2015 General Election, David Cameron, Democracy, Dr Phil Hammond, Ed Miliband, Health, Healthcare, N.H.S., National Health Service, Nicola Sturgeon, Opinion, Paul Knoepfler, Politics, Public Health, Regenerative Medicine, Research and Development, Revolution, Stem Cell Research, Technology
Some things are election issues and others are not. The National Health Service is, quite expressly, an election issue. Yes, it is still lumbering along like a dinosaur which we cannot afford to feed. We have to “defend” the NHS, “protect” the NHS, fund our NHS, ration the beds and operations, and commit ourselves to those lifestyle choices which will enable us to live longer and healthier lives, and to more importantly cut the NHS some much-needed slack.
Stem cell therapy is not an election issue. Indeed, from the news coverage in this country, you would think that it is a largely academic subject, practised as a kind of remote hobby by people who in previous centuries would have been alchemists or necromancers. Well, it is time to confront an obviously unwelcome reality. Companies on both sides of the Atlantic are presently submitting their research to clinical trials which could, within decades or even years, lead to many of the conditions which are currently just treatable on the NHS becoming curable. Paul Knoepfler, the Californian stem cell researcher, maintains that even ageing can be feasibly redefined as a curable medical condition. By replenishing the stem cell colonies which decline in our bodies later in life, we could end up with lifespans longer than those of oak trees.
In other words, so many of the intractable financial problems which have been officially classified as election issues, such as the ballooning costs of dementia care and social care for the elderly, begin to look quite different once stem cell therapy is factored in. The trouble is that stem cell therapy is never factored in. It remains bizarrely invisible throughout British political life.
By way of an example, I draw your attention to the latest edition of the traditionally anti-establishment magazine Private Eye (No. 1389), in which Dr Phil Hammond, appearing under his pseudonym M.D., is pondering the “Dementia time bomb.” It is all fascinating and no doubt supremely accurate, but Hammond’s analysis is striking due to its doggedly ahistorical view of the NHS. For him, the facts are these: “There is no cure although there are treatments that can slow the progression of some types of the condition in some cases. Usually, only about one in three people shows a positive response to such drugs. The longer we live, the more of us will get dementia.” Having been dealt this hand, we are left, Hammond implies, to collectively face a bleak future of squeezed budgets and spiralling costs.
The Prime Minister last year launched a £100 million research campaign to defeat dementia. This involved what was perhaps a first for him: an inspiring political vision. He argued that, “We have to fight to cure it. I know some people will say that it’s not possible, but we have seen with cancer what medicine can achieve.” For Hammond to omit all mention of this crusade (regardless of how credible Cameron’s spending commitments actually are), represents a far profounder and more destructive conservatism than that in which trust-fund managers are awarded tax breaks (or whatever it is that happens under the Tories). Healthcare in politics should not just come down to financing the existing, tumbledown system – it should involve a bit of revolutionary oomph.
You will search in vain for any quote from a UK opposition leader about stem cell therapy, but strangely Nick Clegg’s wife, Miriam Gonzalez Durantez, can be found campaigning in 2009 for mothers to donate their used umbilical cord blood to stem cell banks. That a political leader’s wife has more to say about stem cells than her elected husband readily symbolises the depoliticisation of the subject. There is not a peep from Nigel Farage on stem cells, though Nicola Sturgeon can be found visiting participants in a stem cell transplant study at Edinburgh’s Alexandra Eye Pavilion in 2012. This nonetheless furthers the same trend of depoliticising the technology: leaders in power supervise the seemingly natural growth of the stem cell industry; leaders in opposition automatically agree with whatever the existing government policy is; and this habitual consensus disqualifies stem cells as an election issue.
As Prime Minister, David Cameron has been an energetic advocate of the UK’s life sciences. Last year he committed the UK to involvement in the BIRAX Regenerative Medicine Initiative, a 5 year collaboration between British and Israeli stem cell scientists. But stem cells are not an election issue and so you won’t find the Prime Minister campaigning on this record of fighting to cure Parkinson’s disease.
