Friday, June 30, 2006

Stanford Bioethicist Says More Monitoring Needed on California Stem Cell Research

Stanford bioethicist David Magnus says that the research rules of the California stem cell agency "lack adequate monitoring mechanisms."

His views were reported briefly in a recent piece in the Technology Review by writer Emily Singer in an article entitled "Lack of Human Eggs Could Hamper US Cloning Efforts."

Singer wrote:

"Unlike other types of human research, there are no U.S. federal guidelines governing how these experiments should be carried out. President Bush severely limited federal funding for embryonic stem cell research in 2001, including all research involving the creation of new stem cell lines. This has meant that the National Institutes of Health, the nation's largest source of biomedical funding, has not played its normal regulatory role, and individual states and research institutions have had to pick up the slack. "If there were agreed-upon national standards, it would probably speed up much of this protocol approval process," says Arnold Kriegstein, director of UCSF's stem cell program.

"Both Massachusetts and California, the latter via the California Institute of Regenerative Medicine, have recently enacted rules governing embryonic stem cell research. Both sets of guidelines prohibit paying egg donors, but do allow compensation for direct expenses, such as childcare and transportation. California takes it one step further, allowing women to be paid for time off work. It's unclear if Massachusetts law permits this practice.

"David Magnus, a bioethicist at Stanford University, says these regulatory systems lack adequate monitoring mechanisms, though. 'I think it would be an advantage to think about ways to make sure researchers are doing what they say they are going to do,' says Magnus. 'I would guess that we won't see problem with the first few institutions, which have been very careful. Problems would more likely occur down the road, when [nuclear transfer research] starts to become routine.'"
We asked Magnus for further comment on his statement. He responded:
"I made a general point and said that the CIRM rules are similar to most of our research participant protection system, which focuses on informed consent documents, protocols, etc. and very little on monitoring. We could, for example, do quality control activities that other industries have, such as taping some informed consent sessions to determine if that actual consent process does what it is supposed to do (the studies of this sort that have been done have found some problems that could be eliminated). We could also build in studies of the informed consent process into a lot of the research that gets conducted. At this point the CIRM guidelines are actually completely silent on issues that will arise in clinical trials."
Magnus also has more to say about informed consent procedures in the transcript of the June meeting of the ESC advisory committee for the California Department of Health. The group is formulating rules for ESC research in California that is not funded by CIRM.

Magnus cited informed consent procedures involving gene transfer research. He said,
"If you think of gene transfer research as a comparable, cutting-edge research, that’s a good analog to what we are talking about. There’s a lot of empirical studies about how that’s done, and the IRB’s are clearly not doing a good job. Because if you look at informed consent forms that went through IRBs, they’re full of misleading language.....There are maybe two or three studies published in the past year or two about informed consent forms and how awful they are. And that does not even count how - what actually happened in the actual consent process verbally where there’s not as much data, but what has been collected was terrible."

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