Fetal tissue transplants
A proposed new study of fetal brain tissue transplants and Parkinson’s patients, is generating much controversy in the medical profession – but not for the reasons one might hope.
Dr. Curt Freed, a professor of Medicine and Pharmacology at the University of Colorado’s Health Science Centre, wants to initiate a one-year double blind study with 40 patients suffering from Parkinson’s Disease. He described his proposal on CBC Radio’s science show Quirks & Quirks (February 5).
Forty Patients would have their skulls perforated. Half would receive injections of fetal brain tissue. Half would simply have the perforation closed again, unaware that they had received no treatment at all. (At the end of the year, patients in this control group would be given transplants too, if they wished).
The study would focus on the effectiveness of the transplant, and whether the sham operation had any placebo effect on patients. It would also try to determine the optimum times and amouns of tissue for the procedure.
Dr. Freed’s dedication to this research is remarkable since reports continue to suggest that the benefits of these transplants are more illusion than reality, and there is a risk of stroke and paralysis.
On the CBC program, Dr. Richard Penn of Rush Medical School in Chicago pointed out that this proposal has given rise to great debate within the medical community. He summarized the major objections.
The proposal raises questions about what a physician is allowed to do to patients, he said, and about the ethics of withholding treatment when the patient faces steady degeneration leading to severe disability and death.
Some medical practitioners who still live by the precept “First do not harm,” have serious misgivings about surgical intervention (with its attendant risks) carried out not to heal but to make the patient simply think something was done.
Many question whether patients in a double blind experiment can give truly informed consent — a key element in every invasive medical procedure (except abortion), and the point on which many lawsuits are won or lost.
If this concept of subjecting a control group to a sham procedure is accepted, say some, every new surgical procedure in the future may have to be tested in the same manner: with some patients subjected to real surgery, and some to sham.
Others believe the researchers proposing the study are paying too little attention to the placebo effect (pseudo treatment given to a patient who believes it is genuine).
Placebos are known to be 30% effective in bringing relief to patients with a wide range of medical problems. But generally the effect lasts for only a few months. Freed’s proposed 1-year study would end just at the point when any placebo effect would be wearing off.
Not everyone, however, is expressing these kinds of concern. Dr. Allen Fine of Halifax who has a particular interest in fetal tissue transplants, says the proposed study does not go far enough.
He pointed out that while some alleviation of the Parkinson’s symptoms does occur after transplants, the reason is not fully known. The improvement may be somehow caused by the needle, not the fetal tissue. Perhaps even the moving and manipulation of the patient’s brain triggers the healing.
Dr. Fine says it would be more useful to insert needles into the brains of the control group, even to inject a scaling solution, before closing their perforated skulls for their year of waiting.
Sadly, despite all the uneasiness voiced, nobody expressed concern about the ethics of using the brain tissue of aborted babies.