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Thread: Limits on federal funding have already eroded U.S. research efforts

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    Senior Member bill j.'s Avatar
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    Limits on federal funding have already eroded U.S. research efforts

    At Risk: A Golden Opportunity in Biotech

    Limits on federal funding have already eroded U.S. research efforts

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    Table: Stem Cell Research around the World

    Commentary: Stem Cell Science Needs More from Uncle Sam

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    For decades, the U.S. has been the world leader in biotechnology. It conducts more than 90% of the world's biomedical research, and U.S. federal and private spending on life sciences exceeds that of the rest of the world put together. But on Aug. 9, President Bush limited federal funding for stem cell research to cell lines already in existence. And on Aug. 27, a consequence of that decision became clear: The National Institutes of Health (NIH) announced that 48 of the 64 human embryonic stem cell lines eligible for U.S. funding reside in labs outside American borders.

    That shows how far the U.S. has fallen behind in this promising area of biotechnology. While the U.S. continues to debate the ethical implications, Britain, Scandinavia, and the Netherlands can lay claim to some of the top talent, a track record of public and private support, and a more liberal regulatory framework.

    The U.S. once held the lead in stem cell research, when scientists at the University of Wisconsin became the first to isolate human embryonic stem cells in 1998. Sweden now has 24 of the world's existing stem cell lines, compared with 20 in the U.S. And other countries, in both Europe and Asia, are revving up their own stem cell programs.

    But these nations will be hard-pressed to duplicate what could be done with unrestricted federal funding in the U.S. Their research budgets are tiny compared with the $18.8 billion that the NIH will spend to fund biomedical research this year.

    Meanwhile, major scientific problems remain unresolved: It will be at least a decade before any practical use is found for stem cells, the basic building blocks that are the progenitors of all other cells. And no one is sure how embryonic stem cells can be developed into specific tissues. But ultimately, these cells could hold the key for treatments for Parkinson's, stroke, diabetes, and a range of other deadly diseases.

    The U.S. is not out of the running, of course. The limited funding approved by President Bush could produce interesting results, although it is unclear whether existing stem cell lines are adequate for the experiments that researchers want to do. And private research in the U.S. is largely unregulated and will continue. On Aug. 24, for example, the Howard Hughes Medical Institute said it will fund the procurement of human embryos left over from fertility clinics for Harvard University scientists to use to make new stem cell lines. Harvard scientists say they will distribute the lines free to all comers. Private companies such as Geron Corp., the leading biotech company involved in stem cell research, are also free to do as they please as long as they don't take federal funding.

    TOO TINY. But private enterprises may be reluctant to share patented stem cell lines. Besides, Geron and the few other companies involved in this research are far too tiny to lead the charge. And few large companies are interested in joining the mission at this early, risky stage. "I can't tell you how many times I've given presentations to Big Pharma companies, but nothing really happens," says Dr. Evan Y. Snyder, a neurologist at Harvard Medical School and a leading stem cell researcher.

    The leaders of stem cell research are increasingly found in Europe, with Britain in front. As the home of both the world's first test-tube baby and Dolly the sheep--the first mammal cloned from an adult--Britain has an established reputation in embryology and fertility. British researchers pioneered much of the early work on mouse embryonic stem cells two decades ago. And in January, Britain became the first country to introduce legislation allowing research on embryonic stem cells derived from both surplus and cloned embryos. The latter, known as therapeutic cloning, "has put Britain on the moral and policy cutting edge." says Arlene Judith Klotzko, a British lawyer and bioethicist and the author of The Cloning Sourcebook.

    It's not just Parliament that's supportive. Britain's Wellcome Trust, the world's largest medical charity, with an annual budget of $1.3 billion, is considering funding a British government plan to create a bank of human embryonic stem cell lines sometime next year.

    Even Geron is moving research to Britain. Two years ago, Geron, which controls the rights to five stem cell lines in the U.S., bought Roslin Biomed in Scotland, a spin-off of the Roslin Institute, which cloned Dolly. There are now some 20 Roslin scientists working on Geron-funded stem cell research. "We had always intended to invest more [in the future] in response to the very receptive environment in Britain and the fact that public money might be available," says Geron Chief Financial Officer David Greenwood.

