CIRM public events highlight uncertain future of stem cell research

When governments cut funding for scientific research the consequences can be swift, and painful. In Canada last week for example, the government of Ontario cut $5 million in annual funding for stem cell research, effectively ending a project developing a therapy to heal the damaged lungs of premature babies.

Here in the US the federal government is already placing restrictions on support for fetal tissue research and there is speculation embryonic stem cell research could be next. That’s why agencies like CIRM are so important. We don’t rely on a government giving us money every year. Instead, thanks to the voters of California, we have had a steady supply of funds to enable us to plan long-term and support multi-year projects.

But those funds are due to run out soon. We anticipate funding our last new awards this year and while we have enough money to continue supporting all the projects our Board has already approved, we won’t be able to take on any new projects. That’s bad news for the scientists and, ultimately, really bad for the patients who are in need of new treatments for currently incurable diseases.

We are going to talk about that in two upcoming events.

UC San Diego Sanford Stem Cell Clinical Center

The first is a patient advocate event at UC San Diego on Tuesday, May 28th from 12.30pm to 1.30pm. It’s free, there is parking and snacks and refreshments will be available.

This will feature UC San Diego’s Dr. Catriona Jamieson, CIRM’s President and CEO Dr. Maria Millan and CIRM Board member and Patient Advocate for Parkinson’s Disease, David Higgins PhD. The three will talk about the exciting progress being made at UC San Diego and other programs around California, but also the uncertain future and the impact that could have for the field as a whole.

Here’s a link to an Eventbrite page that has more information about the event and also a link to allow you to RSVP ahead of time.

For all of you who don’t live in the San Diego Area – or who do but can’t make it to the event – we are holding a similar discussion online on a special Facebook Live: Ask the Stem Cell Team About the Future of Stem Cell Research event on Thursday, May 30th from noon till 1pm PDT.

This also features Dr. Millan and Dr. Higgins, but it also features UC Davis stem cell scientist, CIRM-grantee and renowned blogger Paul Knoepfler PhD.

Each brings their own experience, expertise and perspective on the field and will discuss the impact that a reduction in funding for stem cell research would have, not just in the short term but in the long run.

Because we all have a stake in what happens, both events – whether it’s in person or online – include time for questions from you, the audience.

You can find our Facebook Live: Ask the Stem Cell Team About the Future of Stem Cell Research on our Facebook page at noon on May 30th PDT

The Past, the Present, and the Uncertain Future of Stem Cell Research

Ronnie, a boy who was born without a functioning immune system but who is thriving today because of CIRM funded research

When CIRM was created in 2004 the field of stem cell research was still very much in its infancy. Fast forward 15 years and it’s moving ahead at a rapid pace, probably faster than most scientists would have predicted. How fast? Find out for yourself at a free public event at UC San Diego on May 28th from 12.30 to 1.30p.

In the last 15 years CIRM has funded 53 clinical trials in everything from heart disease and stroke, to spinal cord injury, vision loss, sickle cell disease and HIV/AIDS.

UCSD was one of the first medical centers chosen to host a CIRM Alpha Stem Cell Clinic – a specialist center with the experience and expertise to deliver stem cell therapies to patients – and to date is running more than a dozen clinical trials for breast cancer, heart failure, leukemia and chronic lower back pain.

Clearly progress is being made. But the field is also facing some challenges. Funding at the federal level for stem cell research is under threat, and CIRM is entering what could be its final phase. We have enough money left to fund new projects through this year (and these are multi-year projects so they will run into 2021 or 2022) but unless there is a new round of funding we will slowly disappear. And with us, may also disappear the hopes of some of the most promising projects underway.

If CIRM goes, then projects that we have supported and nurtured through different phases of research may struggle to make it into a clinical trial because they can’t get the necessary funding.

Clearly this is a pivotal time in the field.

We will discuss all this, the past, the present and the uncertain future of stem cell research at the meeting at UC San Diego on May 28th. The doors will open at noon for registration (snacks and light refreshments will also be available) and the program runs from 12.30p to 1.30p.

