Friday, June 1, 2012

Rats learning to walk again is impressive, but 'hopemongering' is dangerous in ... - Daily Mail

By Michael Hanlon

PUBLISHED: 06:21 EST, 1 June 2012 | UPDATED: 06:21 EST, 1 June 2012

Journalists who write about health and science are often accused of scaremongering. Coffee will kill you, meat will give you cancer, watch out for those mobile phones!

Usually these stories emerge from research papers or reviews published in reputable peer-reviewed journals and the media have a duty to report them. But sometimes they do not, and in these cases we must be careful.

The opposite of scaremongering is hopemongering and although this sounds like a crime of omission and not a bad thing at all really, the reality is that giving false hope can be just as damaging as creating an unnecessary panic.

Climbing the steps: Researchers used electrochemical stimulation to restore voluntary movement to rats, but it could be decades before humans can receive such treatment

Climbing the steps: Researchers used electrochemical stimulation to restore voluntary movement to rats, but it could be decades before humans can receive such treatment

And nowhere is this more the case, I believe, than in the field of spinal injury research.

Over the past 20 years or so there have been a number of very interesting papers published in some very reputable journals that appear to give ‘fresh hope’ to people who have been paralysed by damage to their spinal cord, the body’s wiring loom, essentially, which carries messages from the brain to the muscles.

The research has often involved attempts to regenerate spinal tissue using stem cells or, as in the case of some rather dramatic research published in the journal Science this week by Swiss scientists, by using a mixture of chemicals and electrical stimulation to encourage regrowth of damaged nerves bypassing the site of injury.

And about a decade ago I began to feel very uneasy about reporting this research. Not because it is not valid; it is.

Breakthrough? After only a few weeks of stimulation, nerve connections begin to grow again in the rats

Breakthrough? After only a few weeks of stimulation, nerve connections begin to grow again in the rats

But because when I did, even when I made absolutely sure all the caveats were there â€" that these are preliminary findings, that the ‘success’ of the experiment was limited and, most importantly, that in nearly all cases these studies have been carried out in rats or mice not people â€" the letters would start arriving, heart-breaking missives from people who had been paralysed or, worse, the parents of children who had suffered this terrible fate.

Letters asking when this breakthrough would mean they could walk again, requests, always polite, for the contact details of the scientists behind the research.

I would have to explain that yes, this is exciting news, but when you are talking about preliminary experimentation in rats it will be years at best, decades at worst before this will realistically lead to treatments being offered on the NHS.


 'It seems crazy that in a world of so many medical marvels we cannot fix a simple wiring problem and make people walk again'  

Our reaction to paralysis is, I believe, qualitatively different to most other serious conditions.

Yes there is always hope that a ‘cure for cancer’ is just around the corner but the grim reality, that ‘cancer’ is not a single disease but a host of conditions that will need to be tackled along numerous fronts in a long, grinding war of attrition, is beginning to sink in.

We do not expect magic bullets for heart disease or for stroke or Alzheimer’s because we accept that these are complex conditions that affect different people in different ways and (in the case of the latter two illnesses) an organ, the brain, whose functioning we really do not understand.

But there is something about spinal injuries that sounds so arbitrary, so mechanical, and so trivial on one level. It seems monstrous that simply severing some cables can lead to such profound, tragic, life-changing effects. I once interviewed a man who had been in the Marines. One day he woke up a superfit, super-strong athlete-soldier.

Then, taking part in routine circuit training, he fell badly, broke his back. No long illness, no slow and steady decline, no infection.

Just slam, bang, old life over and welcome to the new world of wheelchairs and hoists, home carers and bed baths and a million other indignities (and in this chap’s case not a shred of self-pity to go with it).

Christopher Reeve, pictured with wife, Dana, was paralysed and continually vowed to work again until he died in 2004

Christopher Reeve, pictured with wife, Dana, was paralysed and continually vowed to work again until he died in 2004

So no wonder that anything which appears to give hope is so eagerly seized upon by people suffering from something that seems so unfair and (so many hope) temporary.

It seems crazy that in a world with so many marvels where we have mapped the human genome and created synthetic DNA, where we are working on artificial organs have most of the major infectious diseases in our sights that we cannot fix a simple wiring problem and make people walk again.

So what about this latest research? The scientists, in Lausanne, partially severed the spinal cord in a number of rats, artificially inducing paralysis in their lower body.

Then, using a combination of drugs injected into the spinal cord - drugs which stimulate the production of the neurotransmitters serotonin and dopamine - and electrical simulation, the rats were trained to walk again.

The results are quite impressive and after several days’ of training the animals were able to trot along a treadmill and even climb stairs.

Impressive, but, once again, we must be mindful of hopemongering. There are several aspects of this research that suggest that any application in humans is a long way away.

Firstly, and obviously, this is an ‘animal model’. Rats are mammals like us and their basic body architecture and biochemistry is pretty similar but there are profound differences too. The way the rat brain is wired up and the way it communicates with its body differs from that in humans in many ways.

Then there was the nature of the ‘injury’ used in this experiment, a careful and precise partial severing of the spinal nerves using a scalpel. In real life spinal injuries in people tend not to be like this.

More often than not there is not a simple tear or break but extensive bruising and inflammation. Real life is messy and a world away from the lab.

Then there is the fact that the rehabilitated rats were far from independent. They required a continuous stimulation by both chemicals and electricity to be able to walk This was far from being a simple walk-away fix, something the scientists accept fully.

So can we be even a bit hopeful? Yes, insofar as this is interesting research that appears to be going in the right direction. But we are a long, long way from being able to say that a cure for paralysis lies just around the corner.

The brutal reality is that funding for research into these injuries is limited thanks to the fact that in global terms paralysis is, thankfully, quite rare. Drug companies will not invest huge amounts of money into research that may produce little profit.

So, once again, we have to say that we must keep our hope on hold.

Christopher Reeve, the actor most famous for playing Superman, always said he would walk again after being paralysed in a riding accident.

He was a passionate supporter of stem cell research. But, sadly, Reeve died in 2004, still paralysed.

My guess is that barring a dramatic breakthrough of the sort that is becoming increasingly rare in medicine, as the low-hanging fruit get picked off one by one, we will have to wait many decades before  rewiring the human spine becomes a clinical reality.   

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