The unwavering optimism around stem cell therapies is a global phenomenon

Media representations of regenerative medicine across countries and continents have consistently conveyed an overtly optimistic view of the future of stem cell therapies that fuels unrealistic expectations by patients and a false sense of the safety of commercially available treatments.

Widespread advertisements of experimental, and often unproven, stem cell therapies have become commonplace on various media platforms. Photo Credit: C. Chang

The field of regenerative medicine has made significant progress since the discovery of stem cells in mice by Canadian scientists Ernest McCulloch and James Till in 1960. Most people are now familiar with the terms "stem cells" and "regenerative medicine". There has been consistent and widespread media coverage on the topic of stem cells and their potential to treat diseases ever since the isolation of first human embryonic stem cell lines in 1998 by Dr. James Thomson and his team at the University of Wisconsin in Madison. News media can play a decisive role in the formation of public opinion on new scientific discoveries, both in terms of whether innovation is viewed in a positive or negative light and what key issues are brought to public attention. Although the clinical promise and scientific potential of stem cells were in the forefront of media attention from the very beginning, early media portrayal of this field often emphasized questions of ethics, morality and regulation. Studies have shown that media discourse reflected the highly polarized opinions in the public and political arenas surrounding the use of human embryonic stem cells (hESCs) in research. On the one hand, many believed that these cells had the power to completely revolutionize all aspects of medicine and advocated strongly for government funding to further advance this field. Conversely, there were those concerned about the source from which stem cells were derived (e.g., the human embryo), who deemed hESC research as dangerous and unethical.

This scrutiny of this research field was magnified following reports in 2006 that the leading South Korean stem cell researcher Hwang Woo-suk had not only fabricated the findings reported in two papers published in the prestigious journal Science (which were subsequently retracted), but had also illegally obtained human eggs to generate stem cells for his experiments. The field took a further hit in 2011, when Geron, the Californian biotech company, which had pioneered the first ever clinical trial with human embryonic stem cells-derived treatment and generated high expectations about the development of a stem cell therapy for spinal cord injury, decided to completely terminate all stem cell-based research. Regardless of these setbacks and other hurdles related to clinical translation of stem cell discoveries, several multinational studies have reported a continuously optimistic media slant towards stem cell research and therapies. Furthermore, these analyses of media representations have established a shifting thematic focus towards advances in regenerative medicine, rather than questions of ethics and morality. Yet, the current focus on innovation and clinical advances with stem cell therapies in news reporting comes with risks of its own. The public must be vigilant of exaggerated claims about therapeutic potential in media coverage. Scientists also have a duty to communicate realistic timelines for the developments of stem cell therapies and current progress in the field.

A 2015 study by Kalina Kamenova and Timothy Caulfield published in Science Translational Medicine examined the potential effect of the Geron corporation's decision on the media representations of stem cell therapies, and specifically whether the unwavering optimism has subsided after this significant setback in the field. A total of 307 news reports published over a four-year period (January 1, 2010 to December 31, 2013) from three countries (Canada, the United States and the United Kingdom) were analyzed. Of these, 160 articles were published prior November 14, 2011 when Geron halted its stem cell clinical studies and comprised a "pre-Geron" dataset. Conversely, 133 of reports represented the "post-Geron" data set and had been published after the tumultuous decision. Content analysis was conducted to determine the major themes in news coverage, proposed timelines for stem cell therapies and the overall perspective on the future of stem cell research.

It was established that the overarching theme of the news articles was clinical translation, with over one third of articles (37.1%) containing this as their main topic of discussion. Similarly, new discoveries in the field of stem cell research was the second most common theme of the reports (22.8%). This suggests that over half of all articles analyzed pertained to the advancement and anticipated potential of stem cell research. Strikingly, a mere 1.6% of articles comprised discussion surrounding the ethical issues of stem cell research. Given the deeply political and controversial beginnings of the field, these findings demonstrate a notable shift in the attitude and focus of the media with regards to stem cell research across countries. Another important finding was that the media's overly optimistic slant toward the future of stem cell research translation has remained steady in both pre- and post-Geron press coverage. Similarly, there was no substantial change in expectations about timelines for new therapies.

Interestingly, similar thematic trends were also observed in a 2018 study by researchers E. Huang and Mikihito Tanaka from Waseda University in Japan, published in Medical Tribune, a Japanese magazine for medical news. In this study, the same design and methodology used by Kamenova and Caulfield were adopted to analyze Chinese and Japanese news articles pertaining to stem cell research and regenerative medicine. The researchers examined news articles from the same time period as the original 2015 study in Science Translational Medicine and investigated the major themes, the overall perspective on the future of stem cell research and predictions for stem cell therapies in the media. In total, they examined 575 randomly sampled news reports, comprised of 239 Chinese and 336 Japanese articles in top newspapers. Here too, discussions of ethics were noted to be virtually non-existent and comprised less than 4% of articles. Those that did mention ethics often cited a general need for discussion, yet they themselves omitted any concrete conversation on the topic. Instead, Chinese and Japanese news media had new stem cell research findings as the major thematic focus, mentioned in 40.6% and 24.7% of all articles, respectively. This reinforces Kamenova and Caulfield's original findings and suggests that the progress and growth of stem cell research had been placed at the forefront of media coverage worldwide.