    In the rest of Europe, biotech investors in the $44 billion venture-capital industry are scouting opportunities. Both Scandinavia and Britain have thriving venture-capital communities. In Sweden, venture capitalists backed one of the country's first stem cell companies, NeuroNova, in 1998. After raising $7 million in venture capital in 1999, Britain's ReNeuron Holdings PLC became the first European stem cell company to go public. Based in Guildford, ReNeuron, which uses embryonic stem cells from the tissue of aborted fetuses to repair damaged brain cells, raised close to $30 million in an initial public offering.

    RUMORS. Public funding sources anticipate a surge in grant applications for embryonic stem cell research. "We are definitely going to be putting more money into this area, but it's still too early to say how much," says Chris Higgins, director of the Medical Research Council's clinical science center at London's Imperial College School of Medicine. The MRC, which is funding former University of California at San Francisco scientist Roger Pedersen at Cambridge, has a program to recruit the best and brightest international scientists, offering two-year grants of more than $2 million, plus research expenses.

    The program has rumors swirling in the international scientific community about prominent U.S. researchers moving to the more hospitable shores of Britain. "As an academic scientist, if you want to improve methods of deriving embryonic cells, then Britain is better," says Dr. Robin Lovell-Badge, head of developmental genetics at the National Institute for Medical Research, Britain's equivalent of the NIH.

    Britain is clearly supportive. Its Biotechnology & Biological Sciences Research Council has spent close to $28 million on embryonic stem cell research since 1989, the vast majority on mice. Now that the research is legal on human embryos for therapeutic and not just reproductive purposes, that amount is likely to increase rapidly, says Alf Game, head of genetics and biochemistry at the research council.

    Still, few scientists in Britain and elsewhere want to see their U.S. peers shut out. If federally funded research drops off in the U.S., companies there "would be handicapped, as there wouldn't be the normal collaboration between the private and public sectors that has been responsible for so many important scientific advances," says Dr. Martin Edwards, CEO of ReNeuron. For stem cell researchers, those advances are far more important than any national pride of place. Should the U.S. "stop funding this research, it will seriously and adversely affect prospects for human health for the next 100 years," says William A. Haseltine, CEO of Human Genome Sciences Inc. in Rockville, Md., and a renowned biotech researcher. If so, the U.S. will have lost more than its leadership position.

    By Kerry Capell in London, with Catherine Arnst in New York, Arlene Weintraub in Los Angeles, and bureau reports
    : Stem Cell Science Needs More from Uncle Sam

    SEPTEMBER 10, 2001
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    By Catherine Arnst

    Commentary: Stem Cell Science Needs More from Uncle Sam

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    In the late 1960s, Barnett Rosenberg, a professor at Michigan State University, was conducting experiments to determine if electromagnetic energy could stop the growth of E. coli. By pure accident, he discovered that platinum from the electrodes stopped cell growth in the bacteria. Rosenberg brought his discovery to the National Cancer Institute, whose scientists did all the work to turn it into a drug and conducted all clinical trials. Ultimately, Michigan State, which held the patent, licensed it to Bristol-Myers Squibb Co. (BMY ) for marketing. That drug, cisplatin, was approved in 1978 and remains one of the most effective cancer drugs ever.

    The story of cisplatin is a case study of the value of basic research done for the joy of discovery rather than the sake of the bottom line--and illustrates why so many scientists are dismayed about President George W. Bush's recent decision to place restrictions on federal funding of stem cell research.

    DEEP POCKETS. The U.S. government has long had the world's deepest pockets for basic scientific research. But the White House ruled that scientists would have access to that money only if they limit their research to 64 human embryonic stem cell lines already in existence. Many scientists fear that these restrictions will slow progress to a crawl in this promising area of medicine. "Basic science is the only way to do it," warns Robert S. Langer, professor of chemical and biomedical engineering at Massachusetts Institute of Technology. "It's absolutely essential that we have government-funded research, and let's face it, most of the important research comes from the U.S."

    Plenty of countries might argue otherwise, but they would certainly agree that their annual research budgets don't come close to matching the National Institutes of Health's 2001 outlay of $18.8 billion. There is still the private sector. But commercial enterprises have never shown much interest in funding expensive basic science that won't pay off for decades--if ever--and stem cells are no exception. Rochelle K. Seide, a patent attorney who heads the biotech practice at BakerBotts LLP in New York, says she knows of no large pharmaceutical company doing work in this area. And, she adds, the small companies that hold patents on stem cell lines are unlikely to do broad-ranging studies. "If they are interested in cardiovascular therapies, they won't be doing neurological research."

