Regenerative Medicine and the Developing World

Heather L. Greenwood; Peter A. Singer; Gregory P. Downey; Douglas K. Martin; Halla Thorsteinsdóttir; Abdallah S. Daar

Disclosures

PLoS Med. 2006;3(9) 

In This Article

Abstract and Introduction

Introduction

A panel of experts at the annual meeting of the American Association for the Advancement of Science has predicted that stem cell research will survive the fallout of the recent scandal involving falsification of data by South Korean stem cell researcher Woo Suk Hwang.[1] As the field of regenerative medicine regroups, it is important that recent events do not overshadow the potential benefits of the field. These benefits include the opportunity to improve health care for the more than two-thirds of the world's population who live in developing countries.

While developing countries face pressing priorities in providing basic health services to their populations, they are also increasingly struggling to manage epidemic rates of noncommunicable diseases whose prolonged and costly care is drawing significant resources away from these basic priorities.[2,3,4] Although developing countries have been largely neglected by the field of regenerative medicine to date, we suggest that they could potentially benefit from advances in regenerative medicine to address the epidemic of noncommunicable diseases and other pressing health needs.

Regenerative medicine is an emerging field that seeks to combine the knowledge and expertise of diverse disciplines towards the aim of healing impaired function in the body.[5,6] Its goal is not just to replace what is malfunctioning, but to provide the elements required for in vivo repair, to devise replacements that seamlessly interact with the living body, and to stimulate the body's intrinsic capacities for regeneration.[7] The United States National Academies of Science report, Stem Cells and the Future of Regenerative Medicine, estimates that the potential patient populations in the US for stem cell-based therapies include more than a hundred million patients with conditions such as cardiovascular disease, autoimmune diseases, diabetes, cancer, neurodegenerative diseases, and burns.[8]

Though still an emerging field, regenerative medicine has already produced a number of therapies, including the tissue-engineered skin substitute Apligraf[9] and the adult stem cell-containing bone regenerating therapy Osteocel.[10] The L. V. Prasad Eye Institute in India has treated blindness in more than 125 patients using adult stem cell therapy for corneal repair.[11] Ninety percent of those affected by blindness live in poor communities and it is estimated that 60 percent of conditions that cause blindness are treatable.[12] Regenerative medicine could

However, despite the fact that the conditions targeted by regenerative medicine are more prevalent in developing than developed countries,[2,4,13,14] there has been no attempt to systematically understand how regenerative medicine could contribute to improving health in developing countries. Eighty percent of the world's chronic disease deaths,[2] more than 95 percent of infectious disease deaths,[13] and almost 90 percent of deaths due to injury and trauma[4,14] are found in low- and middle-income countries. Chronic diseases, the primary targets of regenerative medicine, affect people at a younger age in developing than developed countries, are much more likely to occur in the poor than the rich in all but the least-developed countries, and resulted in more deaths in 2005 than infectious diseases, maternal and perinatal conditions, and nutritional deficiencies combined.[2]

This paper discusses some of the ways in which regenerative medicine could potentially be used to meet the health needs of developing countries. We do not suggest that regenerative medicine presents easy solutions to the complex challenges facing developing countries, but encourage researchers and policy makers in both developing and developed countries to consider how this new technology might address the health needs of the developing world. First, we present results of a study that systematically identifies and prioritizes applications of regenerative medicine that could potentially be effective in improving health in developing countries. Second, we discuss the feasibility of building capacity in regenerative medicine in developing countries. Finally, we discuss implications and provide recommendations for both developed and developing countries.

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