one directly.) This video covers the Ethics Committee and has part of an interview with Catarina Gonzalez.

There's more video, here. One is from the day the lawsuit was filed and one, "Life Support Decisions" is from Thursday the 22nd, with a long interview, "I live breath to breath," with a mother who faced a similar decision in December.

News stories from the last few days are linked to that page, too.





3/21/07 Mother gets more time to find new hospital for dying son

3/20/07 Dying toddler brings futile care bill to forefront

Answer 3

From Jerri:

Your personalizing of this makes no sense. It's as if you are saying that--if the medical community's ethics are questioned in any way--that's an attack on the community.

We live in a free society and everyone is entitled to their opinion on what medical ethics should be. That said, the medical profession's opinion should not be the final word. If they can't stand the heat of having their positions challenged, I suggest they go somewhere and set up a dictatorship. Otherwise, complaining about others challenging their positions is just whining.

I think the AP reporter is the origin of the several quotes about freeing the bed and "mad dash." But, there are so many copies of each quote, that I don't think you're going to be able to get everyone to pull them.

Can you convince Melanie Childers to stop saying the Bishop is helping to murder Emilio?

There are consequences to your words.

We all do this for the love of the cure, of caring, and because it makes us feel like good people - it soothes our consciences.

I strongly disagree that ethics are a matter of opinion - that one person's opinion is as good as anyone else's. I certainly don't agree that docs who don't want to prolong dying in children with collapsing lungs or to perform abortions are simply expressing an opinion. There is a definite right and wrong, here: First do no harm. Sometimes judgment is needed to weigh the harm vs. benefit. However, the doc is the one who will be forced to act. The option is to have the oversite committee and to offer a time to transfer to someone else.

Can you imagine if a trial continued 24/7/365? That's family medicine - even when we're not on call, we are responsible for our patients. In a small town, everyone knows where you live, go to church and what's in your grocery cart. Family docs who deliver babies are on 5 "call lists" at our hospital. The ER or Deliver can assign a patient who had no prior doc in town from the OB, Gynecology, Medicine, Trauma/Surgery, Pediatrics and Newborn "lists." Why would anyone continue hospital care plus office care if any patient's family could insist on repeat aggressive treatments like Emilio's treatment for pneumothorax or even constant, repeat CPR?

How long would a doc be able to keep a good conscience if this happened a couple of times?


As I said, read what people say about doctors (and by extension, the nurses and everyone else who would have to support the lie) after one of these posts and consider the effect on the patient and family of the family doc in New Braunfels, Texas.

Or consider the LVN who works a 12 hour shift and whose patients now question her complicity with the conspiracy -- her job is even more on the line that the doc, who can go down the street to the next hospital or quit hospital practice all together.

And I'm afraid that that is what is going to happen: more family docs will decide to admit to hospitalists rather than admit their patients to the hospital. Fewer will enter hospital work and geriatricians will become even more scarce.

Especially: more small town docs will find it difficult to transfer their sickest patients to the tertiary centers.

Answering 2

Jerri Lynn Ward responded to my response:

First, I did not accuse YOU of breaking a federal law. If you are receiving information from someone in the hospital, THEY are breaking federal law and not you. Second, the ethics committee does have conflicts of interest whether you want to acknowledge it or not--and there ARE economic conflicts of interest. I don't know what more to do to try to make you understand what a conflict of interest is. And, it doesn't matter whether the conflict impacted the committee's decision or not--it's there.

Regardless, the bed quote was pulled out the reporter's butt. All I said was that ethics committees have apparent conflicts of interest because there are economics involved here. You can believe that or not, I don't care.

As for Melanie Childers letter, I am going to ask Tim to take that down. I didn't read the whole thing when it was posted and, I agree, that's a terrible thing to say.

You may think it's difficult to talk to lawyers, but I also find it difficult to talk to doctors who cannot seem to fathom that there are two sides to every story and that they shouldn't have the final god-like power to decide which story is true--with no oversite except by a committee which is dominated by people dependent for their livlihood on the hospital. This law merely reinforces that tendency.

The fact that you take this personally and go on the attack WHEN YOU HAVEN'T EVEN SEEN THE RECORDS AND HAVE NO IDEA WHAT YOU ARE TALKING ABOUT REGARDING HIS CONDITION, tells me that you believe that, you too, should have unbridled power to make decisions for other people.

Doctor's aren't God and they aren't qualified to make moral judgments about whether a person's life--or whatever is left of it, is valuable to that person and his family.

You can attack me all you want--but when you start disparaging this baby's condition on the internet, I draw the line. If you got all this from the ethics committee report--you seem to forget that the committee never reviewed the records themselves.

The hospital is trying to help us with a transfer, you are not helping.

Jerri Lynn,

Most of the information that I have came from you or quotes attributed to you in the press and in the blogs. The rest did come from the ethics report of test results and testimony from several doctors involved in the baby's care, from experience and from reading as much as I could find on respiratory chain/mitochondrial genetic syndromes. (Flash back to biochem and the Kreb's cycle.)

What do you perceive as a threat to you? I've quoted, reported, and reacted to comments such as this one of yours, but never even attributed a motive to you, much less anything equivalent to your assertions about me, my personal integrity and motives in this post.

Jerri Lynn, as I said: When you make statements in the press, you, Melanie Childers, and all the bloggers and disability activists who have blogged on this (a couple of hundred blog posts alone from a google blog search) not only involve me and other doctors.

You involve my sister the RN, my Mama who was a housekeeper at a hospital 25 years ago, and me, when I was a phlebotomist. You accuse everyone of having a value system based on "economics," and (at least it was reported) on "freeing a bed," rather than our concern for the truth and this child. Every one of these people would have to cooperate with their silence for a week to a month, if you are correct that one or more of the 4 or so doctors mentioned in the Ethics Report are attempting to use - or believe that they have - some " final god-like power."

By the way, search Google blogs and news for "Emilio Gonzales." or your name.

The World News Blog covered the story this morning.
Read the reactions of people to the early news reports, here.

