A House Call
At half past eight on the morning of Friday, September 10, 2004, a meeting began at the laboratories of Massachusetts General Hospital. Huang was to speak. The meeting was limited to physicians and scientists. The chief organizer was Robert H. Brown, a professor of neurology at Harvard Medical School and director of the Day Laboratory of Neuromuscular Research at Mass. General. I had spoken with him by telephone early in the week; he told me he was skeptical.
Huang is of medium height, with a receding chin, and seemed somewhat diffident. His English is limited and strongly accented. He was there, it turned out, not to present his work on spinal-cord injury but to discuss another project that, he said, he had begun 18 months earlier. The title of his talk was “Olfactory Ensheathing Cell Transplantation for Amyotrophic Lateral Sclerosis.” ALS is the devastating nerve disorder better known as Lou Gehrig’s disease. (The accounts in the Scientist, Time Asia, and the Chicago Tribune had mentioned Huang’s turn to ALS.) Huang offered some minimal PowerPoint slides. His summary claim, at beginning and end: “OEC transplantation is safe, feasible, and rapidly improves partial function. Results are observable in two or three days, and improvement continues for two to three months. The mechanism is unclear.” However, his data were shockingly thin – indeed, insultingly so, I came to think. He finished up with half a dozen brief, blurry before-and-after videos of six of what he said had been a set of eight ALS patients, newly able to walk, or to stand, or to sit up, or to move the tongue enough to talk, if indistinctly. Each was followed by charts depicting nerve function before and after the transplant surgery.
His audience treated him with caution and courtesy, while its skepticism and impatience steadily increased. Much of the simplest factual information – pre-data, one might call it – was missing. Halfway through the question period, I asked several questions. When did his work with ALS patients begin? January 2003, he answered. But the videos carried dates, and these were as recent as mid-August 2004, just three weeks earlier. How many patients had he treated? He gave no clear answer; after follow-up questions from others, the likely number seemed to be 10 or 11 – until he said there had been “about 40.” Did they all get fetal cells? No answer.
As the questioning went on, problems with Huang’s methodology seemed to emerge, chiefly the lack of rigorous pre- and postoperative evaluation of patients’ functioning, the lack of controls, and, above all, the total absence of follow-up beyond a few months.
On his home ground, Huang is more assured, smoother. Indeed, with Chinese visitors and with patients, he evinces a certain quiet charisma. Chaoyang Hospital, Beijing, is part of a set of gray, grimy stone buildings around a gated courtyard, with no clear indication of which is its main entrance. Huang’s office is on the hospital’s top floor, but we met on the second, in a serviceable workroom with a central set of tables and, around the walls, shelves haphazardly filled with equipment and supplies. The room sits at the head of a dim corridor along which open, on either side, wards with six beds each, some empty, some occupied by patients, though not all are spinal-cord cases. The patients are surrounded by members of their families – as is customary in China, where much of patients’ care falls to relatives.
Huang and I discussed his procedures in detail. Some who had heard him in the United States wondered whether the cells he implanted were a raw mixture or purified. “We get the olfactory bulb out,” Huang said. “Of course, mixture. Then we culture them and purify them.” The dose for a spinal-cord patient is one million cells, “90 percent OEG cells.” Had he published anything about safety? He ducked the question at first, then said that the cells caused “no long-term fever.” He elaborated: “No problems with the cells; maybe we have complications of the surgery – infection of the area, leakage of the cerebrospinal fluid. The general complications of other surgery.”