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.

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