Your quotes are all over the place. Here's one from yesterday morning and another from 10:52 last night:

“I don’t know the hospital officials want to free up a hospital bed or cut costs by not administering treatment, or whether they just believe that they should be the final arbiters as to whose life is worth living, but the life of a child far outweighs such concerns,” said Ward. “Whatever the reasons for the hospital officials’ mad dash to end this child’s life, little Emilio should not be subject to ‘death by vote’”.

Answering

Jerri,
First, I want everyone to know that I pray for this baby and his mother every time I think of him. I hope the doctors are wrong - but I doubt it. There are simply too many doctors referenced in the report from the Ethics Committee for me to believe that there is a mistake, that Emilio is not dying and that treatment can change this.

I'm copying this to your email address, Jerri, as well as answering on the same public forum where you wrote:

Beverly,

I would like to see some support for your claim that the Bishop has been attacked. If you are accusing me of that, then you are committing defamation.

I have seen no attacks on the Bishop. What is your source?

Furthermore, in your last post, you quoted an article which you represented as a statement by me that this particular hospital had a bed to free up. First, I didn't say that to the reporter and I don't know where she got that. Second, even if I had, the context of the statement was about apparent conflicts of interest.

There is an apparent conflict of interest when a committee that is dominated by people with ties to the hospital make these kinds of decisions--because of the economics.

I am also concerned about the representations that you have been making about the medical condition of Emilio--much of which is contrary to the chart. You are getting close to defamation by representing his condition as worse than it is. This could impact our efforts to tranfer him to a place that will trach him so that he can go home or to long term care.

Further, some of the information you are discussing--though distorted--does not appear to come from the media reports. This leads me to wonder if you are receiving HIPAA protected information in a distorted form.

Are you?

"Defamation?" I think that's a legal term and one that I perceive as a threat in itself, especially with the repetition. And this is why it's difficult to talk to lawyers.

From the moment you asked Wesley Smith to post back in February, and made your own additions, you began a process which attacks me and every doctor, nurse, ward clerk and housekeeper who comes in contact with patients, and who would need to have consciences that would allow them to be complicit in "freeing a bed." Your actions haven't only affected people seeking to reach reporters and their audiences, legislators and the hospital officials that receive your legal notices.

The damage goes far beyond any legal remedy - our integrity and the ability to live up to the professional duties that you accuse us of not doing is damaged and at risk for more damage.

This little boy is alive because many people that you represent as more interested in ending his life used their skills and risked their reputations to continue his medical care. Some of them, I assume - I don't know for sure) even after they knew you were giving press releases, writing briefs, and filing lawsuits. At least one someone stepped up to relieve the pressure from a pneumothorax caused by the ventilator, evidently more than once since the first Ethics Committee meeting in February.

You accuse me of breaking a Federal law by divulging HIPPA (a misnamed law if I ever saw one) -protected information.

I can assure you that I would not bring to the public what I know to be protected under my duty, which is more of a constraint on me than any law. If I had information from another physician (or even had received information because I am a physician) from anywhere other than public records, I probably wouldn't write in public.

I have tried to be careful to note my opinions from experience and reading and to document my sources, making copies from the articles and putting links to them on the blog. It's as I've said: after a certain point, the organ and system breakdown becomes predictable.

I would like to know how the North Country Gazette obtained a copy of the Ethics Committee Report from March 9th.

Follow the links.

I have no idea what you mean by "context." The quote attributed to you about freeing the bed was copied and pasted and linked from the original article. It's here, still, tonight:

Emilio's physicians determined his condition is irreversible and their decision to take him off life support is supported by the hospital's ethics committee. Gonzales' attorneys argue it is a conflict of interest.

“You have a treating doctor who makes the initial decision, then you have an ethics committee at that same hospital with, frankly, a very clear conflict of interest,” Gonzales' attorney Jerri Lynn Ward said. “They have something, a bed they can free up basically, if their decision goes unchallenged."

How could there be any "context" other than an understanding that the treating doctor, the ethics committee, and everyone else at the hospital value freeing a bed more than care for this patient, his life, and the truth?

And yet, tonight, while denying that you said this and/or saying that the context made it permissible for you to say it, you again mention "the economics."


Pro-lifeBlogs, June Maxam at the North Country Gazette and others picked up a common source giving the name of the Bishop and others, along with their phone numbers accusing them of going along with murder and killing - apparently quoting Melanie Childers. I won't quote it again, here. I did send it in the email.

Explaining

This is a re-write of a post I made as part of the conversation about Emilio Gonzales's treatment at Wesley Smith's Second Hand Smoke.


I'm a family doctor because I have always seen the patient as part of the family and (ideally and sometimes not so ideally) the family as integral to the patient's condition and health care. We do treat family members, even if we never see them.

However, when the family's needs conflict with the patient's, the patient's interest has to come first. We naturally identify with a mother's wish to keep her child alive. However, when the doctors sense that we are treating the mom at the expense of the child's care and comfort as he is dying, the duty is to the child, our patient.

The determination as to what the best interests are in each case depends on whether it is true that (as the blogger-published report of the Ethics Committee says) the baby is having increasing injuries requiring aggressive treatments due to the ventilator, more uncontrollable seizures, progressive spastic muscle effects, loss of brain tissue due to the disease and what I suspect is multiple organ failure (liver and kidneys) due to both his underlying cell malfunction and the lactic acidosis.


I just don't believe in conspiracies that would allow a deception to play out over a month. Jerri Ward wrote on Wesley Smith's blog about the earlier hearing on February 19th, and said that the mother originally did not want the child to have a tracheostomy and a permanent feeding tube. Evidently, the mom and doctor were in such conflict that a new attending was named.

The nurses I know would be tearing themselves up over the condition of the baby as it is. To have the doctors write orders that make them cause the baby pain, over and over, without seeing the good of healing or at least a little relief of pain, is abuse of them, as well.

Patients have taught me lessons in caring for them as they die. Even in my first week as a phlebotomist nearly 25 years ago I had to draw blood from a brain dead child. The only way I could get through it was to care for this child and be grateful to his parents for being generous enough to donate his organs. I still treated him - and was encouraged to treat him by my bosses and the nurses caring for him - as though he were a living, feeling person. I count it a blessing that I was able to do what I could to respect them and do what I had to do without causing more pain and injury.


Instead of caring and concern for this mother and Emilio, the fuss and attention is focused on personalities and organizations.

