Supreme Court Rejection of WARF hESC Patent Challenge Discussion

The challenge to the WARF/Jamie Thomson patents/IP on human embryonic stem cells (hESC) is at an end. The US Supreme Court declined to hear the case.

Earlier, the USPTO had turned down the challenge leading to a winding road in the courts.

What do you all think of this stem cell IP challenge and the outcome?

The hESC IP includes 3 patents: 5,843,7806,200,806, and 7,029,913.

For two great stories with helpful background on this development see here and here by David Jensen and Bradley Fikes, respectively. Scripps stem cell researcher Jeanne Loring was a driving force in the challenge.

UK OKs 3-Person IVF: Perspectives

With the House of Lords vote yesterday, the UK officially became the only country in the world to have legalized human genetic modification. The point of this “mitochondrial transfer” or “3-person IVF” technology is not directly to genetically modify humans specifically, but it still will lead to that result in any case.

The noble goal of this experiment is to prevent mitochondrial disease, but it is not quite that simple as the children produced (if any healthy children are produced) would have genomic elements from 3 human beings even if one of them contributes about 1000 times less than the other two. I would still call that a genetic modification. For example, plants and animals with even a single gene transferred to them from elsewhere are defined as GMOs.

Now we can hope that this technology is safe and effective, but we can and should do more than hope.

We can continue to ask for data, transparency, and accountability as this work proceeds. I’m not so sure that these elements are part of the law that passed as some had said that reporting of outcomes would not be required. Does anyone know for sure?

The proponents and practitioners-to-be of this work in the UK have, to use their own words yesterday, “won”. As they proceed with this experiment, I believe that they should account for every single mitochondrial transfer embryo implanted in women using this technology and publicly report the outcome data for each. Healthy birth? Miscarriage? Developmental Disorder? Problem in childhood later on? Genome integrity?

It is medically and scientifically crucial for the scientists and doctors involved to collect and publicly report all this data in a timely manner. This can be done while still protecting the privacy of the families involved.

I hope very single one is a healthy child, but as with all experiments there is no way to be sure in advance.

Red flags in Sally Davies letter on 3-person IVF mitochondrial transfer

There’s been some back and forth between me and some members of the UK Parliament and others in the UK on the issue of mitochondrial transfer 3-person IVF technology.

Some of this has involved the UK equivalent of the Surgeon General, Professor Dame Sally Davies, who at one point apparently called my views “bunk”. I wrote back to her via Lord Alton articulating my concerns and respectfully responding to the bunk allegation.

I am not opposed in principle to mitochondrial transfer technology, but rather from an impartial scientific and factual perspective it is clear to me that far more data from additional animal studies is needed. At some point with any experimental biotechnology intended for human use scientists and doctors have to take the plunge and try it in humans, but my view is that the animal data supporting mitochondrial transfer is incomplete at best.

Now I just recently indirectly received a letter from Davies, which seemed intended to rebut my concerns. I found some things about the letter to be surprising and in some cases to be red flags.

With all due respect, Davies seems to have a dismissive attitude toward those who disagree with her on the urgency for human mitochondrial transfer to proceed as soon as possible. This is evident in a newspaper article she wrote and also in this letter. You can see it without having to read between the lines in her word choices to describe the press and opponents of the immediate approval of the technology: ‘overly simplistic’, ‘sensationalist’, ‘unsophisticated’.

The most surprising element of her letter in reply to my concerns was her argument against a need for additional animal research and data.

It seems she and other proponents of this technology moving forward immediately have a tendency to pick and choose whether to value animal data depending on whether it supports their case or not. In this passage, they are fans of animal data, which they view as fairly definitive:

“The view of the Expert Panel was that experiments involving Pro-nuclear Transfer (PNT) and Maternal Spindle Transfer (MST) in animals (mice, macaques, and some other animals) have not given any cause for concern.”

So on the one hand she and others advocating immediate approval of this technology have asserted that mitochondrial transfer would be safe for humans based essentially entirely on animal studies including the non-human primate work of Mitalipov.

On the other hand, she goes on to argue that additional work of that kind would be bad:

“The use of non-human primate experiments was deemed by the Expert Panel, in its 2013 and 2014 reports, to no longer be necessary given the differences between non-human primate and human eggs / early embryos. Performing such unnecessary animal experiments would indeed be unethical given that non-human primates were not considered a good model for the human in this context.”

It sure seems like a self-contradictory argument, right?

I find the use of the word ‘unethical’ to be strikingly strong.

It is notable that in the past, if memory serves, the Expert Panel did feel that more data was needed (and that data is still not available), but it’s not clear what changed their minds.