The speakers are:

  • Dr. Catriona Jamieson, Director of the UC San Diego Health CIRM Alpha Stem Cell Clinic and Sanford Stem Cell Clinical Center.
  • Dr. Maria Millan, President and CEO of CIRM
  • Dr. David Higgins, CIRM Board member and Patient Advocate for Parkinson’s Disease.

And of course, we want to hear from you, so we’ll leave plenty of time for questions.

Free parking is available.

Go here for more information about the event and how you can register

Free free to share this with anyone you think might be interested in joining us and we look forward to seeing you there.

Advancing stem cell research in many ways

Speakers at the Alpha Stem Cell Clinics Network Symposium: Photo by Marco Sanchez

From Day One CIRM’s goal has been to advance stem cell research in California. We don’t do that just by funding the most promising research -though the 51 clinical trials we have funded to date clearly shows we do that rather well – but also by trying to bring the best minds in the field together to overcome problems.

Over the years we have held conferences, workshops and symposiums on everything from Parkinson’s disease, cerebral palsy and tissue engineering. Each one attracted the key players and stakeholders in the field, brainstorming ideas to get past obstacles and to explore new ways of developing therapies. It’s an attempt to get scientists, who would normally be rivals or competitors, to collaborate and partner together in finding the best way forward.

It’s not easy to do, and the results are not always obvious right away, but it is essential if we hope to live up to our mission of accelerating stem cell therapies to patients with unmet medical needs.

For example. This past week we helped organize two big events and were participants in another.

The first event we pulled together, in partnership with Cedars-Sinai Medical Center, was a workshop called “Brainstorm Neurodegeneration”. It brought together leaders in stem cell research, genomics, big data, patient advocacy and the Food and Drug Administration (FDA) to tackle some of the issues that have hampered progress in finding treatments for things like Parkinson’s, Alzheimer’s, ALS and Huntington’s disease.

We rather ambitiously subtitled the workshop “a cutting-edge meeting to disrupt the field” and while the two days of discussions didn’t resolve all the problems facing us it did produce some fascinating ideas and some tantalizing glimpses at ways to advance the field.

Alpha Stem Cell Clinics Network Symposium: Photo by Marco Sanchez

Two days later we partnered with UC San Francisco to host the Fourth Annual CIRM Alpha Stem Cell Clinics Network Symposium. This brought together the scientists who develop therapies, the doctors and nurses who deliver them, and the patients who are in need of them. The theme was “The Past, Present & Future of Regenerative Medicine” and included both a look at the initial discoveries in gene therapy that led us to where we are now as well as a look to the future when cellular therapies, we believe, will become a routine option for patients. 

Bringing these different groups together is important for us. We feel each has a key role to play in moving these projects and out of the lab and into clinical trials and that it is only by working together that they can succeed in producing the treatments and cures patients so desperately need.

Cierra Jackson: Photo by Marco Sanchez

As always it was the patients who surprised us. One, Cierra Danielle Jackson, talked about what it was like to be cured of her sickle cell disease. I think it’s fair to say that most in the audience expected Cierra to talk about her delight at no longer having the crippling and life-threatening condition. And she did. But she also talked about how hard it was adjusting to this new reality.

Cierra said sickle cell disease had been a part of her life for all her life, it shaped her daily life and her relationships with her family and many others. So, to suddenly have that no longer be a part of her caused a kind of identity crisis. Who was she now that she was no longer someone with sickle cell disease?

She talked about how people with most diseases were normal before they got sick, and will be normal after they are cured. But for people with sickle cell, being sick is all they have known. That was their normal. And now they have to adjust to a new normal.

It was a powerful reminder to everyone that in developing new treatments we have to consider the whole person, their psychological and emotional sides as well as the physical.

