RISKY BUSINESS
Some seek stem-cell therapy abroad for chronic illnesses, but effects are unproven

A small number of Singaporeans are going overseas to seek stem-cell therapy for some diseases, even though it has not been proven 10 be effective in those areas.

At least two doctors whom The Sunday Times spoke to said they have come across such patients.

They usually suffer from chronic diseases such as diabetes, stroke or heart failure.

They go to medical clinics in countries like Thailand, China and Switzerland, where stem-cell therapy
is being touted as a cure-all for ailments such as spinal injuries, autism and Parkinson's disease, and
even in the battle against ageing.

Most patients, however, do not see results.

Cardiologist Leslie Lam from The Cardiac Centre said he saw a patient who had stern cells injected into his
coronary arteries in Bangkok to "cure" his end-stage heart failure.

The man decided to try the treatment after his son learnt about it online.

His condition appeared to improve briefly, but six months later, he died.

Dr Lam said: "For three months, he could walk around Ihe house, when before he would gasp for air constantly."

Dr Lam has not given the treatment to any of his patients here as he is not convinced of its effectiveness. But he said he carried out the procedure once in Myanmar about two years ago - on a patient who was suffering from severe peripheral vascular disease and had to have his leg amputated.

"It was the last resort before his amputation...but after a year, it still had to be done," said Dr Lam.

He adde: "At present, I believe stem-cell therapy should be used onIy as a last resort to treat end-stage
disease . The effectiveness seems to be very short-lived."

Another doctor, neurologist Tang Kok Foo, said he had a patient who flew to Austria to receive stem-cell treatment for stroke without telling him. In the end, the man did not get better.

Dr Tang had another patient who told him recently that a doctor had recommended that she head to China for stem-cell therapy for her torn shoulder muscle.

Dr Tang, however, told her not to do so.

The issue of stem-cell treatment made news recently when plastic surgeon Martin Huang was censured and fined for performing unproven stem-cell treatments on patients.

Dr Huang, who runs The Cosmetic Surgery Clinic at Paragon Shopping Centre, had injected sheep foetal cells into three of his patients between the end of 2006 and early 2007, purportedly to slow their ageing and to rejuvenate them.

The plastic surgeon also used the therapy on himself. He had performed the procedures after six months of research on the topic.

The Singapore Medical Council (SMC), however, said in a statement on Oct 14 that the procedure is generally not accepted by the medical profession, except in the form of a formal and approved clinical trial.

Little is known about such treatments and their alleged anti-ageing effects, "and it is even more doubtful" when animal foetal cells are used, said the SMC.

As most doctors here have ethical reservations about unproven stem-cell treatments, patients who are keen to try them usually have to go overseas to do so.

These patients normally find out about stem-cell treatments on the Internet, where stem-cell companies advertise their services.

A study by the University of AIberta in Canada found at least 19 medical websites claiming to provide stem-cell therapy from places such as China and the Ukraine.

Such sites claimed to provide health or cosmetic enhancement and cures for disease.

Websites most often claimed treatment with adult autologous stem cells - that is stem cells from the patient's own body.

However, treatments Involving foetal stem cells, cord blood stem cells and embryonic stem cells were also offered.

Treatment may cost between $30,000 and $50,000.

Doctors here, however, caution that the use of stem cells in areas other than in the treatment of some cancers of the blood is still being researched and has not been proven to be effective.

Clinical trials are under way to test if it is effective for other conditions such a heart disease.

Dr Tang, who is from Mount Elizabeth Hospital, said: "Patients often get taken in by the glowing testimonies on the websites...but if the treatment is really effective,  why do these institutions need advertisements? People will be banging on their doors to get a cure."

Dr Lawrence Stanton, deputy director of research affairs and senior group leader of the Genome Institute of Singapore, said that any therapy has to go through rigorous testing and must be proven to be safe.

"Some human stem cells are undergoing clinical trials, such as a current ongoing one in America
for spinal cord injuries," he said.

"However, the use of animal cells is very rare and untested. Sheep cells, for example, have not been proven to work or even be safe."

The risks include the patiem going into anaphylactic shock, which can be fatal.

The body could also reject the cells. And there may also be a risk of developing tumours.

Dr Toh Han Chong, head of the National Cancer CentIe's medical oncology department, said the data for unconventional use of stem cells is not mature yet.