    Nor, says Seide, is it likely they will license their lines to potential competitors. Already, two of the private companies that developed some of the 64 stem cell lines approved by the NIH, CyThera Inc. of San Diego, and Reliance Life Sciences P.V.T. Ltd. of Bombay, have said they are not willing to make them generally available just now.

    That's not surprising. If a commercial enterprise is going to spend the hundreds of millions of dollars required to derive a viable commercial product from a stem cell line, it would not be inclined to share its discoveries. "If all this work moves to the private sector, that means any positive data will not be available to other scientists for years," says Dr. Evan Y. Snyder, an associate professor of neurology at Harvard Medical School. "And the public may never hear about negative data."

    EXORBITANT. And then there's the question of profit. It'll be at least a decade before any therapy based on embryonic stem cells is ready for human trials, and those could take another 10 years or more. It already costs from $150 million to $500 million to bring a new drug to market; most of those, like cisplatin, were based on basic research done in university or government labs. If stem cell research works, the resulting therapy "will be exorbitantly expensive because companies will need to recoup their investment," says Snyder. "Only the rich will be able to afford it."

    A case in point is Novartis' (NVS ) breakthrough new cancer drug, Gleevec. Unlike cisplatin, Gleevec was developed completely by the company over 10 years. The drug finally reached the market in May--at a price to the patient of $2,300 per month.

    The solutions to most of the world's most vexing scientific problems are far too large for any one company, or government, to solve. The human genome would not have been deciphered in a decade without the support of the U.S. government, for example, and stem cell research is much the same. Let's hope the President rethinks his position before too much time is lost.

    Senior Writer Arnst covers science and medicine for BusinessWeek.

    [This message was edited by bill j. on September 02, 2001 at 09:48 AM.]

  2. #2
    Senior Member bill j.'s Avatar
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    I moved this article to the top and added it to the first one.

    [This message was edited by bill j. on September 02, 2001 at 09:52 AM.]

  3. #3
    Senior Member rdf's Avatar
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    Thanks for these enlightening stories, bill. I'm afraid we will start seeing more of these types of stories coming out as the full force of what bush has done comes to light. It's just a goshdamn shame, I wish congress would push ahead. Does anybody know if they have the votes to override a veto? Two-thirds I believe.

  4. #4

    U.S. will lose its leadership in science if something is not done about the situation soon

    The United States must not be complacent about its scientific leadership in the world. It was the first government in human history to invest so much into science. Beginning with the Manhattan Project which led to the development of nuclear fission and fusion as sources of energy, the formation of the National Institutes of Health which was the first large-scale peer-reviewed science funding organization, the development of the Center for Disease Control which organizes disease prevention research and efforts on a global scale, and the Environmental Protection Agency to organize environmental research and efforts, the United States led the world in many scientific arenas.

    However, many countries have now successfully imitated the U.S. model. The European Union (EU) has consolidated biomedical research funding, environmental research, and physics research. Asian countries and even cities are now investing enormous amounts into research because they understand that knowledge is the base of wealth. For example, China just invested over $300 million establishing a series of neuroscience centers that have spinal cord injury as one of their high priority research areas. By the way, $300 million goes much further and can fund much more research in China than it can in the U.S. Singapore is now investing $2 billion life sciences research, planning to shift 25% of its work force into this area. This is just one city. Japan, despite their recession, continues to fund much biomedical research. For example, Japanese articles now account for as much as 20% of the neurosurgical literature. Korea is investing in neuroscience research. Even India may be ahead of the U.S. in some areas; for example, the recent NIH list indicates that India may have more embryonic stem cell lines than the U.S. Last year, when I went to Germany, I realized that they are funding more head injury research than the U.S. The Scandinavian countries (with the Karolinska Institute and many other universities) have invested seriously in biomedical research for decades.

    It is true that the U.S. is currently investing $18 billion into biomedical research. However, if you add up the investments from many countries, you will find that the combined countries overseas now exceed the U.S. investment. Given the above, it is not so surprising that over half of the major advances in spinal cord injury research are now coming from overseas. Part of the U.S. success in research stems from the fact that it has attracted many thousands of the best scientists from around the world to work in U.S. laboratories. This "brain drain" continually fed the U.S. scientific machine for nearly 5 decades. Up to about a decade ago, the United States was THE place to do research. This is no longer the case.