CIRM’s Dr. Maria Millan (right) at a panel presentation at the Stanford Drug Discovery Symposium. Panel from left to right are: James Doroshow, NCI; Sandy Weill, former CEO Citigroup; Allan Jones, CEO Allen Institute

And so on to the third event we were part of, the Stanford Drug Discovery Symposium. This was a high level, invitation-only scientific meeting that included some heavy hitters – such as Nobel Prize winners Paul Berg and  Randy Schekman, former FDA Commissioner Robert Califf. Over the course of two days they examined the role that philanthropy plays in advancing research, the increasingly important role of immunotherapy in battling diseases like cancer and how tools such as artificial intelligence and big data are shaping the future.

CIRM’s President and CEO, Dr. Maria Millan, was one of those invited to speak and she talked about how California’s investment in stem cell research is delivering Something Better than Hope – which by a happy coincidence is the title of our 2018 Annual Report. She highlighted some of the 51 clinical trials we have funded, and the lives that have been changed and saved by this research.

The presentations at these conferences and workshops are important, but so too are the conversations that happen outside the auditorium, over lunch or at coffee. Many great collaborations have happened when scientists get a chance to share ideas, or when researchers talk to patients about their ideas for a successful clinical trial.

It’s amazing what happens when you bring people together who might otherwise never have met. The ideas they come up with can change the world.

Facebook Live: Ask the Stem Cell Team About Clinical Trials

Every day at CIRM we get emails and calls from people looking for a stem cell clinical trial to help them. Some have arthritis in the knee or hip and want to avoid surgery. Some have a child with autism and want something that will ease the symptoms. Some have cancer and conventional therapies no longer work for them. Many have run out of options. Some are running out of time.

It’s hard to tell someone who is desperate that you don’t have anything that can help them, that there are no stem cell clinical trials that would be appropriate for them. Many often push back, saying they’ve seen ads online and visited websites for companies that claim to have stem cell therapies that can help them. When I say those therapies have not been approved by the Food and Drug Administration, or even been shown to be safe let alone effective, I can hear the disappointment in their voice.

I know some will go on to try those therapies anyway, because they have nothing else. I don’t blame them. I might do the same myself.

But before making an informed decision about any therapy it is important for people to have all the facts in front of them.

That’s why we are holding a special Facebook Live “Ask the Stem Cell Team About Clinical Trials” event on Thursday, April 25th from noon till 1pm PDT.

We are bringing together three experts who will help us all understand what’s a good clinical trial, and what’s a bogus one. They will talk about:

  • Red flags that a stem cell “clinic” might be more interested in making money than making you better
  • Key things to look for to choose a bona fide stem cell clinical trial
  • What are the questions you need to ask before signing up for any clinical
  • What are good sources of information to turn to for guidance

The Stem Cell Team will talk about CIRM’s Alpha Stem Cell Clinics Network, contrasting the time and resources they devote to offering patients stem cell clinical trials that are endorsed by the FDA, with clinics that promise people their own fat or blood cells can fix everything from bad knees to multiple sclerosis.

Our experts include a doctor and a nurse from the Alpha Clinics Network with years of experience in running and managing clinical trials, plus our own Geoff Lomax who helps support the entire network.

It will be an eye opening, informative and engaging hour and we want you to be part of it.  You can either join us on the day and post questions for the panel to answer, or you can email them directly to us beforehand at info@cirm.ca.gov.

Also, be sure to “like” our FaceBook page before the event to receive a notification when we’ve gone live for this and future events. If you can’t watch the broadcast “live”, not to worry, we’ll be posting it on our Facebook video page, our website, and YouTube channel shortly afterwards.

In the days leading up to the broadcast we’ll give you the broadcast link that will take you to the event itself.

We look forward to having you join us for this really important Facebook Live event.

If you are in the San Francisco Bay Area this week you can join us at our fourth Annual CIRM Alpha Stem Cell Clinics Network Symposium where the topic of how to choose a clinical trial that’s right for you will be front and center.

The symposium is on Thursday, April 18th from 8.30am to 4.30pm. It’s open to the public and it’s free.

