Sep 30 2010
Stem Cell Doctor “Struck Off”
In the US we punish unethical or incompetent doctors by taking away their license (a matter regulated at the state level). In the UK doctors are punished by being “struck off” the register of physicians. You may recall that the infamous Andrew Wakefield was struck off for ethics violations related to his MMR-autism Lancet study.
Now we have news of another UK physician being struck off – this time for prescribing stem cell treatments for multiple sclerosis (MS) patients. Dr. Robert Trossel was found by the General Medical Council (GMC) to have breached good medical practice by “exploiting vulnerable patients.” He gave stem cell treatments to several patients with MS, at a cost of about £10,000 each.
The BBC reports:
At an earlier hearing, the GMC Fitness to Practise panel said that Dr Trossel had exaggerated the benefits of treatment based on “anecdotal and aspirational information”.
His patients, who had an aggressive and disabling type of multiple sclerosis, paid up to £10,000 or more for stem cell injections, with some raising the money through charity events.
However, the stem cells offered were not intended for human use, only for laboratory research.
Whenever I read stories like this my irony meter is often pegged to the right, at risk of breaking. When discussing conventional, but substandard, treatments by MDs we are often given a completely rational assessment. This often includes several points taken for granted as establishing ethical science-based medicine. For example – treatments should not be based upon anecdotes alone, practitioners should not over-hype the safety and effectiveness of their treatments, vulnerable and desperate patients should not be exploited with claims that are not backed by objective evidence, and experimental treatments require full informed consent.
These principles are generally accepted, and we laud the system for rooting out unethical doctors who violate them.
But when the treatment being discussed is so-called “alternative” the same rules magically don’t apply. Then journalists seek out the anecdotes of patients to sing the virtues of the controversial treatment. Proponents are sought to give “balance” to the piece. There is no discussion of exploitation, false hope, squandered expense, or the need for informed consent.
Dr. Trossel is criticized because he, “exaggerated the benefits of treatment based on ‘anecdotal and aspirational information’.” In my opinion, that characterization applies to just about the entire world of alternative medicine. Almost by definition, “alternative medicine” is a loose collection of treatments that are experimental, unproven, or even disproved that are promoted by anecdotes and wishful thinking, over-hyped, and sold to the vulnerable.
To be clear – I am not defending Trossel. By all reports, what he did violated basic ethics and being struck off seems like a reasonable result. He did not give proper informed consent to his patients, who were surprised to learn that the stem cell treatments included bovine material and therefore contains a small risk of transmitting CJD (the human version of mad cow disease). Even with that small but scary risk aside, there are no proven stem cell treatments for MS or any similar condition. The treatments were, at best, experimental – but they were not given as part of an approved experimental protocol. And patients should not have been charged for such experimental treatments.
It certainly does seem as if Trossel was exploiting desperate patients, exploiting the media hype surrounding stem cells, and charging large sums for his services. This is happening around the world, in stem cells clinics that try to lure in foreigners with false hope and dubious claims. Some patients are wealthy, but many raise funds from family, friends, and charity events, only to hand over tens of thousands of dollars to charlatans. There is a crack down on stem cell tourism, but it is still a huge problem, and I suspect that Trossel was caught in this backlash.
To make matters worse, in many states in the US someone like Trossel only has to slap the “alternative” label on what they are doing and they are free from the most basic regulations of medical standards. Many states have so-called “health care freedom laws” that would prevent someone like Trossel from losing their license over such behavior. Some states have specific laws defending specific practices, like chelation therapy, or in CT there is a recent law protecting those who treat “chronic Lyme disease.”
In each case lobbyists have pushed through laws, usually under the radar, that would deprive the public of basic protections so that practitioners could have the freedom to practice ethically and scientifically questionable medicine.
Trossel should follow Wakefield to the US. He can probably find a state with quack-friendly laws, and then he can go back to exploiting desperate patients for financial gain. He just has to practice “alternative” medicine.
12 Responses to “Stem Cell Doctor “Struck Off””
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I like their system better, “stuck off” just has a better ring to it.
~Rhaco
Unfortunately, negative press for THIS guy is going to snowball into negative outlook for stem cell research in general.
Bad apple exhibit A ruining it for the bunch (the bunch being legitimate stem cell research). It’s a shame that this situation is going to be used as ammo (nonsensical ammo.. but ammo nonetheless) for the anti-science farts out there who are against stem cell research..
Good article Steve
I would hope that he gets considerably more punished than merely being “struck off”.
This guy scammed desperate people at £10,000 a time. Money that would have helped said patients in other ways has been wasted, leaving them to suffer with nothing.
He is a criminal, and a cruel, uncaring one at that. He should be stripped of all his assets and in prison before his feet touch the ground.