    Science education in the U.S. may unfortunately not be able to provide a sufficient flow of good scientists and engineers to keep up the American dominance in scientific research. In almost all studies of the past two decades, U.S. has ranked at the bottom of the list of developed countries in terms of K-12 science and math education. Relatively few American students are sufficiently trained or have the motivation to go into research. It is very hard to find good American students who are interested in a career of science. Over half of the science and engineering Ph.D.'s in the United States are being awarded to foreign nationals. In the past, most of these people stayed in the U.S. Now, many are returning to their home countries. As other countries ramp up their investment in research, the brain drain will stop and reverse its course.


    [This message was edited by Wise Young on September 02, 2001 at 09:52 AM.]

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    Things will resolve themselvles. Money will start to leave the U.S. for biotechnology abroad. We must be certain that we vote in the congressional elections in two years, and get people in that support our objectives. Forget party for the woman or man and what they believe.

    We can only LEAD in biotechnology if we have LEADERSHIP in our government. To quote one of the articles I read on this board, right now the U.S. is being lead by a "Luddite," a science phobe that only cares about being re-elected. And he most CERTAINLY believes in vacations

    Eric Texley

  6. #6


    Can you comment more about the research in China?

    What are they doing, trying?

    Is Dr. Cheng's therapy the cutting edge currently?

    What additional research could we be doing to follow the progress of the varied sci approaches being attempted overseas?

    I continue to believe that the most promising procedures currently are available outside of the U.S. But, with cultural, communication and lack of understanding of how their medical "systems" work I am hesitant to venture into the unknown without someone (medical professional) available to consult with about all factors, risks, rewards involved.

    Is there such a service available whereby we can find a bilingual sci researcher / doctor who can help us one-on-one navigate the international waters? (Probably not but maybe a good idea?)


  7. #7
    Senior Member mk99's Avatar
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    U.S. will lose its leadership in science...

    As Wise wrote: "it is not so surprising that over half of the major advances in spinal cord injury research are now coming from overseas".

    Personally I think this is a good thing. Why? Because it means that treatments will be available much faster & sooner in a less regulated environment that in US.

    Of course this means that there is more risk to patients of experimental therapies that are not proven and also if you have cash, you may have a chance to "jump the queue".

    I'm not saying it's right but for many frustrated individuals with SCI it opens doors that otherwise would not exist.

  8. #8
    I have attempted to link the issue of research spending to the issue of saving Social Security by submitting the suggestion below to the Presidential Commision on saving Social Security. In my opinion, the suggestion below could not only help save Social Security, but it could pump billions and billions of dollars into new research and thus as a side effect stop the "reverse brain drain" Dr Young was talking about and it may also motivate more students to become researchers themselves. Now the voice of the small man often falls on deaf ears, so I don´t know how effective my message will be. But, if you don´t open your mouth sometime, no one will hear you at all. Below is the main part of the idea that I submitted.


    Checking the statistics on the Social Security web site, last year
    billions and billions of dollars were paid out to disabled people such
    as myself. Future trends show that social security payment amounts, as
    well as the number of people with disabilities receiving social security
    benefits, will be increasing yearly. This is a dilemma which threatens
    the stability and future of Social Security.

    What options do the US taxpayer as well as the US government have?
    Rest assured, no one wants to see benefits cut, let alone having to pay
    higher Social Security tax rates. Fact is, the only way to reduce the
    amount of money payed out every year, year after year, to the disabled,
    is to attack the reasons why and/or how people are becoming disabled in
    the first place. This statement is very cut and dry and the
    implications are simple. Fight the causes that are swelling the number
    of disabled receiving Social Security, or pay more and more money out
    every year until you either have to cut benefits, or raise taxes in
    order to save the system from becoming insolvent.