It may take years before doctors are able to determine how best to administer such treatment, including finding the right dosage to administer and understanding the side effects that it may bring.

"Most importantly, we need to address the question of whether it really works for other diseases," he said.

USES OF STEM CELLS HERE
In Singapore, adult blood stem cells from the bone marrow are commonly used in the treatment of cancers like lymphoma, leukaemia and aplastic anaemia, for which they have heen proven to have clinical value for more than 20 years.

Stem cells are generally used to treat cancer patients with poor prognosis despite conventional chemotherapy.

Dr Ang Peng Tiam, medical director of Parkway Cancer Centre, estimated thal there are at least 200 stem-cell transplants carried out in Singapore each year for this purpose.

Such transplants have also been recently used to treat autoimmune diseases like severe cases of multiple sclerosis and lupus.

At the Singapore General Hospital, which has the biggest burns unit in the region, skin stem cells are also used to treat burns, said Dr William Hwang, the hospital's senior consultant in the department of haematology.

In the area of cosmetic surgery, plastic surgeon Waffles Wu said that stem cells play a part in fat grafts, although this is not considered stem-cell therapy.

Fat grafts are used to reconstruct the bodies of patients who have lost a breast to cancer or have body deformities due to bad liposuction.

A technical procedure is carried out on the fat to concentrate it before it is injected into the patient. This is to get rid of excess fluids like blood and serum. This leads to a higher concentration of fat and therefore a high concentration of fat tem cells.

When injected into tbe patient, the stem cells in the fat help the grafts to survive, said Dr Wu.

However, he added that he does not use stem-cell therapy as the government has not given the green light for such procedures.

The Ministry of Health (MOH) said it does not keep track of the number of doctors who carry out such treatments, but its spokesman said those providing stem·cell treatments are required to abide by the SMC's Ethical Code and Ethical Guidelines.

Article 4.1.4 of the SMC's Ethical Code and Ethical Guidelines states that a doctor should not offer to patients management plans or remedies that are not generally accepted by the profession, except in the context of a formal and approved clinical trial.

If the stem-cell treatments are found to be poorly supported by evidence, they should not be offered to patients.

A doctor who wishes to enter a patient in a clinical trial must ensure that the trial is approved by an ethics committee.

Medical practitioners here who are found flouting ethical guidelines and adrninisterlng unproven stem-cell treatments to their patients, whether in Singapore or elsewhere, will be subjected to disciplinary action, the spokesman added. She said they will be asked to stop such practices immediately.

The public should also take care to avoid unproven and possibly risky treatments. When in doubt, they should always seek a second medical opinion. she added.

In Singapore, only human stem cells are used in treatments. Animal stem cells have been used so far to study mechanisms of diseases only.

Plastic surgeon lvor Lim said he is aware that some doctors here are organising overseas trips for stem-cell beauty treatments, but he said he does not do it.

"I am a staunch believer in the role of human stem cells for wound repair and skin regeneration. But there is insufficient scientific evidence on animal stem cells used in human beings and I wouldn't dare try it," he said.

What is stem-cell therapy?

Stem cells are cells with the ability to grow into the human body's more than 200 cell types.

There are two main types of stem cells - embryonic and adult.

The former are derived from human embryos and can develop into any cell type of the body. The latter are undifferentiated cells found in a tissue or organ that can eventually yield some or all of the specialised cell types in that tissue or organ.

Stem-cell therapy is a form of treatment that uses stem cells to replace dlseased or destroyed tissues.

One of the proven ways in whlich it is used now is in bone marrow transplants, said Dr Tara Huber, senior research scientist at the Genome Institute of Singapore.

She said a patient with diseased blood cells is given radiation therapy which kills the dlseased as well as healthy blood cells. The dead cells are then replaced by bone marrow from a donor, which contains hematopoietic stem cells.

"These stem cells In the donor's bone marrow then give rise to blood cell ," she said.

The process involves taking the cells from the donor and putting them into the patient's bloodstream intravenously.

Donors have to be closely matched genetically and patients may be given medication to suppress their immune systems should there be evidence of rejection.

Dr Huber added that while It Is well established and acceptable to use stem cells in this manner, other uses of stem cells are still largely being researched.