The Parkinson's Experiment

By MICHAEL D. LEMONICK

Even before the latest issue of the New England Journal of Medicine came off the presses, the new experimental surgery to treat Parkinson's disease had sparked more than its share of controversy. Pro-lifers hated it because the operation used cells from aborted fetuses to replenish patients' dying brain tissue. Many others were troubled because clinical trials of the procedure involved "sham surgery"--in this case, drilling through the skulls of half the patients in the study without giving them any treatment.

But when the first results of the trials appeared in the Journal last week, researchers found themselves mired in an even deeper flap. The surgery did help some patients a little, partially alleviating the rigidity and slow movements typical of Parkinson's. But for others, that improvement came at a price: a year or more after the operation, about 15% of patients developed uncontrollable writhing, joint flexing, chewing and other movements. At least one person was so debilitated that he could no longer eat and had to be fed through a tube.

Pro-lifers are using the study in their ongoing war against fetal-cell research of any kind. Says Republican Senator Sam Brownback of Kansas: "Not only are you destroying one human being [the fetus], you may be destroying two." A few scientists called for such operations to be halted immediately, and some nonscientists wondered why they had ever been done in the first place.

The answer is that Parkinson's is such a devastating disease that sufferers and their families are desperate for a cure. Drugs can alleviate the symptoms, but not retard the progressive death of brain cells. That's why fetal-cell transplants were first proposed and why some doctors were already performing the operation on patients who could afford it (cost: as much as $40,000). The researchers in the controversial study were doing what scientists are supposed to do: conduct a rigorous study to determine whether a treatment actually works.

Now that results are in, some press accounts have breathlessly painted the episode as an unmitigated disaster. But that's not really true. Knowing that fetal cells can grow successfully in a patient's brain is a major step forward. And, says Dr. Thomas Freeman, a Parkinson's expert from the University of South Florida, "it's naive to think that you can do a medical intervention in people with end-stage disease and not have complications."

But even proponents agree that fetal cells alone won't eradicate Parkinson's--if only because there aren't nearly enough fetuses to do the job. Scientists are looking instead to stem cells, unspecialized cells that eventually turn into every tissue in the body. "That," says Dr. Gerald Fischbach, former head of the National Institute of Neurological Disorders and Stroke, "could be a renewable resource." Unfortunately, stem cells are most easily harvested from human embryos, and that means the controversy underlying the Parkinson's surgery isn't about to go away.

--By Michael D. Lemonick. Reported by Rachele Kanigel/Oakland and Dick Thompson/Washington

With reporting by Rachele Kanigel/Oakland and Dick Thompson/Washington