You can find details about the event, including how you can register, HERE.

Mending Stem Cells: The Past, Present & Future of Regenerative Medicine

UCSF’s Mission Bay Campus

For years we have talked about the “promise” and the “potential” of stem cells to cure patients. But more and more we are seeing firsthand how stem cells can change a patient’s life, even saving it in some cases. That’s the theme of the 4th Annual CIRM Alpha Stem Cell Clinics Network Symposium.

It’s not your usual symposium because this brings together all the key players in the field – the scientists who do the research, the nurses and doctors who deliver the therapies, and the patients who get or need those therapies. And, of course, we’ll be there; because without CIRM’s funding to support that research and therapies none of this happens.

We are going to look at some of the exciting progress being made, and what is on the horizon. But along the way we’ll also tackle many of the questions that people pose to us every day. Questions such as:

  • How can you distinguish between a good clinical trial offering legitimate treatments vs a stem cell clinic offering sham treatments?
  • What about the Right to Try, can’t I just demand I get access to stem cell therapies?
  • How do I sign up for a clinical trial, and how much will it cost me?
  • What is the experience of patients that have participated in a stem cell clinical trial?

World class researchers will also talk about the real possibility of curing diseases like sickle cell disease on a national scale, which affect around 100,000 Americans, mostly African Americans and Hispanics. They’ll discuss the use of gene editing to battle hereditary diseases like Huntington’s. And they’ll highlight how they can engineer a patient’s own immune system cells to battle deadly cancers.

So, join us for what promises to be a fascinating day. It’s the cutting edge of science. And it’s all FREE.

Here’s where you can go to find out more information and to sign up for the event.

Mending Stem Cells: The Past, Present and Future of Regenerative Medicine

To Mend: (verb used with object) to make (something broken, worn, torn or otherwise damaged) whole, sound or usable by repairing.

It’s remarkable to believe, but today doctors literally have the tools to repair damaged cells. These tools are being used to treat people with diseases that were once incurable. The field of regenerative medicine has made tremendous progress in the last 15 years, but how did these tools come about and what is the experience of patients being treated with them?

These questions, and hopefully yours too, are going to be answered at the fourth annual CIRM Alpha Stem Cell Clinics Symposium on April 18, 2019 at the University of California at San Francisco.

UCSF Mission Bay Campus

The symposium is free, and the program is designed with patients and the public in mind, so don’t be shy and put your scientific thinking caps on! A complete agenda may be found here

Perhaps one of the most remarkable discoveries in the past decade are new tools that enable doctors to “edit” or correct a patient’s own DNA. DNA correction tools came about because of a remarkable string of scientific breakthroughs. The symposium will dive into this history and discuss  how these tools are being used today to treat patients.

One specific example of the promise that DNA editing holds is for those with sickle cell disease (SCD), a condition where patients’ blood forming stem cells contain a genetic error that causes the disease. The symposium will describe how the CIRM Alpha Stem Cell Clinics Network, a series of medical centers across California whose focus is on stem cell clinical trials, are supporting work aimed at mending blood cells to cure debilitating diseases like SCD.

Doctors, nurses and patients involved with these trials will be telling their stories and describing their experiences. One important focus will be how Alpha Clinic teams are partnering with community members to ensure that patients, interested in new treatments, are informed about the availability of clinical trials and receive sufficient information to make the best treatment choices.

The fourth annual CIRM Alpha Stem Cell Clinics Symposium is an opportunity for patients, their families and the public to meet the pioneers who are literally mending a patients own stem cells to cure their disease.

For registration information go here.


71 for Proposition 71

Proposition 71 is the state ballot initiative that created California’s Stem Cell Agency. This month, the Agency reached another milestone when the 71st clinical trial was initiated in the CIRM Alpha Stem Cell Clinics (ASCC) Network. The ASCC Network deploys specialized teams of doctors, nurses and laboratory technicians to conduct stem cell clinical trials at leading California Medical Centers.