    What to do? First, a little backround history. During the early to
    mid 1940´s, the United States was threatened by the second world war.
    Now in order to fight this war to win, the country needed one thing of Money to build tanks and ships and to equip soldiers
    and to build airplanes and manufacture artillery and so on. Now a large
    financial source came from the citizens of the US through the War Bond
    (Victory Bond) program. War heroes, as well as celebritys, campaigned
    tirelessly throughout the US on eight different War Bond drives. Radio,
    magazine, and newspaper companies showed their patriotism and support
    for the War Bond effort by donating in the first 3 years of the war
    alone over a quarter billion dollars in free advertising. The results
    were fantastically successful. A total of $185.7 billion (in 1940´s
    dollars) was raised for the US Treasury in a time span just short of 5
    years. A total of 85 million Americans invested in War Bonds, an
    achievment that has not been repeated nor matched by any other country
    ever since. The main result of this effort? The United States had not
    only the financial means to win the war, but it pulled together a nation
    by increasing the moral of those who were on the "home front" by
    stimulating the feelings of participation, patriotism and individual
    self sacrifice.

    The United States not only won the war, but it became as a result the
    number one economic and military power in the world and it continues to
    enjoy this status even to this day. Now is the time, in my opinion, to
    learn from past successes and fight the next enemys of the United
    States. These enemys have all been around for a very long time and
    they have various names. Alzheimers. Cancer. Multiple Sclerosis.
    Parkinsons. Stroke. AIDS. And many others. They not only cause
    enormous physical and mental damage to the victim and their families,
    they also cause huge financial damage as well. We see this in the
    staggering costs of healthcare, the ever increasing drain on Social
    Security resources, and the lost income tax base caused by the disabled,
    and in some cases additional family members, having to leave the work
    force. Now in order to fight the enemy, you need the tools of the trade
    to obtain victory. In this case however we need researchers and
    scientists instead of soldiers. Laboratorys instead of ships.
    Microscopes instead of mortars. Beakers and Bunson burners instead of
    bullets. Most important however, just as during World War Two, is the
    need for money. But how can we raise the money needed to fight this war?

    The answer is by selling US Research Bonds. Based exactly on the War
    Bond, and by using the tried and true tactics from the War Bond era, the
    mission would be to raise funds to fight the war against diseases and
    afflictions that are costing our nation dearly. We already have the
    heros and celebritys to grease the Research Bond campaign wheels.
    People like Lance Armstrong, Michael J. Fox, Christopher Reeves and
    Magic Johnson are but just a few. Getting the public involved and
    motivated is the key to winning the war. By getting the advertising
    industry involved as it was during World War Two, the "buy US Research
    Bonds" message would get out that much faster. With the Internet, that
    advertising would know no limits. Additional support could be created by
    linking the program with the ongoing Combined Federal Campaign; thus
    allowing a tax deductable contribution option as well. Instead of the
    money going into the Treasury as it did during World War Two, it would
    go into the NIH. From there, those research projects which show the
    most promise for advancements could be massively supported. Projects
    such as stem-cell research. Genetic research. AIDS research. Cancer
    research. And so on.

    Now, how would this effort benefit Social Security? By promoting
    intensive research, the "time to cure" timeline for the multiple types
    of diseases and disorders could be drastically reduced. As new cures
    and treatment options are discovered and applied to the mainstream
    medical system, those who would have normally been disabled (do to
    cancer or multiple sclerosis for example), will be able to continue to
    work while getting treated and thus never even need apply for Social
    Security disability benefits. And those citizens who currently are on
    disability benefits would then be able to get treatment, get
    rehabilitated, get off Social Security and get back to work. As medical
    advances and discoveries increase, the financial burdon to Social
    Security would decrease. The amount of people on the disability pay
    roll, as well as the amount of new applications, would steadily
    decrease. The yearly progressive savings that Social Security could
    accumulate would, in turn, ensure its long term financial health.
    Perhaps if the long term savings were that substantial, it could even be
    possible to cut the Social Security payroll tax rate; that in itself
    would generate positive economic advantages to the taxpayer´s buying
    power. Other benefits would be the creation of new jobs and export
    markets, an increase in the income tax base, and the intellectual
    stimulation that would envigor an entire generation. The US could also
    gain valuable geo-political capital by showing the world it´s will to
    win the battle against sickness and disease, and especially in the
    battle against AIDS. All US citizens would have the chance to purchase
    Research Bonds and join together in an effort that could rid humanity of
    some of its worst enemys. You could even allow Research Bond purchases
    to be credited to a citizens voluntary personal retirement account. Not
    only would this strengthen the citizens voluntary retirement account
    with a safe and secure investment, he or she would at the same time
    ensure that Social Security will be alive and strong when retirement
    comes by promoting medical advances which in turn could one day even
    help his or herself.

