Bionetworking: experimental stem cell therapy and patient recruitment in India

Abstract

Over the last three to four years, an increasing number of private and public sector tertiary level hospitals and research centres in India have been using stem cell therapy, especially adult stem cell therapy, in the guise of experimental therapy for a variety of medical conditions. The promotion and growth of this experimental field across local and national borders traverses regulatory, ethical, social and financial boundaries. In this complex context, the article examines how healthcare centres in India negotiate bio-medical and health care circumstances in promoting a therapy that raises questionable medical, technical and ethical issues. The process of promoting experimental stem cell therapy is explained here by employing the concept of bionetworking and illustrated by two case studies of hospital groups. The case studies show how through bionetworking a centre creates and maintains novel networks of mutual exchanges with other collaborative bodies situated in local, national and global relations of inequality. Drawing on a three-month period of fieldwork and interviews in various locations in India, this article shows that: (1) Questionable stem cell therapy is promoted through bionetworks that resonate across local, national and global constellations; (2) Regulatory gaps facilitate the growth of such therapeutic practices; (3) The experimental stem cell therapies augment the healthcare divide in Indian society; (4) The weakening Indian state facilitates commercialisation of health, indirectly supporting the 'bionetworking' practices of therapy providers.

Bionetworking and Strategic Linking between India and Japan: How Clinical Stem Cell Intervention Continues despite New Regulatory Guidelines

“…They were particularly averse to collaborative exercises. These different institutional sectors had developed varying strategies of dealing with ESCTs, which had generated new discursive dialects of bioethics (Patra & Sleeboom-Faulkner 2009). Dr.…”

“…Knowing how providers operate requires knowledge that pertains to institutional arrangements and strategies to circumvent regulatory safety nets. This we attempt to explain through the notion of 'bionetworking', which refers to social entrepreneurial network activities involving biomedical research and healthcare institution that respond to the health needs of the patients commercial demands of therapy providers (Patra & Sleeboom-Faulkner 2009). A bionetwork consists of a plurality of actors engaged in 'biotechnical ventures' In this article, then, we are more concerned about the strategies of these institutions (the how) adopted to continue the provision of stem cell intervention.…”

“…While these efforts are highlighted nationally and internationally (Salter 2008;Lander et.al. 2008, Tiwari & Raman 2014, significant concerns have been raised since the early 2000s over unproven stem cell treatments being offered at government and private clinics, hospitals and companies with apparently little regulatory oversight (Jayaraman 2005;Srinivasan 2006;Pandya 2008;Patra & Sleeboom-Faulkner 2009Tiwari & Raman 2014). These therapies are understood to be lacking in preclinical evidence of their efficacy and safety (Cohen &Cohen 2010).…”

Para-states and medical science: making African global health

“…These contradictions, arising from trying to do the right thing in the wrong context-trying to do something-produce public health science in Africa today. The ethical and political choices faced by public scientists under these conditions might not always differ from those involved in for-profit pharmaceutical trials (see Petryna 2007;Patra and Sleeboom-Faulkner 2009); the difference is that whereas pharmaceutical research and development works in spite of personal dilemmas, public health research needs to address these contradictions; it cannot afford ignoring them if the public in public health is to make sense in the long term (Geissler , 2014.…”

Badnam Science? The Spectre of the ‘Bad’ Name and the Politics of Stem Cell Science in India

“…15 Within academic debates-most notably, social science commentaries-the key concerns have centred around issues of governance vacuum, potential for harm, patient recruitment and patient exploitation, reputational risks, and therapeutic ambivalence (Patra and Sleeboom-Faulkner 2009;Salter 2008;Sleeboom-Faulkner & Patra 2011, Prasad 2015. The protagonists, mainly clinicians and scientists, are portrayed as breathing easily in a governance vacuum or as manipulating a range of uncertainties in pursuit of reputation enhancement (Salter 2008;Sleeboom-Faulkner & Patra 2008).…”