You might think that stem cell therapy would make today’s politics altogether less harrowing. The drive to industrialise stem cells for the masses provides our politicians with a visionary political narrative, an exhilarating political journey. It offers the refreshing, even unfamiliar sense that our country has some sort of future. In a political era in which a wide array of public institutions, ranging from the Catholic church and care homes to the BBC and banks, have all been on the receiving end of widespread (and typically deserved) mass contempt, stem cells could not only rejuvenate patients but political authority more generally. A prospective stem cell crusade already has an encouraging precedent in the urgent mobilisation of resources against Ebola. The scramble to cure Ebola could be broadened to a scramble to cure, well, everything.
Why, therefore, is this not happening?
The answer, I think, is that there is a profoundly anti-democratic bias within the stem cell industry itself, from scientists who distrust public enthusiasm and are wary of stimulating the masses beyond anything more than a polite appreciation of their work. For instance Paul Knoepfler observes, in his Stem Cells: An Insider’s Guide (2013), that, “sadly most stem cell scientists remain largely inaccessible to patients because the scientists mistakenly believe that there should be a distance, a wall between them and patients.” There are, I hasten to add, perfectly sensible and understandable reasons behind this fear of “going native.” If a scientist convinces themselves that they might have the ability to end the suffering of patients who they have come to know, then this could encourage them to cut corners and make dangerous errors. Nonetheless, gradualism cannot be the foremost virtue amongst stem cell scientists. Such an outlook is in danger of overshadowing the technology’s promise.
Stem cell therapy is such a distressing subject because, to different degrees within different socioeconomic classes, there will be identifiable generations who are the last to miss out. There will be people who die from particular medical conditions a few years, or even a few months, before the cure becomes available or affordable to them. Maintaining the sense that stem cell therapy is an obscure, utopian technology postpones the pressure which will surely begin to build up once stem cell treatments are increasingly within our reach. You have probably followed the heartrending stories of cancer victims who cannot get new and sometimes untested treatments on the NHS. Their suffering is often politicised; it sometimes generates a furious tabloid reaction. In the early years of the stem cell age, these stories could become vastly more common.
Knoepfler is an inspiring scientist and his Insider’s Guide, which I am currently reading, provides a valuable educational resource. He freely uses the term “revolution” when referring to stem cells. He wants to engage with the public, to honestly convey the potential of stem cells but in a spirit of revolutionary realism. He is worried by the resemblance between stem cells and cancer cells, and he thinks that the technology can only progress if it follows stringent safety requirements. The fate of gene therapy, which is still suffering from an “ice age” of investor confidence after some spectacular medical disasters in the late 1990s, offers, for Knoepfler, a salutary example. He does a great job of highlighting the work of deluded or fraudulent stem cell doctors who sell at best useless, and at worst dangerous, therapies to seriously ill patients.
Yet this is a guide to American stem cells. Knoepfler insists that only private finance can reliably fund stem cell research, albeit within a framework of ever tighter state regulation. He is at sixes and sevens over the precise relationship between the two. To caricature his position, he thinks that uneducated or simply desperate patients will be too dazzled by the new technology to approach it with the necessary caution. He reasons that, “Hype can prevail. People can get used or hurt. There is a certain danger.” He imagines “a world in which stem cell deregulation has gone to an extreme where patients can receive stem cell injections via a drive-thru like a burger or a cup of coffee.”
Even if this deregulation was likely (and it sounds rather wonderful for a supposed dystopia), in a deregulated culture the quacks would still be, as Knoepfler confusingly concedes, wiped off the map by litigation. In a deregulated culture, patents could also educate themselves about the risks of stem cells by consulting resources such as Knoepfler’s own book. You could even argue that they would have the responsibility to do this. Moreover, Knoepfler celebrates the work of patients who have campaigned for the responsible use of stem cells. These real patient advocates sound like a far cry from Knoepfler’s fictional “drive-thru” stem cell purchasers.
In the UK, however, the public can theoretically determine how much of their wealth is allocated to medical research not by splashing their own cash but by putting pressure on their elected representatives to spend public money. So here the “hype” is, or at least it could be, a matter of politics rather than of commerce. We could have a riot for stem cells.
Tychy is hardly qualified to educate people about stem cells. If all of my inner organs suddenly fell out at my feet, I couldn’t tell you which was the spleen and which was the bladder. But in the coming months and years, this website will be arguing that stem cell therapy should be politicised. This subject will matter to you and yours far more than a mansion tax or a banker’s bonus levy or the ending of compulsory pension annuities. We should all become more educated about the topic and we should all begin to acquire some opinions about it.
[Previously on Tychy: “End Our NHS.”]