StateClinics_Image_CMYK

These teams work with academic and industry partners to support patient-centered for over 40 distinct diseases including:

  • Amyotrophic Lateral Sclerosis (ALS)
  • Brain Injury & Stroke
  • Cancer at Multiple Sites
  • Diabetes Type 1
  • Eye Disease / Blindness Heart Failure
  • HIV / AIDS
  • Kidney Failure
  • Severe Combined Immunodeficiency (SCID)
  • Sickle Cell Anemia
  • Spinal Cord Injury

These clinical trials have treated over 400 patients and counting. The Alpha Stem Cell Clinics are part of CIRM’s Strategic Infrastructure. The Strategic Infrastructure program which was developed to support the growth of stem cell / regenerative medicine in California. A comprehensive update of CIRM’s Infrastructure Program was provided to our Board, the ICOC.

CIRM’s infrastructure catalyzes stem cell / regenerative medicine by providing resources to all qualified researchers and organizations requiring specialized expertise. For example, the Alpha Clinics Network is supporting clinical trials from around the world.

Many of these trials are sponsored by commercial companies that have no CIRM funding. To date, the ASCC Network has over $27 million in contracts with outside sponsors. These contracts serve to leverage CIRMs investment and provide the Network’s medical centers with a diverse portfolio of clinical trials to address patients’’ unmet medical needs.

Alpha Clinics – Key Performance Metrics

  • 70+ Clinical Trials
  • 400+ Patients Treated
  • 40+ Disease Indications
  • Over $27 million in contracts with commercial sponsors

The CIRM Alpha Stem Cell Clinics and broader Infrastructure Programs are supporting stem cell research and regenerative medicine at every level, from laboratory research to product manufacturing to delivery to patients. This infrastructure has emerged to make California the world leader in regenerative medicine. It all started because California’s residents supported a ballot measure and today we have 71 clinical trials for 71.

 

 

Promising Approach to Curing Spina Bifida Gets $5.6 Million from Stem Cell Agency

300px-Spina-bifida

Every day in the U.S. four children are born with spina bifida. It is the most common cause of lifelong paralysis and also frequently leads to other serious health problems affecting the bowel and bladder. The impact on families is enormous. A new approach to repairing the defect that causes spina bifida was today awarded $5.66 million by the Board of the California Institute for Regenerative Medicine (CIRM).

In spina bifida the spinal cord doesn’t form properly, in many cases leaving a section of it open, exposing tissues and nerves. The current standard of care is surgery, but even this leaves almost 60% of children unable to walk independently. Diana Farmer MD, and Aijun Wang PhD at U.C. Davis will use mesenchymal stem cells, taken from a donor placenta, and place them on a form of synthetic scaffold over the injury site in the womb. Tests in animals show this approach was able to repair the defect and prevent paralysis.

“Spina bifida is a devastating condition for babies born with this disorder and the families who care for them,” says Maria T. Millan, MD, President & CEO of CIRM. “CIRM has funded this important work from its earliest stages and we are committed to working with Dr. Farmer’s team to moving this work to the stage where it can be tested in patients.”

The CLIN1 award will provide funding to enable the UC Davis team to do the final testing and preparations needed to apply to the FDA for permission to start a clinical trial.

Dr. Farmer says she and Dr. Wang, have been working on this approach for more than ten years and are excited about being able to take the next step.

“There were many times of frustration, many times when cell types we explored and worked with didn’t work,” says Dr. Farmer. “But it’s the patients, seeing them, talking to them and working with them, that keeps me motivated to do the science, to keep persevering.”

If this therapy is successful it will have a huge economic impact on California, and on the rest of the world. Because spina bifida is a lifelong condition involving many operations, many stays in the hospital and, in some cases, lifelong use of a wheelchair this has a huge financial, and psychological, burden on the family.

