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    NASA's wickedly up & down week: broader lessons about science and medicine
    By Paul Knoepfler | August 12th 2012 01:00 PM | 2 comments | Print | E-mail | Track Comments
    About Paul

    Associate Professor of Cell Biology and Human Anatomy at UC Davis School of Medicine. Long-time stem cell and cancer scientist. Cancer survivor...

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    All science, whether biology or physics, whether microscopic or at the solar system level, is about experiments.

    Sometimes we as a society forget that.

    In fact, experiments are at the heart of investigations as diverse as studying cells to exploring space to medical treatments.

    For NASA, the last week has been a tale of two wickedly different experimental outcomes. As much as scientists hope for a "no fail" string of experimental successes that is unrealistic.

    http://youtu.be/9oLaC1VYoTM

    First, on Monday (August 6) NASA had the astonishing success of landing its rover Curiosity on the surface of Mars within 2 miles of its target landing zone after a nearly 400 million mile journey. The whole Curiosity project is really one giant experiment composed of many different high-risk steps/smaller experiments. It is far from over, but Curiosity has already passed several of the highest risk steps. The launch itself was risky in a sense as Curiosity is powered with plutonium. Should it have blown up (as frequently happens with space craft-see below) on Earth or in Earth's atmosphere, it could have been disastrous. Then the spacecraft successfully landed on Mars after a high-risk, highly experimental mode of descent. Taken together, so far Curiosity is an enormously successful experiment that will go on for many years providing data of great use. For more on Curiosity and the latest photos, regularly check out this awesome site that is regularly updated.

    Second, only three days later, NASA had a neck-snapping opposite outcome for another experiment. NASA had its prototype lander, Morpheus, planned for future lunar explorations literally go up in flames during a test and blow up. A disastrous outcome for this $7 million experiment in space exploration.

    http://youtu.be/yZPnTK3Bhgw

    However, scientists know that experiments will often fail. For example, as much as they are painful, NASA budgets for failures of this kind.

    My field of biomedical science is highly experimental too and this is true of even clinical medicine. The treatment of every individual patient is really an experiment because people are so different and each disease (even if called by the same name) is actually at the very least a bit different. In most cases the treatments for patients are not high-risk because the treatment in question (e.g. drug or surgery) has gone through year's of experiments starting in labs and going through clinical trials.

    However, imagine the level of risk for unproven medical treatments. The level of risk is extraordinarily high and patients are the guinea pigs. For example, unproven stem cell treatments given by dubious for-profit clinics to vulnerable patients are super high risk experiments at heart. Unlike most science, these experiments on patients suffer from another challenge and that is that the doctors conducting these experiments have one main motif: profit.

    As any scientist with real life experience will tell you, most often experiments fail. When an experiment in my lab in test tubes or on cells in a plastic dish fails, it is unfortunate, but we can throw it out and start anew, hopefully having learned something from the experience.

    When a NASA experiment fails, millions of dollars may be down the toilet, but again hopefully scientists learn and assuming no astronauts were involved, no life is lost. However, indeed some astronauts have lost their lives. I admire their courage and it is notable that astronauts go into these experiments knowing their lives are at risk.

    But when for-profit clinics experiment on patients, if the experiment fails the patient can die. A truly catastrophic blow up.

    Since the clinics often fool patients into thinking the risk is low, one might argue there is no informed consent for the patient and they may die or be permanently injured without having known in advance of the true risk.

    The recent FDA legal win in a federal court giving them explicit authority to regulate treatments using grown stem cells and to classify stem cells grown and multiplied up to 1,000-fold as "Drugs" is at heart recognizing the reality that these stem cell treatments are experiments. In my opinion, a recent WSJ editorial a few days ago arguing against that court ruling for the FDA totally missed the boat on the risks involved.

    One of the hardest and most important lessons for scientists as they "grow up" in the lab or the field during their careers, is that most experiments will fail. I'm not sure the doctors running dubious stem cell clinics ever learned that lesson and this may in the end be part of the reason why they are so willing to conduct what are in reality experiments on vulnerable patients to try to make money.

    If you are a patient reading this, I urge you to go into any possible treatment with your eyes open that what you are really doing is being a subject of an experiment. Check out my list of top 10 things you need to know as a patient considering one of these therapies in my patients guide to stem cell treatments. I also am doing a global educational outreach program (SCOPE) on stem cells that has a basic fact sheet on stem cells in 19 languages and counting. Learn about stem cells in your native language if you choose there.

    If I were in your shoes as a patient (or the friend or loved one of a patient), I'd opt instead for a scientist-run, rigorously monitored clinical trial of stem cell therapies. You can find a clinical trial using my handy dandy list of stem cell clinical trials for your disease of interest with just a couple clicks.

    Comments

    Hank
    A failure is a good sign for NASA where it can be a very bad thing in medicine; the difference is human life.  Now that NASA has stopped trying to drum up Apollo 11-level enthusiasm for the space program, it no longer has to agonize over a zero-defects mentality that cripples their ability to actually do anything. It's okay if robots die.

    I think the ruling is a big win for patients and science; the hype around stem cells was created by the culture war last decade and, like NASA, biologists can instead settle into figuring out what the real science sweet spot is because the cranks capitalizing on hype will get drummed out.
    pknoepfler
    This is a great point, Hank. The "no failure" mentality at NASA was harmful to creativity and productivity.
    Paul S. Knoepfler, Ph.D. Associate Professor UC Davis School of Medicine http://www.ipscell.com