It's shocking to me to see the use of the word "futile" brought up over and over - even though it's not in the law at all. It's used as some sort of weapon and focus to call in the troops. There are bad doctors, bad nurses, bad judges, husbands, wives, children and bad examples of surrogates. This law does not make it any easier for them to end a patient's life. The doctors and hospitals still have to answer to the public, courts and community. No doctor wants his failure to heal made part of a public press event and no hospital wants to be known as a place where patients are killed if they don't go home well. The formal process laid out in the law gives structure to very hard times in the lives of patient's families. (and I've offered several times to come to the aide of anyone in Texas who suspects that the law is used to cause the death of someone who is not dying)


What's worse is the attack mode and personalized accusations in the press and the blogs. Who would have ever thought that anyone would publish the names and phone numbers of a Bishop, accusing him of complicity with murder?

We can be sure we're being mocked by our traditional non-pro-life counterparts. At the American Society of Bioethics and Humanities meeting last year in Denver, it seemed as though most of the sessions knocked the concept of conscience and individual rights that trump the community's.

We're fighting the skeptics and unbelievers - not to mention those who claim to be believers yet feel the need to justify their complicity with abortion and push for embryonic stem cell therapy for their diabetic daughters, etc. The claims that nurses and doctors just want to empty a bed in the hospital make it harder to assert that our beliefs are not just personal opinions, that they are matters of right and wrong. Not to mention that we don't come off as good Christians when we make statements that assume the worst of nurses and doctors or when we ally with someone whose reaction is to attack a Bishop.

"Living Life's End"

The title is from a 2005 essay by Gilbert Meilaender in First Things. Not surprisingly, Dr. Meilaender speaks with much more clarity than I ever could in discussing the sort of dilemma that we face when considering the baby, Emilio Gonzales, and the treatment vs. the care he is to receive from his doctors, his mother, and the State and the distinction between letting "die those who were clearly dying," and “letting patients die who are in fact not dying.”

We are not abandoning the care of Emilio by saying, "This much and no more." If he requires constant painful intervention and technology while his condition continues to deteriorate, we do not cease to care for him when we cease to intervene and use technology.

As Dr. Meilaender points out,

On the one hand, we should not aim at their death (whether by action or omission). We shouldn’t do whatever we do so that they will die. On the other hand, because we do not think that continued life is the only good, or necessarily the greatest good, in every circumstance, we are not obligated to do everything that might be done to keep someone alive. If a possible treatment seems useless or (even if useful) quite burdensome for the patient, we are under no obligation to try it or continue it. And in withholding or withdrawing such a treatment, we do not aim at death. We simply aim at another good: the good of life (even if a shorter life) free of the burdens of the proposed treatment.(emphasis mine)

The reports at the Capitol are conflicting with what is being told at the North Country Gazette, Prolife Blogs, and Second Hand Smoke. And with one another.

No one that I know is arguing that Emilio is not dying - or that he could have died from any number of past events if the doctors had not intervened. It is time to stop intervening.

There is also a difference between causing another to do his duty and forcing another to act against his conscience and what he believes is his duty because you very much want him to do what you want him to do. How often do you want your doctor and your ICU nurse to practice going against her or his conscience? How often should the State force an action - a repeated action that causes other people to be forced to act - against a professional's conscience?

The Texas Right to Life lobbyists told me that they are offended because the Ethics Committee mentioned Emilio's "dignity." If the report published by the North Country Gazette is the actual Committee report, the members affirm Emilio's human dignity - but say that the aggressive treatment is an assault against his human dignity:

• The current aggressive treatment plan for Emilio amounts to a nearly constant assault on Emilio’s fundamental human dignity, and with little, if any, corresponding benefit to Emilio. Thus the burdens associated with such care clearly outweigh its benefits.

A trial of care including the ventilator, the feedings, and the chest tubes for a pneumothorax were appropriate. When Emilio continues to require more invasive care, when we can not keep him the same, much less make him better, it is time to stop hurting him, at least.

To force the doctors, nurses, phlebotomists and all the other people who are caring for Emilio to put aside their concern for his best interests, to subjugate their consciences and duty to Emilio for his mother's wishes is simply wrong.

To accuse them and even the Bishop of the diocese of Austin, of acting with the intention to "murder" Emilio (as June Maxam of the North Country Gazette quotes Melanie Childers as doing here and as "plb" quotes NCG here), to state that the hospital Ethics Committee is willing to speed Emilio's death in order "to free up a bed" (as Jerri Lynn Ward is quoted as saying in this news article: “You have a treating doctor who makes the initial decision, then you have an ethics committee at that same hospital with, frankly, a very clear conflict of interest,” Gonzales' attorney Jerri Lynn Ward said. “They have something, a bed they can free up basically, if their decision goes unchallenged."
, is simply evil.

(Edit 8:30 AM 3/21/07 addressed the "dilemma" of spelling)

More on Texas end of life case

A reader, unfortunately, shows us the other extreme of the end of life debate. However, she missed the point entirely. Our discussion about the end of Emilio's life is a debate about conscience, laws, and whether because doctors are licensed by the State, they abdicate their duty to act in the patient's best interest.

It is also a demonstration that the first principle of medical ethics should be non-maleficense, not autonomy. In the name of "autonomy," the mother is demanding that the doctors carry out acts that they believe are not in Emilio's best interests. The lawyer for the mother questions what the doctors are telling other hospitals, and patient's rights advocates accuse the doctors of abusing an "imbalance" of power.

The doctors - and the Ethics Committee, in their report as published by The North Country Gazette - have shown the evidence that leads them to believe that this child is experiencing pain and being harmed due to the actions of the doctors.

Here's the case they made, with a little explanation and guess work from me:

The lungs cannot tolerate the ventilator. We know this because of the repeated pneumothoraces (or "leaks"). Any one of these instances would have lead to a "natural death" by the compression of the lung tissue - and even the heart - if the doctors had not intervened on the mother's request.

There are large areas of the child's brain that are dead, and more are dying due to the seizures (and probably, the build up of lactic acid and other toxins). We know this because it shows on the MRI and the EEG.

