Tuesday, March 27, 2012

Paradigm, Paradigm, uber alles!


JAMA published a study looking at the effects of bone marrow derived stem cells on patients with heart failure.  Predictably, the study did not demonstrate significant benefits for the patients who actually received the stem cells as compared to the placebo group, which is not an uncommon outcome in these kinds of stem cell therapy trials.

From a scientific perspective, what is important is that the underlying (and unstated) paradigm is preserved.  In this case, as in virtually any other in this area, the putative stem cells are used precisely like a drug would be used, as a stand alone intervention.  Which is precisely the inverse of what in vivo tissue regeneration is.  And rather than the methodology, which is biologically unsound (well, it is really absurd, but if that is written folks get offended), is unshakeable, so the discussion degenerates to a mostly morally driven discussion about the 'value' of the autologous pluripotent bone marrow cells use here and the vaunted 'embryonic stem cell."   The value of virginal stem cells has significant appeal independent of efficacy and a constituency that has significant economic interest in their use, but 'parts is parts' as the story goes.  The elusive feature is the dangerous one as well.  The gruelingly childish, no, make that magical, idea that investigations in biology require careful manipulation of a single variable at a time is not supportable, not true and virtually impossible.  But aside from that, even if it were possible to operationalize, it is contrary to the basic of biological activity.  All biologic emerges within a recursively non-linear milieu and is wholly dependent upon that milieu for initial trajectory and outcomes.  Without concurrent nurturing (whatever that may mean) of the context, the milieu for stem cells, there is no plausible reason to expect any enduring efficacy.  But it's "Paradigm, paradigm, uber alles!" in the stem cell field for the foreseeable future, at least in the mainstream of medical research, however backwater it really is.