“It affects them in so many ways; parents having to miss work or take time off work to care for their child, other children in the family feeling neglected because their brother or sister needs so much attention,” says Dr. Farmer. “That’s why we are so grateful to CIRM. Because this is a rare disease and finding funding for those is hard. CIRM has been a perfect partner in helping bring this approach, blending stem cell therapy and tissue engineering, together to help these families.”

This video shows English bulldogs treated with this approach who are now able to walk:

California’s Stem Cell Agency Accelerates Treatments to Patients

The following article is an Op Ed that appeared in today’s print version of the San Francisco Chronicle

SanFranChronicle_Web

Biotechnology was born in California in the 1970s based on the discovery out of one of its universities and California is responsible for an industry that has impacted the lives of billions of people worldwide. In 2004, the voters of California approved Proposition 71, creating the California Institute for Regenerative Medicine and setting the state on the path to becoming a global leader in stem cell research. Today the therapies resulting from the institute’s work are not just changing lives, they are already saving lives.

Lives like Evie Vaccaro, who is alive today because of a treatment CIRM is funding. Vaccaro was born with SCID, also known as “bubble baby disease,” an immune disorder that often kills babies in their first two years. Vaccaro and dozens of other babies were given stem cell treatments thanks to the institute. All are showing improvement; some are now several years past treatment and considered cured.

An accident left Jake Javier from Danville paralyzed from the chest down on the eve of his high school graduation. Javier was treated in a CIRM-funded clinical trial. Today he has regained the use of his arms and hands, is driving a car and is a sophomore at Cal Poly San Luis Obispo. Five other patients treated at the same time as Javier have all experienced improvements meaning that instead of needing round-the-clock care, they can lead independent lives.

A study by the Tufts Center for the Study of Drug Development estimated it takes at least 10 years and $2.6 billion to develop one successful drug. In 14 years, and with just $3 billion, CIRM has funded 1,000 different projects, enrolled 900 patients, and supported 49 different clinical trials targeting diseases such as cancer, kidney failure and leukemia. Four of these programs have received an expedited designation by the U.S. Food and Drug Administration, meaning they could get faster approval to help more patients

We have created a network of world class medical clinics that have expertise in delivering treatments to patients. The CIRM Alpha Clinics offer treatments based on solid science, unlike the unlicensed clinics sprouting up around California that peddle unproven and potentially harmful therapies that cost patients thousands of dollars.

CIRM has:

  • Supported the creation of 12 stem-cell research facilities in California
  • Attracted hundreds of top-tier researchers to California
  • Trained a new generation of stem-cell scientists
  • Brought clinical trials to California — for example, one targeting ALS or Lou Gehrig’s disease
  • Deployed rigorous scientific standards and support so our programs have a “seal of approval” to attract $2.7 billion in additional investments from industry and other sources.

We recently have partnered with the National Institutes of Health to break down barriers and speed up the approval process to bring curative treatments to patients with Sickle Cell Disease.

Have we achieved all we wanted to? Of course not. The first decade of CIRM’s life was laying the groundwork, developing the knowledge and expertise and refining processes so that we can truly accelerate progress. As a leader in this burgeoning field of regenerative medicine, CIRM needs to continue its mission of accelerating stem-cell treatments to patients with unmet medical needs.

Dr. Maria T. Millan is President and CEO and Jonathan Thomas, JD, PhD, is the Board Chairman of the California Institute of Regenerative Medicine. 

 

 

TELL ME WHAT I NEED TO KNOW: A Patient Advocate’s guide to being a Patient Advocate

A few weeks ago I was at the CIRM Alpha Stem Cell Clinic Network Symposium at UCLA and was fortunate enough to hear Gianna McMillan speak about patient advocacy. It was a powerful, moving, funny, and truly engaging talk. I quickly realized I wanted to blog about her talk and so for the first few minutes I was busy taking notes as fast as I could.  And then I realized that a simple blog could never do justice to what Gianna was saying, that what we needed was to run the whole presentation. So here it is.