More than likely, feeding by IV, a feeding tube placed in the gut or even by mouth harms this child. We know that the cells lining the intestines grow and replace themselves faster than any other cells in the body. Probably, the lining of the gut is mostly dead because the cells require energy from the mitochondria to replace themselves and to fight off infection. Where the lining does remain, food in the form of fats, proteins and many nutrients must be moved into the system from the gut by actions of cells that require energy, rather than passive absorption. Everything must be moved through the gut by the actions of muscles that require energy or they will sit, build up, and decay.

Even in a child who has a healthy liver and functional mitochondria, long-term "total parenteral nutrition" damages the liver. In this case, the cells of the liver aren't likely to be functioning well due to the mitochondrial defect and to the build up of lactic acid and other poisons, including those IV feedings. Virtually all food is processed in the liver by cells that use energy to function. Most waste products are also processed by the liver, again, in cells that use energy.

Very soon, if not already, Emilio will need kidney dialysis. Due to the brain damage and the acid build up in his blood, his blood vessels will not be able to contract and hold his blood pressure up and his heart will beat irregularly.

The doctors laid this out for the Committee. The Committee's report laid it out for us. From what I've read in the press and other blogs, the doctors have tried to explain this to Emilio's mother.

And yet, we read that the doctors, the hospital, the Catholic Church and the State of Texas are all conspiring to kill Emilio against his mother's wishes.

Leigh's Disease (Long post on end of life and baby Emilio Gonzales)

The mitochondria are the power plants of the cells. They take the sugar and turn it into the power that runs all the processes of the body. Leigh's disease is a defect in the genes of these mitochondria or of the body’s ability to make a protein or an enzyme that is used in the mitochondria, like pyruvate dehydrogenase.

The prognosis for individuals with Leigh's disease is poor. Individuals who lack mitochondrial complex IV activity and those with pyruvate dehydrogenase deficiency tend to have the worst prognosis and die within a few years. Those with partial deficiencies have a better prognosis, and may live to be 6 or 7 years of age. Some have survived to their mid-teenage years.

The defect can be nearly complete or it can be very mild depending on which of the many genes that can be involved are involved. The cells may be able to make energy but only very slowly - or very, very slowly. Or some cells may be able to make some power, but others can't. Some functions of the body need constant energy, others do not.

Pro-Life Blogs and other blogs carry posts about the very sad case of little Emilio Gonzales, who has been diagnosed with "Leigh's Disease." Unfortunately, they are full of implications that doctors (and even the Bishop of the diocese of Austin) are planning to "murder" the baby boy.

We do not have good tests to determine where the genes went wrong and they can go wrong in several places causing different symptoms and even different symptoms in the same child at different times. So this is a “syndrome” or a diagnosis given when we see a pattern of symptoms. AIDS is a syndrome that has only one cause -- infection with a virus instead of many different gene defects -- but it still develops differently in different people and can mimic different diseases in the early stages.

Sometimes Leigh’s disease does respond to thiamine – but only if the defect is in certain genes. Not in the vast majority of cases.

Another name for the syndrome is “Subacute Necrotising Encephalitis,” because in the late stages, areas of the brain die and break down. This little boy's nerve cells all over his body, including large areas in his brain, have died. This can be seen on his MRI.

It’s also supported by the findings on his EEG – that shows that he is having seizures one third to one half of the time. The seizures cause more cells to die.


However, the pain nerves still live: the report says he still reacts to painful stimuli as though he is in pain. He isn't able to process the pain.

Other organ systems fail as the lactic acid builds in his blood and tissues – cooking the proteins that make up the muscles, enzymes, and most structures of the body. If you’ve ever been sore the day after exercise, you know what lactic acid build up in one spot feels like and how long it takes to go away.

And, of course, growing and healing takes energy. The fastest growing cells for most of us line the intestines and make up the liver where food is processed - they die first, but can grow back sometimes - so the symptoms seem to come and go. When they are dead, it hurts the patient to give him tube feedings that must be absorbed by the gut or to give IV feedings that contain anything that must be processed by the liver.

Even the kidneys use energy. And the sphincters of the bowel and bladder do, too. If there is an imbalance between nerves, the sphincters spasm shut - so Emilio needs a catheter in his bladder.

The lungs stiffen with prolonged ventilator use. The stiff lungs and muscles mean that the pressure from the ventilator needs to be so high in order to give him enough oxygen that he is having leaks appear in his lungs as some of the airways break. The baby's lungs are repeatedly collapsing and having to be re-inflated. This means that over and over, he has a “pneumothorax.”The air goes into the sac around his lungs, squeezing the lung tissue itself down. The pressure outside the lungs is even higher than the pressure the ventilator is making inside the lungs -- each push from the ventilator pushes more air through the leak.

The docs then have to place a chest tube or chest tubes – possibly in a baby, they would use the temporary insertion of large bore needles - to release the air around the lungs, and allow the lung itself to inflate.

Some of the air moves between the tissues of his body, coming to the surface in little pockets – causing “subcutaneous emphysema.” Patients tell me that the pneumothorax and the subcutaneous emphysema hurt. The chest tube does not take away the air in the tissues – that takes days or weeks to be reabsorbed.

What would I do? I would suggest that the mother and the docs adopt a strategy of "this much and no more." Give Emilio droppers of fluids by mouth, to keep his mouth moist. Hold him as much as possible. Continue the ventilator, but stop placing the chest tubes and stop changing the ventilator settings. Do not add new medicines and do not resuscitate when the heart stops.

The Ethics Committee Report has been published at the North Country Gazette.

Medical Update Since Last Ethics Committee Meeting on 2/19/07:

Dr. Alexandra Wilson, the patient’s current attending physician, states that Emilio is unable to move his arms and legs and only has abnormal posturing movements with stimulation. He rarely opens his eyes, does not gag, cannot cough and cannot breathe without use of the ventilator; his pupils are not normally responsive to light. In addition, he can not empty his bladder and has to have a catheter. He does appear to experience pain, as he grimaces in response to deep stimulation, and is now receiving pain medications. He also bites his tongue, which causes bleeding, making it necessary to place a device in his mouth to prevent further injury to his tongue. In addition, he has experienced repeated full and partial collapses of his lungs, and his physicians and the treatment team are having great difficulty keeping his lungs inflated, even with the assistance of the mechanical ventilator. Finally, he is now having seizures, some of which produce visible physical symptoms, and scans (MRIs) of his head show progressive loss of brain tissue.

