European perspectives on therapeutic cloning

Human Embryonic Stem Cell Research, Abortion, and Publication Bias in the New England Journal of Medicine

Publication bias in medical journals depends on outside influences and the particular ideological bent of the editorial board. The New England Journal of Medicine (NEJM) is a premier medical scientific publication having among the highest impact rankings of any research journal. The Vioxx question and industry ties it highlighted have led to legitimate questions of whether significant conflicts of interest have arisen within NEJM that compromise the free exchange of scientific information and ideas. Over the past two decades, several socially charged areas have been treated with considerable bias in the editorial policy of NEJM, including the issues of human embryonic stem cell research and abortion. From 2000 to 2017, NEJM published over twenty pieces favorable toward human embryonic stem cell research and over fifty pieces favorable to abortion, with virtually no publication of contrary opinion. An aggressive editorial defense of Planned Parenthood Federation most recently seems particularly striking. A secular journal which is meant to represent the entire spectrum of physician opinion in controversial issues has a practical, if not also an ethical, responsibility to provide an unbiased forum for intelligible discussion for evaluation of the merits of particular issues. To do otherwise is publication bias that suppresses legitimate contrary viewpoints having merit and validity.

NONTECHNICAL SUMMARY

Publication bias in medical journals is detrimental to the free exchange of ideas regarding controversial issues. From 2000 to 2017, a premier publication, the New England Journal of Medicine (NEJM), has shown considerable bias in only publishing articles and editorials highly favorable toward human embryonic stem cell research and abortion, without permitting valid discussion and publication of contrary opinion. The recent strong editorial defense by NEJM of Planned Parenthood Federation in their sale of aborted fetal body parts seems particularly striking and disproportionate. Publication bias suppresses legitimate contrary viewpoints with merit and validity, suppressing fair debate in controversial issues.

Aspects on properties, use and ethical considerations of embryonic stem cells - A short review

Mammalian embryonic stem cells have the potential to differentiate into all cell types of an adult individual. The culturing of human embryonic stem cells renders possible studies that were previously only available in animal models. Embryonic stem cells constitute a particularly attractive tool for studies of self-renewal, commitment, differentiation, maturation and cell-cell interaction. There is currently considerable hope that studies of embryonic stem cells will lead to new therapies; either by themselves, through cell replacement strategies, or by generating results assisting other fields of research to reach clinical results. There are, however, considerable challenges to be met before embryonic stem cells can be used in large-scale clinical trials.Stem cell research is an area that has given rise to much debate internationally, within science, law and politics as well as within philosophy and ethics. The ethical attitudes expressed in the public debate over stem cell research notably divide over three important distinctions: (1) Reproductive versus therapeutic cloning; (2) Using already existing embryos versus producing new embryos for research purposes; (3) Production of embryos from eggs and sperm versus through somatic-cell nuclear transfer. The potential medical benefits that may result from embryonic stem cell research arguably support a continued development in this area. However, some opponents argue that this research offends the (relative or absolute) moral status of an unborn human. Furthermore, the research would probably prove to be a both time-consuming and very expensive method for treating disease. Thus, the questions arise whom the new technique wouldbenefit and at what cost, if ever developed.

The Ethics of the Treatment of Spinal Cord Injury: Stem Cell Transplants, Motor Neuroprosthetics, and Social Equity

The intense desire for a "cure" in individuals with spinal cord injury (SCI) has resulted in the transplantation of stem cells and embryonic and other cell types into the injured spinal cord to enable limb function. We review the ethical issues concerning the procurement and use of embryonic stem cells. A brief survey of the current state of human SCI transplantation is presented. We explore the interface between basic science and the clinical management of SCI and discuss the ethical issues of therapy. At what point is it ethical to conduct human experiments when the experimental data is still at an early stage of development? Is it ethical to perform these operations on a vulnerable group of patients without adequate scientific controls and analysis of the results? Motor neuroprosthetics is developing rapidly and will enable limb movement controlled by the paralyzed patient and other device control such as wheelchairs and communication boards. How can there be a more equitable distribution of such expensive technology and other treatments of SCI? Both clinicians and scientists should be mindful of these complex ethical issues when undertaking pioneering therapies for patients with SCI.

The use of personal data from medical records and biological materials: ethical perspectives and the basis for legal restrictions in health research

This paper discusses the moral justification for using personal data without informed consent, from both medical records and biological materials, in research where subjects are not physically present in the study and will never have any contact with the study investigators. Although the idea of waiving the requirement for informed consent in certain investigations has been mentioned in several ethical guidelines formulated by epidemiologists and physicians since the late 1980s, these guidelines are now of limited use due to legal restrictions on the use of personal data in most western countries. Several misconceptions that form the basis for legal restriction of health research are discussed: lack of knowledge of the need to link personal information from health services with personal information produced outside the health system in many biomedical investigations; the assumption of a deterministic model of disease causation in which the prediction of disease occurrence is based on a genetic association despite the fact that most genotypes for common diseases are incompletely penetrant; the lack of a logical rationale for the recommendation in the Declaration of Helsinki that only research that offers some benefit to study subjects is justified; the great lack of knowledge about research methodology revealed in some alternatives proposed to avoid using personal data; and the lack of a debate about the ethical double standard of institutions and investigators in countries that prohibit the use of personal data but finance and carry out studies in other countries where it is permitted.

Stem-cell therapy for renal diseases

Significant attention is currently directed to the biological and therapeutic capabilities of stem cells for developing novel treatments for acute and chronic kidney diseases. To date, viable sources of stem cells for renal therapies include adult bone marrow and embryonic tissues, including the metanephric mesenchyme and mesonephros. Native adult kidney stem cells have yet to be identified. Systemically introduced stem cells can engraft in sites of renal disease and injury to show donor phenotypes. Stem cells can differentiate into cells similar to glomeruli, mesangium, and tubules in the kidneys. The impact of stem-cell engraftment and differentiation on renal function presently is unknown. Identification of renal diseases treatable with stem-cell therapies is expected to evolve as stem-cell technologies advance. Methods of modifying stem cells to improve homing, differentiation, and integration into host tissues need further characterization. Ethical and legal controversies about embryonic research and cloning are shaping the regulation and funding of stem-cell research for kidney diseases. Scientific and clinical understanding of stem cells and their potential for renal treatments are in the early stage of development. This field offers great promise, and there are significant opportunities for future investigation in clinical, biological, and ethical aspects of stem-cell therapy for kidney diseases.