Gianna McMillan

Gianna McMillan at the CIRM Alpha Stem Cell Clinic Symposium: Photo courtesy UCLA

TELL ME WHAT I NEED TO KNOW

Gianna McMillan, MA – Patient/Subject Advocate, Bioethics Institute at Loyola Marymount University

Stem cell research and regenerative medicine are appealing topics because patients, families and society are weary of inelegant medical interventions that inflict, in some cases, as much harm as benefit. We are tired of putting poison in our loved ones to kill their cancer or feeling helpless as other diseases attack our own bodily functions. California, full of dreamers and go-getters, has enthusiastically embraced this new technology—but it is important to remember that all biomedical research— even in a new field as exciting and inspiring as stem cell therapeutics – must adhere to basic premises. It must be valid science and it must be based on an ethical partnership with patients and research subjects.

In the world of research ethics, I wear a lot of hats. I have been a subject, a care-giver, an Institutional Review Board (IRB) member (someone who actually reviews and approves research studies before they are allowed to proceed), and I have worked with the government on regulatory committees. These days I am finishing my doctoral studies in Bioethics, and while I love the interplay of philosophy and ethical principles, I most truly identify as an in-the-trenches Patient/Subject Advocate. I am compelled to champion patients who struggle with new and devastating diagnoses, hoping desperately for a cure, and who might be faced with decisions about participating in research for their own benefit and for the greater good of science.

In the old days, doctors made decisions on behalf of their patients— who, meekly grateful for the guidance, did whatever they were told. It is a little different now. Patients are better informed, often do their own homework, and demand to be an integral part of their treatment plan. The world of research has undergone similar changes. Instead of investigators “doing things to research subjects”, best practices involve patients in the design of clinical trials. Patients and experienced subjects help decide what specific questions should be the focus of the research; they identify endpoints in the research that are meaningful to the patient population being studied; and they assist in devising tools for patient-reported outcomes and delivery of study results.

The investigator and the research subject have come to be seen as partners.

While the evolution of this important relationship is healthy and wonderful, it should not be assumed that this is an equal partnership. Why? Because subjects are always at a disadvantage.  I realize that this might be an uncomfortable concept. Physician-investigators in charge of the study might want to qualify this statement it by insisting “but we do our best to accommodate their needs”. Subjects would also rather not admit this—because it is hard to make a decision with confidence while simultaneously acknowledging, “I am really at a disadvantage here.”

However, I have learned the hard way that an honest partnership requires addressing some uncomfortable realities.

A short personal story illustrates what I am talking about. When my oldest son was five years old, he was diagnosed with malignant brain cancer. Before meeting with our son’s treatment team for the first time, my husband and I decided that my husband, articulate and concise, would take the lead. He had a legal pad, with a list of questions… each question and answer would take us down the page until, at last, we would use all the information to make a decision—a life or death decision – on behalf of our young child.

In the meeting, the neurosurgeon pointed at brain scans and explained a few things. And then radiologist drew pictures of machines and treatment angles. The oncologist described risks and benefits and side effects. Then we all looked expectantly at my husband—because it was his turn. This lovely man opened his mouth. And closed his mouth. And then burst into tears, holding that legal pad over his chest like a shield. He could not speak. After a few seconds of horrified silence, I stammered out what few questions I could remember. The doctors answered, of course. Their mouths moved, and I leaned in and nodded while making eye contact – but I have no idea what they said.  All I heard was a loud white noise that filled my skull and my husband’s raspy breathing, and my own voice crying out in my head – “Oh my God! My child! My child!”

The point of this story is to illustrate that good people, educated and prepared, ready to bring their best selves to make the most important decision they would ever make, one that would affect the life of a beloved child— these people could not function. Despite this, in just a few days’ time, we were introduced to a research study, one that might cure our child while limiting the damage to his growing brain.  No matter how well-intentioned the research team was—no matter how desirous they were of a “partnership” with us, we were at such a distinct disadvantage, that the relationship we had with these investigators could not be categorized as one “among equals”.