Dr. Brendle Glomb, pediatric pulmonologist, then discussed Emilio’s pulmonary status, which as noted above has continued to deteriorate. He explained the current functioning and support provided by the ventilator, and then described why Emilio would no longer benefit from a tracheostomy. He also noted that the repeated collapse and reinflation of Emilio’s lungs is damaging to the lungs, and increases the risk that they will tear or even burst during attempts at re-inflation.

Dr. Jeffrey Kane, pediatric neurologist, then discussed Emilio’s current neurological status, which has continued to deteriorate since the last consultation. Overall Emilio shows no purposeful response or movement, which is evidence that the deeper functioning of the brain is absent. In addition, Emilio’s EEG suggests that Emilio is experiencing many more seizures than those at the bedside can see. Based on his review of Emilio’s most recent EEG, Dr. Kane believes Emilio’s brain may be experiencing seizures between 1/3 and ½ of the time. Dr. Kane believes that the seizure activity will continue to increase, and that continued seizures will accelerate the death of Emilio’s remaining brain tissue. In response to a question, Dr. Kane noted that the current brain damage is not reversible, even if the seizure activity for some reason should slow or stop. Instead, he believes that Emilio will continue to experience the relentless and progressive loss of his brain tissue and brain function, and that no therapy or other intervention has been identified which could stop or reverse this process.

Dr. David Anglin, a pediatric intensivist involved in Emilio’s care, then discussed Emilio’s care-setting. He noted that during the Ethics Consultation on February 19, 2007, there was some hope that Emilio might be able to be transferred to a lower-acuity care setting or discharged home, and particularly if he were to undergo a tracheostomy and receive a feeding tube. However, given Emilio’s continued deterioration, he is too ill to survive anywhere but an intensive care setting, and he certainly is not a candidate to be discharged to home.

Edit 03/19/07 at 21:30 - cleaning up grammar.

Texas Politics, Bias and Bioethics

"All politics is local," is a quote attributed to - and the title of a book co-authored by - the late, former Speaker of the House, Tip O'Neill.

The lesson seems to be one that Texas State Representative Juan Garcia, D-Corpus Christi, learned well. It doesn't hurt to stack the deck in your favor, either.

Evidently, the Representative held a meeting at a church in Corpus Christi, Texas and only invited the people that agreed with him to present arguments on stem cell research to a local group of clergy.

Read "stem cell research" to include embryonic stem cells from human embryos.

I'm certain that the Representative knows the names of groups who could have directed him to people like me who could make the case for the basic science and human rights issues inherent in "the stem cell debate." (Okay, I did say, "people like me.")

Instead, the clergy evidently found themselves faced with advocates who do not believe that research in stem cells and regenerative, cellular medicine can proceed without embryonic stem cells. Advocates who include representatives from State Universities and from the "Texans for the Advancement of Medical Research," a group dedicated to the advancement of destructive embryonic stem cell research and cloning.

A similar one-sided, and self-serving argument was made this week by Tom Okarma, the president of Geron, one of the biotech companies that holds the patents on human embryonic stem cells.

This, in spite of proof such as that given to the House State Affairs Committee last Monday, of children who are alive because of stem cell transplants from cord blood. And the hope of so much more from readily available umbilical cord cells: including functional liver tissue, lung cells, nerve cells and pancreatic islet cells.

Vision from Adult Stem Cells

British researchers have improved the site of patients with a congenital defect, using stem cells that appear to recruit their own stem cells from the bone marrow. From The Argus news report:

Four patients have so far received the treatment successfully in one eye and reported an improvement in their comfort and vision, and now await treatment in their other eye.

All had little or no vision because they had few or no limbal stem cells under the eyelid which help keep the surface of the cornea clear and healthy.

Mr Daya believes the stem cell transplant somehow triggered the production of new limbal stem cells in the patients.

He said: "We think the donor cells have attracted stem cells from the bone marrow to make new limbal stem cells, which have arrived at the eye through the bloodstream."

Mr Daya said that if donor cells could trigger stem cell regeneration in eyes, they could also work in other organs such as the liver and pancreas.

He said: "Once we understand what has prompted their growth, then we can understand what they can do for other parts of the body.

"It's extremely exciting."

Once again showing that the promise and future of regenerative therapy is in learning to recruit and stimulate the patient's own stem cells.

And no one has to die for it.

Umbilical Cord Blood Saves Lives

Today, the Texas House State Affairs Committee heard from a young man who was born with sickle cell disease. Young Joseph, Jr. told the Representatives that his baby brother saved his life. And now, he doesn't have to take medicine or get shots any more. (The oblivious hero slept through the hearing.)

And of course, I told about my granddaughter who received cord blood stem cells at 15 months old from an unrelated, anonymous little boy to cure her Kostmann's nutripenia. That's her with me, last August when we testified to the Senate State Affairs Committee.

You can watch the video at the Texas Legislature Online website archived files from 3/12/07, here, beginning around 25 minutes in. (Don't miss the earlier testimony in favor of legislation to protect embryos and embryo adoption. Joseph and his family testify at 45 to 47 minutes.)

Representative Robert Puente (D- 119) presented his House Bill 709 was before the Committee and is a perfect example of the "common ground" that is possible for those of us looking for ethical ways to further (ethical, non-embryonic) stem cell research.

The Bill would require the State Department of Health Services to develop and distribute a brochure to educate expectant parents about donating and banking cord blood. We heard that there are free opportunities for all mothers and fathers to donate their child's cord blood, if they have time to make the arrangements.

We also were privileged to hear from David Harris, Ph.D., of The University of Arizona. (His testimony begins at 30 minutes on that video) Dr. Davis began the first cord blood bank, and he told us that his children were the first to have their cord blood banked at birth.

I learned quite a bit, including that there are out of State public banks that will accept cord blood stem cells from Texas, and that there is a procedure to donate blood from a private, "family" bank to the public bank.


Here's a few sites with more information:

The Texas Cord Blood Bank

The MD Anderson Cord Blood Bank

HealthBanks (a commercial health information site)

Truly transplantable lung stem cells

Researchers at The University of Michigan have proven that mesenchymal stem cells are present in the lungs, and that these cells have transplanted along with the rest of the lung.