Remarkably, then in a nutshell what she seems to be saying is that the only ethical thing to do since animal models are imperfect–except of course the specific past ones that we feel supported safety–is to experiment on humans and do it now.

That is more ethical?

This all sounds a lot more like politics than biomedical science. I say, let’s focus on the data and not the politics, but I’m not holding my breath.

UK Surgeon General Calls My Concerns on 3-person IVF “Bunk”

What is one to do when the equivalent of the Surgeon General of the UK calls one’s concerns about something “bunk”?

It sure gave me some pause. What’s going on?

First, some brief background.

The debate over 3-person IVF/mitochondrial transfer technology has been getting more heated.

The epicenter for the discussion is the UK where the technology is part way through getting Parliamentary approval. In fact, it could be approved by the House of Lords as soon as tomorrow after it was approved by the House of Commons a few weeks back.

The FDA held a committee hearing on this technology in the US a few months ago and it could eventually be approved in the US in say 3-5 years if more data turn out to be more supportive. Very similar to the FDA, my view is also one that we need more data.

If ground zero on this debate is in the UK, why am I as an American scientist involved?

I happen to be one of the few scientific publicly outspoken opponents of approval of this technology for use now. Note again that I could eventually back it in the future, however, if more data supported safety and efficacy. My concerns relate primarily to the risks of creating children with birth defects and human genetic modification (a third person’s mitochondria).

Even though I’m across the ocean from the UK, my position that we need more time and data and in particular an article in the UK press, which quoted me on my concerns, have ruffled some feathers in the UK sally davies

In fact, Professor Dame Sally C. Davies, the UK Chief Medical Officer (roughly the equivalent of the US Surgeon General) went so far as to call my assertion that 3-person IVF could yield children with a higher risk of cancer “bunk” in the House of Lords.

That’s a strong word.

So, again, what to do? This was a few weeks ago.

I decided to write to her indirectly via a letter to Lord Alton, a member of the House of Lords also concerned about approval of this technology. I indicated in the letter why I didn’t think my position was bunk and what were my concerns were on this experimental technology.

Now she has written a letter intending to rebut my concerns again. Lord Earl Howe also signed the letter.

She and I still disagree, which is not unusual in biomedical science, right? For context, as best as I can tell she and I probably agree on 99% of other issues.

I respect her even though we disagree about this one issue. Hopefully that is mutual.

I’m going to write more about the specifics of her most recent letter, which I think is quite surprising in some ways, in a post to come.

How Much Do Stem Cell Treatments Really Cost?

Stem cell treatments of various kinds are now widely available in America at more than 100 stem cell clinics offering non-FDA approved interventions for dozens of conditions.

American patients are often recruited on the Internet to travel around the US or to Mexico and other countries.

How much do these stem cell treatments cost?stem cell treatment cost

American clinics charge approximately $10,000 per treatment. Notably, many patients gets more than one of these non-FDA approved treatments and must pay each time of course.

Some clinics have reduced prices to the $7,000-$8,000 range. Interestingly, costs for treatments outside of the US are usually far higher than in the US, charging anywhere from $20,000 all the way up to $100,000. These clinics still generally have Americans as clientele. Whether inside or outside the US, insurance does not cover the costs of these potentially dangerous, unproven treatments.

Clinic profits are difficult to estimate and vary depending on the type of stem cells and other factors such as malpractice insurance cost. However, I have heard estimates of the clinics’ own costs being around $1,000-$2,000 per treatment, yielding a very high profit margin.

Part of the way that clinics cut corners to boost their profits is by not following FDA regulations, putting patients in danger. Clinics typically do not do pre-clinical studies to get evidence of safety and efficacy before starting to sell their offerings to patients. Clinics also do not include sufficient follow up in the cost of the treatments. They do not publish their data to get peer review and feedback. They often do not have GMP compliant facilities or devices.

Patients themselves are frequently unable to afford these expensive, unproven stem cell “treatments”, and so they turn to their communities including churches, friends, and family to do fundraisers. For example, a coach reportedly recently raised $70,000 for a stem cell intervention from his community. Update: The non-FDA approved Stemedica stem cell intervention sold in Tijuana via partner Novastem reportedly costs $32,000-$40,000 a pop.

With the rapidly increasing number of clinics right here in the US, in theory one might imagine costs would go down due to competition. It’s not clear if that is driving some clinics to lower prices.

Of course other costs to patients going to dubious clinics, sometimes not considered, include the price of false hope, potential injury due to dangerous stem cell “treatments”, possibly being excluded from a real clinical trial in the future, and injury from deferring other arguably more real treatments.