Even now, more than twenty years later, it is painful for me to reflect on this. But I have learned, working with hundreds of families whose children went into clinical trials, that if we can be honest about the dysfunctional nature of this situation, we might take some action to improve it. Let me be specific about the ways research subjects are at a disadvantage.

  1. They often don’t speak the language of the disease.
  2. They are unfamiliar with the process of research.
  3. They are wrestling with emotions: despair, denial, anger and hope.
  4. Their life has been disrupted – and there are consequences.

Compare this with the research team, who knows the lingo, designed the research plan, is not personally affected by the scenario and well, this is business as usual: enroll a subject, let’s get going! How is the notion of “partnership” affected by such unequal circumstances?

Is a meaningful “partnership” even possible?

I say, yes! And this notion of “partnership” is especially important as new technologies come to invade intimate qualities of “self” and the building blocks of what makes each of us human. However, we need to be realistic about what this partnership looks like. It is not equal.  I am going to take a stand here and say that the partner who has the advantage (in this case, the researcher/scientist) is morally obligated to meaningfully address the disadvantage of the other party. This bears repeating. The partner who has the advantage is morally obligated to meaningfully address the disadvantage of the other party.

Over the years, families and subjects have told me what they want and need from the doctors and researchers they work with. They say:

  1. Tell me what I need to know.
  2. Tell me in a way I can hear it.
  3. Tell me again and again.

Let me expand on these a bit. First, if I am a patient new to a diagnosis, a treatment or research—I probably do not know what I do not know. Help me learn vocabulary, procedures, and systems. Tell me about the elements of informed consent so that I recognize them when I see them in the documents you want me to sign. Explain the difference between “standard of care” and “experimental treatment”. Help me understand the research question in the context of the disease (in general) and my own ailment (in particular). Give me the words to ask the questions that I should be asking.

Secondly, there are many different ways of sharing this information: print, video, websites, peer mentors, nurse-educators, and research team members. Hit the topic from all sides and in multiple formats. Thirdly, please realize that there is a learning curve for me— and it is closely tied to my emotional journey with my predicament. I may not be able to absorb certain facts at the very beginning, but a few weeks later I might be mentally and cognitively in a different place. And obviously, I might be an inexperienced research subject when I sign the consent form— but a few months later I will be vastly more sophisticated and at that time, I need the opportunity to ask my more considered and context-savvy questions.

I want to point out that researchers have access to a deep well of wisdom – a resource that can advise and support ethical actions that will help their disadvantaged partners: researchers can ask their experienced subjects for advice.

Remember those hundreds of families I worked with, whose children ultimately enrolled in clinical trials? These experienced parents say:

  • Let me tell you what I needed to know.
  • Let me tell you how I needed to hear it.

Getting input from these experienced subjects and caregivers does two things.

First, the research team is leveraging the investment they have already made in the participants of their studies; and secondly — very importantly — they are empowering the previously disadvantaged partner. Experienced subjects can to share what they have learned or give suggestions to the research team. Physicians and researchers might even build a stable of peer mentors who might be willing to help newbies learn about the process.

Everything I have said applies to all avenues of clinical research, but these are especially important considerations in the face of new and exciting science. It took a long time for more traditional research practices to evolve into an investigator/subject partnership model. Stem cell research and regenerative medicine has the opportunity to do this from the very start—and benefit from previous lessons learned.

When I was preparing my remarks for today, someone casually mentioned that I might talk about the “importance of balancing truth-telling in the informed consent process with respect for the hope of the family.” I would like to unequivocally state that the very nature of an “informed consent process” requires 100% truth, as does respect for the family—and that this does not undermine our capacity for hope. We place our hope in this exciting new science and the doctors and researchers who are pioneers. We understand that there are many unknowns in this new field. Please be honest with us so that we might sort out our thoughts and our hopes for ourselves, in our own contexts.

What message would I wish the scientists here, today, to take away with them?      Well, I am putting on my Patient/Subject Advocate hat, and in my Patient/Subject Advocate voice, I am saying: “Tell me what I need to know!”