The virologist Jonas Salk said that “hope lies in dreams, in imagination and in the courage of those who dare to make dreams into reality”. Salk was certainly daring – he risked paralysing himself, his wife and their children while testing his polio vaccine. Thankfully, it paid off. None of them experienced any ill effects and his work is credited with saving millions.
Risks have to be taken for medicine to advance, and someone is always the first to receive a treatment. But there are risks, and then there are risks.
Salk tested his vaccine on cells, monkeys and children who had already had polio before turning his unexposed family into guinea pigs. His approach is far from standard protocol today, but he did a lot to reduce the risk of something going wrong.
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There is less evidence to justify an operation that took place this month in Russia. Details are scant, but the procedure involved cutting out a section of spinal cord from someone with a complete spinal cord injury and gluing in a replacement piece from a donor. The transplant was a world first, but there is little evidence to believe it will have worked or that now was the time to try it.
The transplant was a world first, but there is little evidence to believe it will have worked
History tells us that acting ahead of medical evidence can have catastrophic results. Take the first synthetic organ transplants, which replaced tracheas with plastic tubes. The surgeon who fitted them admitted they hadn’t been tested on large animals because they “didn’t have the time”. Complications and deaths followed.
With new medical procedures, the gold standard is randomised controlled trials, which are costly and take time, but they aren’t the only route. When someone is critically ill, there are compassionate-use protocols that make interventions available before they are fully tested. Pig kidney transplants are currently being trialled this way, for example.
The dream of spinal cord transplants will surely become a reality one day, but only if the science underpinning them is built first. Courage, dreams and imagination are of course good, yet with experimental surgeries, evidence is better.