In the past, it was believed that the mesenchymal stem cells ( a versatile group of stem cells - see the information in the quote below) were derived from the patient's lungs. We now know that they came from the donor and they they persist for years, aiding in the repair and function of the

In the cases where the donor and recipient are different genders, most of the stem cells are found to be from the donor. Some of the cells have been found more than 11 years after the transplant.

So much for the "first transplantable" claims out of Houston.

One of the most telling findings was that, in cases where the transplant donor and recipient were not of the same sex, nearly all the MSCs (about 97 percent) originated in the donor, indicating that they were present in the tissue since the time of transplantation. "We were able to isolate the cells derived from the donor as far as 11,5 years after transplantation," says Lama, assistant professor in the Division of Pulmonary and Critical Care Medicine at the U-M Medical School. "We discovered the existence of a population of MSCs that reside and self-renew in the tissues of the adult lung – something that might hold true for other organ systems as well.

"Potentially the most important outcome of our finding is that it could lead to an understanding about therapeutic options using MSCs that reside in adult organs," Lama continues. "These lung-derived cells are different from MSCs derived from bone marrow in the expression of various genes, which makes us believe that they are specific to the organ they are isolated from."

The study appears online March 8 in advance of publication in the April print issue of the Journal of Clinical Investigation.

MSCs are widely seen as a potential source of therapies for numerous diseases and conditions, such as heart disease, cystic fibrosis, graft-versus-host disease, muscular dystrophy, and as a possible source for improved recovery of cancer patients undergoing chemotherapy.

Lama’s laboratory currently is working on another study involving the lung-derived MSCs that shows potential importance of these cells in lung transplantation. That study is not yet complete, but so far it indicates a very strong ability of these MSCs to suppress the immune cells that are involved in organ rejection. In addition to helping prevent organ rejection, other possible uses for the lung-derived MSCs could be therapies related to heart attack and pulmonary fibrosis, Lama says.

MSCs are termed progenitor cells; that is, they can differentiate into only limited number of cell types such as bone, cartilage and fat cells. However, previous laboratory studies have demonstrated the beneficial effect of these cells in various diseases, such as models of heart attacks and pulmonary fibrosis.

The current study of MSCs included 172 bronchoalveolar lavage fluid samples collected and analyzed from 76 lung transplant recipients at the U-M Health System. The ability to isolate these cells with relative ease from lavage fluid is a very significant finding as it provides a potential source to isolate MSCs, says Victor J. Thannickal, M.D., associate professor of Internal Medicine in the Division of Pulmonary and Critical Care Medicine and senior author on this study. "The specific roles of these cells in chronic lung diseases are yet to be fully defined, but will be an active area of research in years to come." Source : University of Michigan Health System

Stem cell review, March 2007

It's time to write an updated review on the status of stem cell therapy.

For one thing, I wrote about the lung cells from two different labs and sources, yesterday. Next, Richard Doerflinger has written his "75 new reasons" to support non embryonic stem cell therapy over on "DO NO HARM." And then, there's the news out of China (here, at Reuter's) that a group of researchers will soon begin a large trial of cord blood stem cells in spinal cord injury has a lot of people talking.

Yesterday morning, Rep. Beverly Wooley from the Houston Area held a press conference with the local embryonic stem cells and cloning advocates to announce the latest version of her clone and kill bill, HB 2704. The bill contains the usual redefinition of "cloning" (as "implantation or attempted implantation") with a twist (" of any human embryo created by a method other than fertilization") and would create an Advisory Committee comprised of 7 scientists, 1 medical ethicist, 1 member of a religious organization (what, the rest can't go to church?), and representatives of the research centers. There is no call for treating physicians like family doctors, hematologist/oncologists, or transplant surgeons who would and do guide patients through the stem cell treatment. There is no patient or disease advocate member.

This in spite of the fact that Texas researchers are making progress, now, in real patients, treatment that doesn't depend at all on creating and killing embryos. For example, there are Drs. Cox and Baumgartner in Houston, who have been doing a study on using children's own bone marrow in trauma cases, focusing on new damage. The team is severely limited in funds for the research that could help Texas children, today.

While there is hope, what should we hope for? And what do all these studies and reports mean?

Every day, we learn more about the stimulation and recruiting of stem cells from the patient's own body and from donor cells, like cord blood.

Donations of cord blood, fat, peripheral blood, bone marrow are found much more easily and in larger numbers in practical terms, because there are more people than embryos that will ever be available for destruction, more babies being born than embryos in any lab or freezer, and because no one has to die for them.

Cord blood "unrestricted somatic stem cells" appear to me to be the most promising of all the stem cells.

The answers are obvious if you think about it -- even the "embryonic proponents" are trying to make adult stem cells.

None of the treatments involved in therapy - now or in any likely future therapies - are actual embryonic stem cells, because the cells we need will only function in specific conditions and surroundings. The specific conditions and surroundings are only found in place, in the actual site of damage.

Embryonic stem cells function is to make embryonic tissues and must develop into precursors and then specific tissues. The "gold standard" test for embryonic stem cells is their ability to make tumors called teratomas in mice. And this is what they would do in any body, as long as they are "embryonic stem cells."

The manipulations that are required to manage their development - like "transfecting" the cells with genes inserted by retroviruses, as in those lung cells from Houston (yesterday) - are themselves dangerous and risky for patients. In contrast, the non embryonic cells are much easier to manipulate and behave better in the body.

If you read the research articles, even those embryonic cells from the inner mass are not all universal cells. They have had some genes turned on and some genes turned off. The researchers select out the cells they desire by creating conditions that favor only those cells.

The trick in both embryonic and adult stem cell research is to find and support only the cells that are desired. And, again, the conditions that support the cells desired are only reliably found in the body, in site, and are best for non-embryonic stem cells and precursors.

On the other hand, "adult" or non-embryonic stem cells are found all over the body. Like the embryonic stem cells, there are many kinds. We are discovering which organs and tissues have their own stem cells in relatively large amounts, and which do not. Researchers have found precursors or other cells in bone marrow, fat, and cord cells and cord blood that can be induced to turn into the necessary cells, in numbers large enough for treatment.

