Giving Up on Gene Therapy Is Wrong Reaction Death of Jolee Mohr should lead to new patient protections
by Arthur L. Caplan
The recent death of Jolee Mohr is likely to have a seismic impact on the future of gene therapy research.Biotech
companies, private investors and government funders will shy away from
sponsoring further research because Mohr died while a subject in an
experiment using genetic engineering to treat disease.
But giving up on gene therapy is not the right lesson to learn from this tragedy. Mohr had rheumatoid arthritis, an immune system disorder that caused pain and stiffness in her joints. By
using HUMIRA, a relatively new anti-inflammatory drug made by Abbott
Laboratories, she was able to keep her symptoms under control. Despite
her arthritis, Mohr played with her 5-year-old daughter, gardened, went
boating and accompanied her husband, Robb, to church. She even
volunteered at county fairs. So how did it happen that this active 36-year-old woman wound up dead in a Chicago hospital? Jolee
Mohr died soon after her right knee was injected with genetically
altered viruses as part of a research trial of gene therapy for
rheumatoid arthritis. The viruses were aimed only at the cells in her
arthritic knee, hopefully making this approach to treatment safer than
the existing drug treatments. Targeted Genetics Corp., the
Seattle-based company that sponsored the rheumatoid arthritis study,
has halted the work and dozens of participants are being monitored. The
irony of gene therapy is that despite its name, it has achieved little
in the past decade in terms of therapy but has, rather, been associated
with serious problems including deaths. Eight years ago, 18-year-old
Jesse Gelsinger died in an early experiment with gene therapy at the University of Pennsylvania.
Ironically, Targeted Genetics Corp. had acquired some of the genetic
technology that had been used in the experiment in which Gelsinger
died. The death of Jolee Mohr may be seen as the latest best reason to give up on gene therapy. The
finger-pointing about her death is well underway. Targeted Genetics
Corp. has already hinted that maybe Mohr died not because of the gene
therapy, but as a result of problems associated with HUMIRA, the
arthritis drug she was taking before she signed up for the gene therapy
trial. Robb
Mohr says his wife did not understand that she had agreed to be in a
safety study of gene therapy, which was not intended to benefit her in
any way. Dr. Robert Trapp of the Arthritis Center of Springfield, Ill.,
who had been Jolee Mohr’s physician for seven years and recruited her
into the study, says she signed a 15-page informed consent form and
that he answered all her questions about the study. The study and its
consent forms were reviewed and approved as U.S. law requires by an
institutional review board, this one set up for the for-profit research. If in fact Mohr did not understand the nature of the research she agreed to participate in, is this board partly to blame? This question leads to another: Did the doctor
closely monitor Mohr’s health before enrolling her in the gene therapy
trial? And another: Shouldn’t someone other than her doctor have made
the request for her to participate in a safety study of gene therapy
since it might be easy for a patient to assume that a request from her
doctor to try something would not be made unless the doctor thought
there was some benefit in it?I
have had the chance to see the informed consent form that Jolee Mohr
signed. In my opinion it is hard to read and not as clear as it should
have been about the fact that she was being asked to participate in a
safety study with risks but no expected benefits whatsoever for
treating her arthritis. It will take months if not years before these
questions about who knew what when to get answered. Lawyers will have a
fine old time running the meter while they battle out who is to blame
and what is to be paid for the death of Jolee Mohr. Lost in all of this mess are three key points. First,
there is no excuse — none — for someone to be allowed to sign up for a
study of an experimental drug or treatment never before used in human
beings if they don’t clearly understand when the sole aim of such a
study is to see whether the drug or treatment is safe. If people
cannot really understand complex 15-page consent forms, then why are
those documents still being used?
Second, if research is to advance, including gene therapy but also embryonic stem cell research
and other novel therapies, then someone has to go first after all the
animal testing and lab work has been done. Those first subjects face
very real risks, including death. But there is nothing anyone can do
to completely eliminate those risks. Third,
there is no national insurance program for those injured in early-stage
research studies, meaning bereaved families may have to go through the
rigmarole of a costly and slow trial so that they can pay their medical
bills when a loved one dies or is severely injured in this type of
medical research. Since those willing to be in safety studies are
really helping future patients, don’t we owe it to them to help in the
rare case where something unexpectedly goes terribly wrong? And lastly, questions remain about the system
we have had in place for decades to protect human subjects in
research. Subjects have to give informed consent, and committees,
known as institutional review boards, have to sign off on the research
and the consent forms before a study can start. But in a world where
drug companies sponsor more and more research approved by for-profit
review committees and carried out locally by private doctors who can make a lot of money recruiting subjects these protections may not be enough. Jolee
Mohr’s death is a horrible tragedy. It should not, however, end
research on gene therapy, which may be the only way to treat a variety
of ailments and diseases. That death should, however, cause us to
reexamine whether we are adequately protecting the heroes who help
medicine make progress.
Posted: 2007-09-17 |