    An effort of this nature would compliment each and every one of the
    Guiding Principles. Research Bonds would not change the benefits of
    retirees or near-retirees. Research Bonds could increase the Social
    Security surplus. Research Bonds could ensure that payroll taxes would
    remain stable, and even over the long term allow a tax cut in the event
    of substantial savings. Research Bonds have nothing to do directly with
    the Stock Market, however the stimulation that could result from the
    Research Bond effort into medical research could well allow the stock
    market to grow with a new dynamic. Research Bonds could ensure the long
    term financial survivability of the disability and survivors insurance
    programs. And finally, Research Bonds could be included in an
    individuals voluntary personal retirement system. The War Bonds program
    is an old, and very successful idea that has proved its effectivness.
    We are all free today because of it. Repackaged into Research Bonds,
    the potential is there to conquer our biological and genetic foes once
    and for all, and save Social Security and hopefully uncountable lives as
    well. I can vision a possible campaign poster using a picture of James
    Montgomery Flagg´s Uncle Sam wearing a lab coat. Pointing his finger at
    the viewer, his slogan would be: "I want you to buy US Research Bonds".


    PS: The Guiding Principles are conditions placed on the Presidential Commision that any suggestion or solution should meet in order to be considered. You can read them at

    [This message was edited by Mike C on September 03, 2001 at 03:05 AM.]

  9. #9

    Regarding China's biomedical research program


    China is an enormously complicated country. It has four times the population of the United States. Its disability problems are correspondingly huge. Its health care system ranges from state-of-the-art western medicine to acupuncture and herbal medicines. Chinese researchers and doctors seldom publish in U.S. journals and researchers here are not aware of the work that is going on there.

    Henreich Cheng is in Taiwan (which, as you know is not the same as mainland China). There is great interest in both Taiwan and mainland China in spinal cord injury. There is also, I believe, some rivalry between spinal cord injury groups in different parts of the country. When I visited China a year or so ago, I was surprised to find that most of the groups there are not working together and did not know each other. Many were meeting for the first time when they came to hear my lecture. I asked in Beijing about omentum transplants, expecting that people would know about the work, only to find that they did not know. Travel by scientists and doctors between different parts of China is still relatively limited but it is increasing.

    Surgery in China differs significantly from the U.S. not only because it has a very different tradition but because the surgeons there have a deeper experiential base. The average Chinese surgeon, for example, probably operates far more than the average U.S. neurosurgeon. It is not unusual to find a Chinese surgeon there who has done 5000 spinal surgeries whereas such a number is virtually unheard of here in the U.S. I went to one hospital in the midwest of China that was the central tertiary care hospital for a population of 100 million people!

    Although nobody knows for sure, I have heard estimates of as many as 3 million people with chronic spinal cord injury in China. When I went through the hospital, I realized that there were almost no high quads. This may be because the ambulance system is limited and few of the centers have artificial ventilation facilities. Methylprednisolone is being used in China but, surprisingly, it is much more expensive in China than it is in the United States.

    In China, there are almost no regulations concerning cell transplants. As far back as the 1970's, they have been doing fetal transplants. Likewise, they have been using omentum transplants for nearly 20 years, not only to treat spinal cord injury but stroke and brain cancer (they use the vasculature established by the omentum graft to deliver chemotherapy to tumors). The concept of clinical trials has not yet taken hold in China. Standards are based on anecdotal experience.

    Regarding science, China has begun to invest substantially in establishing centers of excellence in different regions. They are training young people and setting up laboratories by the hundreds. It is still too early to tell but I believe that there will be a huge outpouring of scientific research from China in the coming decades. For nearly 20 years, between 1965 and 1985, senselss persecution of academics and an emphasis on non-scientific pursuits resulted in the loss of one or perhaps two generations of young people from the sciences. Thus, there are few people in their 40's or 50's who are trained scientists. There are, however, many people in the 20's and 30's who are scientists and they are beginning to be productive.


  10. #10
    Incidentally, I will be away from these forums for about 10 days because I will be travelling around India. India has a population that is rapidly overtaking China's population and they have a huge spinal cord injury problem as well. I went there last year to give a lecture and was stunned both by the quality and quantity of surgery that they were doing, as well as the intense interest in spinal cord injury research. They have a very different attitude towards recovery of function. Unlike the U.S. where people are told to accept their injury, patients are told that they must walk or die.


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