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September 21, 2022

Japanese regulations on regenerative medicine are failing patients

ASHBi Professor Misao Fujita leads a group of bioethicists who argue the Act on the Safety of Regenerative Medicine must be revised to better protect patients.

Many nations across the world, including Japan, are making significant investments in regenerative medicine. This is largely due to its potential to cure people of spinal injuries, recover from strokes, among other various anticipated benefits. However, nowadays it is growingly becoming difficult for patients to unambiguously distinguish regenerative medical therapies that are medically-proven from those still undergoing further scientific investigations. To overcome these issues, in 2014, Japan passed the Act on the Safety of Regenerative Medicine (ASRM). But now, a new study in Cell Stem Cell by Professor Misao Fujita and colleagues investigated the types of regenerative medicine being performed under the ASRM in Japan and found that further revisions are necessary if it is to effectively prevent patients from mistakenly selecting unproven treatments.

Among regenerative medicines, applications of cell therapies have generated the most interest. Japan's strength in stem cell research has pushed the country to aggressively fund all kinds of cell therapies in hopes of curing intractable diseases and putting Japan at the forefront of this potentially revolutionary patient care.

Indeed, many countries have seen extraordinary promise in cell therapies, but so too have many unethical clinics, that have advertised treatments which has led to serious complications and even death in over a dozen countries including Japan.

"The ASRM requires any provision plan for a therapy be accompanied by explanatory and informed consent documents. In 2017, revisions to the act required these documents be published on the MHLW (Ministry of Health, Labor and Welfare) website," said Fujita.

In the study, Fujita and colleagues referred to the MHLW, website for information about clinics offering cell interventions in Japan, collecting explanatory and informed consent documents on 3467 provisional plans in total.

Alarmingly, the study found there were treatments that would be subjected to international criticism. The study cautioned three structural issues in ASRM, the absence of scientific verification requirement, the failure to distinguish research and treatments, the absence of any clearly definition for medical innovations and unproven interventions.

"The ASRM does not prohibit interventions so long as they follow the procedures stipulated by law," described Fujita.

In other words, even if a treatment is scientifically unproven, it can be administered. Moreover, she worried, its presence on the MHLW website may provide what she calls a "seal of approval" that the treatment is safe and effective even when it actually is not.

Moreover, 2% of the examined plans failed to include the required explanatory documents, putting further doubt into the quality of the review process.

For Fujita, the study shows that the ASRM should address at least these three points before patients can be confident about the cell therapies provided under this law.

"The ASRM has already gone revisions. We wish our study will guide more changes to strengthen its quality," she said.

Paper Details
  • Journal: Cell Stem Cell
  • Title: Current Status of Cell-based Interventions in Japan
  • Authors: Misao Fujita1,2*, Taichi Hatta3, Kazuki Ide4,5
  • Author Affiliations:
    1. Uehiro Research Division for iPS Cell Ethics, Center for iPS Cell Research and Application (CiRA), Kyoto University, Sakyo-ku, Kyoto, Japan
    2. Institute for the Advanced Study of Human Biology (WPI-ASHBi), KUIAS, Kyoto University, Sakyo-ku, Kyoto, Japan
    3. Graduate School of Public Health, Shizuoka Graduate University of Public Health, Aoi-ku, Shizuoka, Japan
    4. Division of Scientific Information and Public Policy, Center for Infectious Disease Education and Research, Osaka University, Suita, Osaka, Japan
    5. Research Center on Ethical, Legal and Social Issues, Osaka University, Suita, Osaka, Japan
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