American Medical Association approves stem cell researchBMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7404.1417-a (Published 26 June 2003) Cite this as: BMJ 2003;326:1417
Doctors' participation in cloning stem cells for research and treatment—but not for making babies—is consistent with medical ethics and was approved by the American Medical Association's House of Delegates at its annual meeting in Chicago last week.
The new recommendations will be submitted to a medical journal for publication; meanwhile a summary is posted on the news section of the association's website (www.ama-assn.org).
There is no conflict between the recommendations and the Bush administration's opposition to all research involving cloning, said Dr Michael Goldrich, chairman elect of the association's council on ethical and judicial affairs. He said that President Bush's stance related to federal funding for stem cell research, whereas the association's report “gives guidance to physicians.”
The council has been considering stem cell cloning for three years. It supports the present moratorium on human cloning.
President Bush opposes all cloning on ethical grounds and has restricted funding and research to existing cell lines. Although there are 64 stem cell lines, some are privately held, and only about 11 are available for research. Dr Goldrich, who is an otolaryngologist and clinical assistant professor at the University of Medicine and Dentistry of New Jersey, New Brunswick, said researchers were concerned that there was not enough diversity. Stem cells from discarded embryos at fertility clinics could be used for treatment purposes, but that would require long term immunosuppression of the recipient.
The new recommendations say that it might become possible to use stem cells to replace diseased or damaged tissue or to deliver genes or proteins in gene therapy. “The ability to isolate human embryonic stem cells has rekindled expectations that these cells will play a major role in regenerative medicine,” said the association's press release.
Somatic cell nuclear transfer, used for therapeutic cloning, produces “designer stem cells” that are unique to each patient. Because the patient's own cells are used, immunosuppression is not necessary. In this technique the nucleus is removed from a donor oocyte and is replaced by the nucleus from one of the patient's somatic cells. The egg is incubated in a solution to produce cell division. After a few days the stem cells are harvested from the embryo and can be used to treat the patient's disease.
Dr Goldrich said, “This is a very active area of research, with implications for diabetes, neurological disorders, Lou Gehrig's disease [amyotrophic lateral sclerosis], Parkinson's disease, Alzheimer's disease, and cardiovascular research. Already, injections of stem cells into the heart have been used to regenerate muscle tissue. On the horizon is the ability to grow tissue and organs.” He said that stem cells had already been used to regenerate muscle tissue in research in Brazil (3 May, p 950).
The technique can also be used in basic research to understand molecular and cellular events underlying human disease.
Some doctors and religious groups oppose all cloning. One opponent, Dr John McMahon, a surgeon from Helena, Montana, told United Press International, “Two cells make a baby.”
The new recommendations say that a doctor may decide not to take part in research using stem cells derived from cloned embryos. “If the doctor is uncomfortable doing the research or using the technique, he or she has an obligation to the patient and should refer the patient to another physician [who is using the technique],” Dr Goldrich said.
The recommendations also call for oversight and monitoring, probably by a federal agency. Patients involved in stem cell research must participate voluntarily and must receive full information about risks and benefits.