Thematic focus of news articles on stem cell research and therapy in Chinese and Japanese media. Credit: Professor Mikihito Tanaka, University of Waseda.

This shift from ethics towards reporting about new discoveries and clinical translation speaks to the gradual normalization of this field of research. It is also likely in part due to the discovery of induced pluripotent stem cells (iPSCs) by Takahashi and Yamanaka in 2007. They discovered that the use of four transcription factors was sufficient to reprogram mature human cells, such as skin cells, into stem cells called iPSCs. Now the use of morally charged hESCs could be reduced and, in some cases, was no longer required because scientists could instead use iPSCs in their research. Accordingly, only 21.5% of media reports in the study by Kamenova and Caulfield remained centered around hESCs, a significant change from the early years of discovery where reporting was centered on embryonic stem cell research (e.g., an analysis of newspaper reporting in the United States showed that hESC research dominated discussions in 2001).

Both studies were also in agreement regarding a second major finding: the overall optimistic attitude of the media towards stem cell research and its future. Huang and Tanaka reported predominantly optimistic viewpoints on the future of stem cell research in both the Chinese and Japanese articles analyzed. This finding is in line with Kamenova and Caulfield's original study, which showed that 55.6%, 51.1%, and 68.4% of articles in Canada, the United States and the United Kingdom, respectively, were optimistic about the future of stem cells. The similar results generated by the two studies suggest that stem cell hype has become a global phenomenon, spreading across different countries and continents. This is of particular importance, given that these findings were utilized by the International Society for Stem Cell Research (ISSCR) when developing their 2016 guidelines for stem cell research. These guidelines provide scientists with suggested steps to help prevent and deter the propagation of inaccurate information about stem cell research and unrealistic timelines for therapies. In brief, not only should researchers avoid reporting findings that have not yet been peer-reviewed, but the ISSCR also urges scientists to be transparent with regards to the initial objectives of the study. Only placing emphasis on positive findings, without specifying whether these were in fact the primary endpoints of the study at hand, risks skewing the public's view of the current state of the field.

Attitudes towards stem cell research by country based on Kamenova and Caulfield's study in Science Translational Medicine (2015). Credit: Lewis, R. 2017. Ethics to Hype: How Media Frames Regenerative Medicine. EuroStemCell.

In addition to demonstrating the striking similarities between media representations of stem cell therapeutics in the East and West, the reproducibility of the initial study in an Asian context suggests that this methodological framework is a reliable and robust means to assess the attitudes of media towards the field of regenerative medicine. Interestingly, not only were the overall feelings towards stem cell research highly optimistic in the Kamenova and Caulfield study, but so were the proposed timelines for translation of therapies into the clinic, with most predictions citing 5-10 years or less to achieve. These are rather unrealistic timelines for developing and bringing new drugs and treatments to the market. It would be of great interest to re-examine whether the proposed timelines were met, as well as if the overly optimistic media portrayal has been maintained in the years following the original study.

Overly optimistic media representations of the future of stem cell therapies can significantly distort public perceptions about the reality of stem cell research. Although the results of one study may show therapeutic promise and researchers may envision successful translation within a time frame of 5-10 years, it is extremely unlikely that clinical implementation will happen so quickly given the lengthy regulatory process for new treatments. Media hype around stem cell therapies often instills a false sense of hope in those who may need life-saving treatments. Without proper context and realistic timelines, these patients may be quick to take an opportunity to receive scientifically unproven treatments that are commercially available and widely advertised online and on social media.

The hype around stem cells is closely linked to the phenomenon of stem cell tourism, whereby patients travel to countries to obtain risky stem cell procedures. Consequently, trusting consumers who have seen only confident and positive reports by the media fall trap to illegitimate groups charging high prices for stem cell treatments that have not been scientifically validated. A return to the conversation surrounding the necessary regulations and ethics of stem cells is required, as the public may not know where regulatory boundaries lie. As highlighted by Dr. Ryan Lewis, just because the media has forgone discussion of the ethical implications and regulation does not mean that they have been resolved. Clear guidelines as to what treatments have been approved for what particular disorder are needed and scientists must be sure to delineate in media commentary the specific application of their research, rather than citing a broad or one-size-fits all application.

All in all, the findings from the above-mentioned studies show an important international shift of the media's views surrounding stem cell research and therapy, whereby ethics have been virtually omitted from the conversation. This research field still holds significant potential for medicine, but the media must find a middle ground in reporting new discoveries and clinical advances that strikes a healthy balance between hype and reality. The general public must keep in mind that the development of new treatments takes time and there are important regulations and research frameworks in place for a reason. To help bridge this gap, scientists must recognize the importance of their role as spokespeople and communicate transparently and openly on the current state of research.

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