From the article -”They were all vulnerable patients who already found themselves failed by the medical profession in this country and as a result were searching, some with desperation, for a cure or relief elsewhere”-
That statement annoyed me. Will I be failed by the medical profession because they didn’t stop me dying of old age? I want my immortality damnit!!!
Stem cell experts launch consumer protection site: http://www.ncahf.org/digest10/10-38.html
While tangental to the point of the blog post, does anyone else find the phrase “paid up to £10,000 or more” annoying? Call me cranky, but the author of the article should indicate and then nullify an upper limit to the amount paid in the same phrase.
Ha. I complain about the writing of the author of the original article and then fail to proofread my own post well enough.
I mean to say… Call me cranky, but the author of the article should NOT indicate and then nullify an upper limit to the amount paid in the same phrase.
Do you really buy into this argument as a real risk?
I understand that this is theoretically possible, but I cannot find a single reported example where a tissue culture media supplier has contaminated a researcher’s stem cells with vCJD.
If anyone working with stems cells, I think it’s reasonable that they would use media produced from countries with extremely low incidents of BSE such as the USA. Current risk of transmission of BSE in the United States is minimal because (1) BSE has not been shown to exist in this country since a single case 2006; (2) adequate regulations exist to prevent entry of foreign sources of BSE into the United States; (3) adequate regulations exist to prevent undetected cases of BSE from uncontrolled amplification within the US cattle population; and (4) adequate preventive guidelines exist to prevent high-risk bovine materials from contaminating products intended for human consumption. Knowing the potential risk, the people at a research facility would be idiots to use media produced cows raised in the UK.
Should there be warnings for every theoretical issue with any particular procedure?
Just to clarify, there have been only three confirmed cases of BSE in cows in the US (2003, 2004 and 2006). www dot cdc.gov/ncidod/dvrd/bse/
“From the article -’They were all vulnerable patients who already found themselves failed by the medical profession in this country and as a result were searching, some with desperation, for a cure or relief elsewhere’-
“That statement annoyed me. Will I be failed by the medical profession because they didn’t stop me dying of old age? I want my immortality damnit!!!”
Please do not compare dying of old age with living with multiple schlerosis. Especially if we’re talking about more aggressive or later stage forms of MS.
Not all MS patients feel this way, but many MS patients are particularly disenchanted with the medical profession. Not that they blame individual doctors, or doctors in general, but for the longest time, the best the medical profession had to offer was advice on how to live with MS before dying from MS… with death sometimes being preceded by paralysis, vision loss, loss of bladder control, etc.
Beyond the symptoms, discussions of MS will frequently include topics such as divorce, alcoholism and physician-assisted suicide.
Many of the medications that are available today haven’t been around for so long. And they’re *very* expensive, can only be administered to some MS patients, only help some of the MS patients who do take them, and sometimes have serious side-effects which some (but not all) MS patients still choose over MS itself. Don’t get me wrong, for those people who are helped by this, it can make a real difference, but it’s far short of what’s needed.
On top of that, at least here in Canada, the government and the MS Society of Canada has shown no sense of urgency in starting clinical trials on angioplasty or stenting for those people who have veinous issues that could benefit from treatment, to even determine whether or not those people might see a difference in their symptoms.
They have a nasty medical condition; they have very limited and expensive proven options for treatment; some perceive their own advocacy group as turning its back on them; and some are considering spending their savings or remortgaging their homes to travel overseas for an unproven medical procedure, either after careful analysis or out of desperation, because that’s all they have.
I am sure none of them would consider themselves failed by a medical profession that allows them to die of old age.
@LarryG,
You might be interested in reading Dr Novella’s article a few weeks ago about venous insufficiency (or CCSVI) and MS.
http://www.sciencebasedmedicine.org/?p=6465
As he stated in that article,
@SquirrelElite
Thanks for the link to that article. I hadn’t looked at that but I was aware of two of the studies he refers to.
My reply above was to clarify the sense of feeling “failed by the medical profession” that is described in the BBC article.
Also, I do *not* believe the resources given to confirming or disproving Zamboni’s hypothesis to be misplaced, esp. considering that his recommended treatment follows from it. Quite the opposite… it does need to be investigated.
But while investigating that, why isn’t the treatment itself, at least for those patients who are candidates for it, being more actively and directly investigated?
As for keeping the discussion about the scientific evidence, where’s the scientific evidence on the effects of angioplasty or stenting for those MS patients who are candidates for it?
We don’t have it. And, sadly, at least here in Canada, the federal government, CIHR and MS Society have publicaly indicated that they are not interested in getting it at this time.
The conspiracy theorists can deal with this simply enough and be content with their “rabbit hole” and explain it all away.
But for the rest, who want the evidence, they are left with the sense of being “failed.”
I wrote
“But while investigating that, why isn’t the treatment itself, at least for those patients who are candidates for it…”
but meant to write
“But while investigating that, why isn’t the treatment itself, for those patients who are candidates for it…”