The supposed advantage of embryonic stem cells - their tendency to become any cell in the body - is actually a disadvantage because they're so hard to control. And the "disadvantage" of non-embryonic stem cells - that they're already partially specialized - is what makes them easier to manipulate.

For another review of stem cell therapy, go here.

Follow-up: HPV Testing, Men, and Prevalence

I did a little research on testing for HPV, especially in men.

The CDC site on HPV is here and it's up to date. http://www.cdc.gov/std/HPV/STDFact-HPV.htm

Digene, http://www.digene.com/labs/labs_hpv_01.html is a swab test for women. Negatives are true negatives for current risk of cancerous changes at the cervix. If negative, then 99.5% accurate - no HPV present at that time. (Can not rule out past infection, but only 1 in 1000 chance of cancerous changes without active infection.)

There is no approved test for males. A few urologists will test with the Digene test - but it's not very sensitive and can miss a lot of disease.

There is a blood test for some of the strains of HPV. However, one article (free online) states that less than 60% of the women who had HPV never become "seropositive."

The new article in the Journal of the American Medical Association from March on the numbers of infection in women is free at http://jama.ama-assn.org/cgi/content/full/297/8/813
Table 1 is very good - and look at the married women: infection rate is 17%. However, for those who said they'd never had sex, the infection rate is 5% and for those with only one partner, 11%.

Umbilical Cord vs. Embryonic Stem Cells

The Proceedings of the National Academies of Science (PNAS) has published the article that was the subject of this blog last week, and which claims that researchers at the University of Texas at Houston have produced the "first transplantable source of lung epithelial cells." There is no evidence that these cells are "transplantable," and they are definitely not the first team to produce Alveolar Type II ("ATII") lung cells from more primitive stem cells. The article does an excellent, if technical, job of explaining the importance of ATII lung epithelial cells:

The alveolar epithelium covers [approximately] 99%of the internal surface area of the lung and is composed of two major cell types, the alveolar type I (ATI) cell and the alveolar type II (ATII) cell. ATI cells are large flat cells through which exchange of CO2/O2 takes place. They cover [approximately] 95% 0f the alveolar surface and comprise [approximately] 40% of the alveolar epithelium and 8% of the peripheral lung cells. In contrast, ATII cells are small, cuboidal cells that cover [approximately] 5% of the alveolar surface and comprise 60% of the alveolar epithelium and 15% of the peripheral lung cells. They are characterized by the unique ability to synthesize and secrete surfactant protein C (SPC) and by the distinct morphological appearance of inclusion bodies, known as lamellar bodies. Important functions of ATII cells are (i) to synthesize, store, and secrete surfactant, which reduces surface tension, preventing collapse of the alveolus; (ii) to transport ions from the alveolar fluid into the interstitium, thereby minimizing alveolar fluid and maximizing gas exchange; (iii) to serve as progenitor cells for ATI cells, which is particularly important during reepithelialization of the alveolus after lung injury; and (iv) to provide pulmonary host defense by synthesizing and secreting several complement proteins including C3 and C5 (1–3) as well as numerous cytokines and interleukins that modulate lymphocyte, macrophage, and neutrophil functions (4). Severe pulmonary diseases can be caused by deficiencies or genetic mutations in proteins synthesized by ATII cells that are important in maintaining normal lung homeostasis. For example, complete deficiency of surfactant protein B (SPB) is caused by genetic mutations in the SPB gene. This deficiency results in impaired pulmonary surfactant composition and function and is a major cause of fatal neonatal respiratory disease (5, 6). In addition, ATII cells synthesize and secrete the serine protease inhibitor alpha-1-antitrypsin (alpha-1 AT) which also plays a key role in alveolar homeostasis by regulating protease imbalance and adjusting fluid clearance (7, 8), the importance of which is supported by the association of alpha-1 AT deficiency with the development of pulmonary emphysema (9). Cystic fibrosis is thought to be primarily a disease of the upper airway and submucosal epithelia and is caused by mutations in the cystic fibrosis transmembrane conductance receptor (CFTR) (10). CFTR is an important regulator of Cl and liquid transport in the lung (11–14) and is functionally expressed by human ATII cells, strongly suggesting a critical role for CFTR in regulating ion and fluid transport in the lung alveolus in addition to the upper airway (13).

(The numbers in parentheses refer to footnotes. Also, I had to change some of the characters to words: "alpha" and "approximately")

The PNAS report and UT Houston's Press Release do not contain any note about the earlier umbilical cord blood stem cell research, although the latter was published on line and in print in Cytology, at least 2 weeks before the initial submission of the PNAS article.

Both research teams report that they followed the techniques developed and reported in the lab of another researcher, Samadikuchaksaraei, in growing, multiplying and guiding the differentiation of their primitive cells toward the more specialized lung cells that were desired. Both report the successful production of ATII lung cells, as demonstrated by the way the cells look and by demonstrating the production of Surfactant Protein C - which, in human development is only found in mature ATII cells after the unborn (or premature) child has reached 36 weeks of gestation.

The Houston team claims that one reason their process is superior to the earlier Embryonic Stem Cell research is that they were able to produce mature cells in 10 days, while Samadikuchaksaraei's team took 15 days. If the ability to produce the cells in what Wetsel, et. al., describe as a "timely manner," then it is important to note that the Minnesota team produced their mature ATII cells in 3 to 8 days.

The Houston team also claims that is possible that their new cell lines might one day be transplanted, although there has never been any research reporting the successful transplantation of epithelial cells into the lungs. Another problem is that the cells were guided to change by "transfection" with a segment of DNA that is inserted into the genes of the cells, using a retrovirus. Any use of these cells, even if anyone ever proves that we can transplant cells into the lung and cure a disease, will be complicated by years of research to prove that the gene therapy that produced these cells is safe and stable in the lungs of the patients. The authors do not give us any references to support this hypothesis.

