I do not understand the business ethics of neo-economics of the free market variety. However, i have heard of the following explanation by the father of modern economics, Bernard mandeville: " THE FUNDAMENTAL PRINCIPLE OF CLASSICAL ECONOMICS WAS ORGINALLYEXPRESSED IN BERNARD MANDEVILLE'S THE FABLE OF THE BEES, EVEN BEFORE ADAM SMITH. DESPITE THOSE WHO WOULD CHEAT AND STEAL, INDIVIDUALS NECESSARILY INTERACT IN A WAY THAT CAUSES SOCIETY AS A WHOLE TO PROSPER."
Maybe that is where our friends in science derive their moral strength from! There is a true story of a patient of my dad who was suffering from a kind of heart failure due to a rare and incurable disease - dilated cardiomyopathyof unknown cause - unknown to me at this point in time. The patient was well enough to go about daily chores, and even to travel extensively on holidays both in India and abroad. One day, the relatives came to ask my dad if he would permit them to take the patient to a southeastern country for SCT that would relieve the disability totally. To the best of my knowledge, SCT is only an experimental method and the last word is yet to be written. Dilatedcardiomyppathy itself does not have a good prognosis, although this particular patient was doing extremely well for the disabling condition.
Many of the readers will not understand the situation in that context. My dad was in a catch 22 situation. If he had said no and the patient died later, the blame would be on him for not allowing a wonderful possible cure. If, on the other hand, if he had okyed the transplant and the patient died after that, the blame would still be on him. He explained his position in detail. They went ahead with the procedure. The hospital there insisted that all the tests be repeated as they did not have faith in the Indian results!
Ejection fraction is an imprecise estimate of the heart's pumping capacity. Following the procedure, the patient collapsed and he had to be hospitalized in the intensive care unit at a phenomenal cost. The patient survived narrowly, and was able to return to India in a couple of weeks time. The hospital doctors wanted the patient to be brought back after three months for reassessment. A repeat EF after returning to India showed only 10 percent, whereas the hospital abroad had reported 25 percent on discharge! The patient never got back on the feet and had to be hospitalized here again. In a few days, the patient met maker in heaven, in peace.
The moral i learnt is that the stem cell claptrap is so powerful that it induces gullible patients to have the experimental procedure done. Even so-called well-informed people in society think SCT is something that will cure all ills of humankind. How i wish this were true!
Daily media reports show how poor people cannot get stem cells for varied diseases, from leukemia to maculardegeneration, because of their poverty. I personally feel that it would be good if all of them could afford the treatment. However, SCT is still only an experimental method. It needs more refinement before being used on a routine basis, and for donors and facilities to be available universally.
The present audit is not very encouraging. The seattlegroup reported only 49 percent disease-free survival for two years for those with cancers! Long term survival data shows that the benefit is the same for long term chemotherapy as well as a combination of it with SCT. In acute lymphoblastic leukemia the transplant related mortality and morbidity equals the decreased relapse rate, offsetting any benefits. For Hodgkin's disease, high dose of chemotherapy and stem cells together do not alter the prognosis. I could go on and on with similar stories for every indication for SCTs. One of my friends had assured me three years ago that by the end of 2006 all maculardegeneration patients would be able to see, as one of the research institutes in the country had assured him that it would be so. Now it is 2009, and macular degeneration still haunts the victims!
In this technological hype, we are missing the crucial point. Science could discover stem cells and alter them invitro to do what we want them to do in vivo. However, what they do once they enter the human body depends on many imponderables that we have no control over, since the human body does not follow linear laws of deterministic predictability. Rather, it follows non-linear dynamic laws of the new science of chaos, where the outcome cannot be predicted by our patchy initial knowledge of a few measurable parameters. We cannot measure millions of other parameters with the tools now in our possession. The whole area of cancer treatment is grey; and that is fertile ground for medical claptrap to work on the psyche of patients. Cancer therapy is one of the big businesses in medicine and involves billions of dollars. Naturally, the morals and ethics of neo-classic economics work there too.
Different people and societies have always held different and mutually conflicting moral beliefs. So too with scientific beliefs. "BUT THE MERE FACT OF GENUINE DISAGREEMENT DOES NOT SUPPORT THE CLAIM THAT THERE ARE NO OBJECTIVE TRUTHS, IN EITHER MORALITY OR SCIENCE" - so writes Kenneth Friedman, professor of economics in New York. Moral relativism has another danger. It is tolerant. It can tolerate Hitler as well as Mahatma Gandhi. This is frequently seen in medical science. Therefore, even when there is no objective evidence of "TRUE BENEFIT" from stem cell transplant as of now, the moral relativism ofneo-classical economics tolerates the view that is worth a try.
What we are missing in this whole drama is that there are eminently curable diseases like diarrhoea that kill children in thousands every year, in our country and elsewhere. Nearly 75 percent of children in India have nutritional immune deficiency that makes them vulnerable to fatal ailments. Starvation is also a real problem. The cost of one stem cell transplant, which might give the seriously ill child a remission of two to five years, could save thousands of poor children from avoidable death. Think about it before making a plea for stem cell transplant at taxpayers' cost, a likely step for popular governments. I make a fervent plea for parsimony in this area of uncertainty.
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