For most south pacific islands there are few problems more urgent than diabetes. But what risks are acceptable in the search for a solution? Cook Islanders are agonizing over that question as they consider whether to allow a New Zealand biotechnology company to test a controversial treatment in their country.
The Auckland-based Diatranz Ltd. believes it may be possible to cure diabetes by xenotransplantation-transferring living animal tissue to humans. With approval from the Cook Islands government, it plans to inject insulin-producing pig cells into 24 volunteers with type 2 (non-insulin-dependent) diabetes, an obesity-triggered disorder in which the body is unable to process sugars. The disease can lead to blindness, kidney failure and heart disease. "Plain humanity dictates that we do more than we're doing at the moment," says Diatranz medical director Bob Elliott. With diabetes prevalence as high as 40% in parts of the Pacific, "the disease is totally out of hand and orthodox treatment isn't working."
The proposal has met with strong opposition, not least from the New Zealand government, which last year rejected a request from Diatranz to conduct a similar trial on New Zealanders with type 1 (insulin-dependent) diabetes. The main reason it gave for the rejection was chilling: on advice from gene technology experts, the country's director-general of health, Karen Poutasi, said she couldn't dismiss the possibility that the procedure could cause an hiv-like retrovirus to leap the species barrier and infect human patients. Poutasi invoked "the precautionary principle," vetoing the therapy while any doubts remained about its risks.
Diatranz didn't give up. After a sympathetic approach last year from Cook Islands politician Joe Williams, it applied to the Robert Woonton-led government to conduct the experiment at Rarotonga Hospital. Woonton agreed "in principle," but last month the government began consulting members of the public and international experts, some of whom oppose the trial. The Cook Islands "do not have appropriate regulatory authorities ... to safeguard the patients," said Tony d'Apice, head of the Montreal-based International Xenotransplantation Association. The country was probably an attractive host for such a trial, he added, "precisely because they do not have such safeguards." Paul Zimmet, director of the International Diabetes Institute in Melbourne and a former student of Diatranz's Elliott, says that for physiological reasons, "I don't think it's entirely appropriate that this procedure be used for type 2 diabetes," which he says is best managed through diet and exercise.
Elliott says most opposition to the trial is based on "irrational and irresponsible fear." Concerns about a pig-to-human viral transfer may have been valid five years ago, he says, but research has since allayed them. As for doubts about safeguards, Diatranz would pay for an independent monitor for the trial. "We're taking a very responsible attitude. We're not prepared to take any shortcuts," says Elliott, who believes diabetics will be "queuing up" to take part. The Cooks must now balance their hopes for a potential cure against the fear of a new disease.