From the Discussion section of the PNAS article:

"Lung injury due to chronic pulmonary diseases, such as chronic
obstructive pulmonary disease and asthma, and inherited genetic disorders, such as cystic fibrosis and 1-AT deficiency are leading causes of morbidity and mortality worldwide. Cystic
fibrosis and 1-AT deficiency are two of the most common inherited genetic defects affecting Caucasians. In addition, SPB deficiency is a major cause of respiratory disease and fatality in neonates. All three of these diseases are caused by single-gene defects and therefore have been logical candidates for gene therapy. However, efficient vector delivery and sufficient transgene expression needed for therapeutic benefit have remained elusive. Recent research advances indicate that gene delivery via transplantation of cells derived from human stem cells may provide an attractive alternative to viral or liposome vector based gene therapies. Moreover, transplantation of cells derived from human stem cells may prove ideal for the repair and regeneration of injured lung tissue.

Because of its ability to proliferate as well as to differentiate into ATI cells, the ATII cell is an excellent choice of lung cell for possible therapeutic use in gene delivery and repair of the alveolus.

. . . The use of ES cells as a source of transplantable cells in the lung alveolus will require the generation of significant quantities of highly pure ATII cells. To achieve this goal, we chose to genetically modify hES cells so that resulting differentiated ATII cells could be enriched through antibiotic selection. Our approach was to establish a stable transfected hES cell line containing a single copy of the human SPC promoter-Neor fusion gene. When subjected to differentiation in vitro, it was hypothesized that ATII cells derived from this genetically modified hES cell line (SPCP/NEO.74) would express the Neor gene and would therefore survive G418 antibiotic selection, whereas, all of the other differentiated cell lineages as well as the pluripotent cells would be eliminated by G418 selection. Immunocytochemical and flow cytometric analysis of the surviving G418-selected cells supported this hypothesis, indicating that this genetic selection approach resulted in an enrichment of hES-ATII cells to 99% when cultured on Matrigel-coated plates. Our protocol reproducibly produced from each 10-cm culture dish 106 essentially pure ATII cells within 15 days of differentiation. These differentiated ATII cells survive for at least 2 days in culture in the absence of G418 and will provide in a timely manner sufficient numbers of pure ATII cells for future transplantation investigations."

(No footnote references were removed from this quoted portion.)


The abstracts are available on line for free, but the actual articles are available only by subscription or by paying for temporary access:

From Proceedings of the National Academies of Science, published online March 2, 2007

"A pure population of lung alveolar epithelial type II cells derived from human embryonic stem cells"

Dachun Wang, David L. Haviland, Alan R. Burns, Eva Zsigmond, and Rick A. Wetsel. Research Center for Immunology and Autoimmune Diseases and Laboratory for Developmental Biology, The Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases, University of Texas Health Science Center; Department of Biochemistry and Molecular Biology, University of Texas Medical School; and Cardiovascular Sciences Section, Department of Medicine, Baylor College of Medicine. Communicated by C. Thomas Caskey, University of Texas Health Science Center, Houston, TX, January 4, 2007 (received for review November 22, 2006)

Alveolar epithelial type II (ATII) cells are small, cuboidal cells that constitute 60% of the pulmonary alveolar epithelium. These cells are crucial for repair of the injured alveolus by differentiating into alveolar epithelial type I cells. ATII cells derived from human ES (hES) cells are a promising source of cells that could be used therapeutically to treat distal lung diseases. We have developed a reliable transfection and culture procedure, which facilitates, via genetic selection, the differentiation of hES cells into an essentially pure (>99%) population of ATII cells (hES-ATII). Purity, as well as biological features and morphological characteristics of normal ATII cells, was demonstrated for the hES-ATII cells, including lamellar body formation, expression of surfactant proteins A, B, and C, alpha-1-antitrypsin and the cystic fibrosis transmembrane conductance receptor, as well as the synthesis and secretion of complement proteins C3 and C5. Collectively, these data document the successful generation of a pure population of ATII cells derived from hES cells, providing a practical source of ATII cells to explore in disease models their potential in the regeneration and repair of the injured alveolus and in the therapeutic treatment of genetic diseases affecting the lung.
Keywords: complement , differentiation, surfactant proteins, alpha-1-antitrypsin, cystic fibrosis transmembrane conductance receptor

And here's the abstract of the report from November in Cytotherapy, (2006) Vol. 8, No. 5, 480-48 (Note the association with BioE, Inc., the company that's doing the cancer research with MD Anderson):

"Differentiation of umbilical cord blood-derived multilineage progenitor cells into respiratory epithelial cells."

MJ Berger, SD Adams, BM Tigges, SL Sprague, X-J Wang, DP Collins and DH McKenna, Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota, USA, Clinical Cell Therapy Laboratory, University of Minnesota Medical Center, Minneapolis, Minnesota, USA, and BioE Inc., Saint Paul, Minnesota, USA

Background - Umbilical cord blood (UCB) has been examined for the presence of stem cells capable of differentiating into cell types of all three embryonic layers (i.e. endo-, ecto- and mesoderm). The few groups reporting success have typically confirmed endodermal potential using hepatic differentiation. We report differentiation of human UCB-derived multipotent stem cells, termed multilineage progenitor cells (MLPC), into respiratory epithelial cells (i.e. type II alveolar cells).
Methods - Using a cell separation medium (PrepaCyte-MLPC; BioE Inc.) and plastic adherence, MLPC were isolated from four of 16 UCB units (American Red Cross) and expanded. Cultures were grown to 80% confluence in mesenchymal stromal cell growth medium (MSCGM; Cambrex BioScience) prior to addition of small airway growth medium (SAGM; Cambrex BioScience), an airway maintenance medium. Following a 3 - 8 day culture, cells were characterized by light microscopy, transmission electron microscopy, immunofluorescence and reverse transcriptase (RT)-PCR.
Results - MLPC were successfully differentiated into type II alveolar cells (four of four mixed lines; two of two clonal lines). Differentiated cells were characterized by epithelioid morphology with lamellar bodies. Both immunofluorescence and RT-PCR confirmed the presence of surfactant protein C, a protein highly specific for type II cells.
Discussion - MLPC were isolated, expanded and then differentiated into respiratory epithelial cells using an off-the-shelf medium designed for maintenance of fully differentiated respiratory epithelial cells. To the best of our knowledge, this is the first time human non-embryonic multipotent stem cells have been differentiated into type II alveolar cells. Further studies to evaluate the possibilities for both research and therapeutic applications are necessary.
Keywords - endodermal differentiation, respiratory epithelium, stem cells, umbilical cord blood.