Ethics and Markets – Stem Cells
10-19-11
A couple of recent developments have motivated me to make a few comments beyond the opinions I sometimes interject into these posts.
The first is that a friend recently asked about the ethics of stem cell transplants. Apparently the phrase “stem cell transplant” has become a kind of buzz word that unnecessarily causes emotional reactions. While there are serious ethical issues surrounding the use of embryonic stem cells for research and medical procedures, none of those issues relate to the use of stem cells such as I donated for transplant to my brother. In its statement “On Embryonic Stem Cell Research,” the United States Conference of Catholic Bishops very plainly stated: “Stem cells from adult tissues, umbilical cord blood, and placenta (often loosely called ‘adult stem cells’) can be obtained without harm to the donor and without any ethical problem, and these have already demonstrated great medical promise.”
Another ethical issue is whether donors should be paid to donate. Currently such payment is illegal under the National Organ Transplant Act (“NOTA”). In October of 2009, a lawsuit – Flynn v. Holder, CV 09 0772 – was filed in federal court in California challenging the constitutionality of the ban on such payments. The district court recently dismissed that case. The dismissal has been appealed, but for now the ban on payment remains the law.
There is a recent article in the Southern California Law Review which may be read at http://lawweb.usc.edu/why/students/orgs/lawreview/documents/SCalLRev84_Young.pdf
The author, a brand new 2011 graduate of the University of Southern California Law School, argues that the ban on payments should be lifted because it would offer greater incentives for people to donate and increase the possibility that those needing transplants would find a suitable donor.
It seems, at least in my opinion, that the underlying issue is not really an ethical one or the concern for access to treatment. Rather, it is what kind of market can be created for stem cells and who is going to profit from their use. At present, I am in favor of the prohibition on compensation under NOTA which keeps the US in conformity with international standards.
That prohibition does not mean that there is not an active market in some types of stem cells, however. There are currently more than 150 companies involved in some manner in the stem cell market, some of which are publicly traded, and which offer a wide variety on ways to enter the stem cell market. Aastrom Biosciences, for instance is developing technology intended to help umbilical cord and bone marrow stem cells to replicate. Some companies like Geron have been working for several years developing therapies based on the controversial use of embryonic stem cells. Others, like Pluristem Therapeutics, Inc., have made advances utilizing less controversial placental stem cells.
I am not in any way recommending any kind of investment in any of these companies (though, in the interest of fair disclosure, I want to say that I own a small amount of stock in Pluristem). I merely want to point out, with examples, that there is already an active market in stem cells. Payment to stem cell donors, if permitted, would eventually increase the scope of that market. However, unless such payment becomes an accepted international practice, it seems a bad idea.