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Hockey legend Gordie Howe's stem cell treatment is stirring controversy because the company behind the treatments didn't initially reveal some of the stem cells came from an aborted fetus.

Stemedica Vice President Dave McGuigan told The Detroit News and other media in February that "only adult stem cells were used" in the injections Howe received at a clinic in Mexico. Stemedica President Maynard Howe (no relation to Gordie) made similar statements.

But Stemedica recently confirmed to USA Today sports reporter Brent Schrotenboer that one of the two types of cells used in Howe's treatment — and for retired pro quarterback John Brodie — came from an aborted fetus that was 14 to 16 weeks old. Schrotenboer posed the question after obtaining a certificate of origin documenting the company's use of fetal cells.

Stemedica's choice of words raises questions, experts say, about the public's right to know the origin of stem cells with which they may be treated — and about whether patients receive enough information to give informed consent.

The cells are scientifically categorized as "adult," the company argues, because they can differentiate into a limited number of cell types, unlike embryonic cells that can develop into any kind of cell in the body.

"Scientifically they are (adult cells), but the source is controversial," said Jennifer McCormick, assistant professor of biomedical ethics at the Mayo College of Medicine in Rochester, Minnesota. She noted they can also be called "somatic" stem cells.

"If you're using fetal stem cells, then you should accurately describe them as fetal stem cells."

The use of embryonic and fetus-derived stem cells is considered controversial by anti-abortion and other groups because they worry that it encourages the killing of nascent human beings.

Gordie Howe's son Murray Howe declined, through his publicist, to comment on the issue. But Howe's family was well-informed of the source of the stem cells and was comfortable with it, according to USA Today.

"It's great that this tissue can be used for something that can help mankind," Toledo physician Murray Howe told USA Today. "...It's up to our whole society to decide what ends up in the tissue bank. To me, this is only positive — using the cells to help people."

Stemedica officials did not return multiple calls from The News seeking comment. But Stemedica's Maynard Howe acknowledged to USA Today the company's desire to avoid controversy.

"We just don't want to get people confused about what it is," Maynard Howe told USA Today. "They're really considered legally adult stem cells even if they're fetal-derived."

But some medical ethicists argue researchers and health companies should be straight forward about the source of stem cells.

Where stem cells originate is something that individuals "should be very informed about and able to make a choice," Mayo's McCormick said.

"Right now in the U.S., embryonic stem cell research can be controversial with many people against it based on their religious and spiritual principles — and there are many other people who are not against it," she said.

"A malicious lie"

These are issues of morality as well as of law, said Brian Scarnecchia, an associate professor and expert on bioethics and human life issues at the Catholic Ave Maria College of Law in Naples, Florida.

Stemedica's statement that only "adult" stem cells were used illustrates how ambiguity and nuance of language can be used to cloak issues of morality in medicine, Scarnecchia said.

"Clearly, using this verbal engineering to avoid controversy is what (St. Thomas) Aquinas would call a malicious lie. It's a serious sin," he said. "I suppose the defenders of this position might try to mischaracterize this as something of a white lie — that's ridiculous."

Howe's experimental treatment at the Clinica Santa Clarita in Tijuana, Mexico, initially spurred debate over the effectiveness of clinical trials in foreign lands, which are outside the institutional review process and Food and Drug Administration oversight that govern trials in the United States. The FDA approves very few stem cell clinical trials, experts say, so it's unlikely similar treatment would be available in this country.

The 87-year-old Howe's treatment and recovery from a stroke stirred the interest of Bill Van Horn, 62, of West Bloomfield, who contacted Stemedica after reading about it in The Detroit News. The article filled him with hope for his 82-year-old mother, who suffered a stroke similar to Howe's.

Stemedica didn't mention that some cells his mother would receive were grown from fetal brain tissue, and Van Horn admits he didn't ask. He was preoccupied about his mother's condition and then dissuaded after learning that the treatments — which Howe received at no charge — would cost a prohibitive $32,000.

"I'm not really up on medical ethics so I'm not 100 percent sure that I would have asked, (but) it would have concerned me if I knew it was fetal cells," Van Horn said. "My interest in my mother's health probably would have outweighed my concern about that, (but) if they had volunteered that, I would have at least (tried) to find out more about it."

Ethics will be high on the agenda this week at the annual meeting of the International Society of Stem Cell Research in Stockholm, Sweden. The society is expected to release new guidelines, long in the making, to address informed consent and other issues raised by the treatment and alleged cures of high-profile celebrities such as 87-year-old Howe, who has dementia, and Brodie.

Stem cell guidelines

Under professional guidelines observed in Australia, the words "adult stem cell" can be used only to describe cells that come from an adult. There are no such U.S. guidelines, and informed consent guidelines included in a patient handbook by the International Society of Stem Cell Researchers do not address the issue.

Mayo Clinic's McCormick noted that use of stem cells derived from embryos or fetal tissue is legal in the United States, though restrictions exist on embryonic stem cell research involving federal funding.

President George W. Bush in 2001 limited federal funding for embryonic stem cell research to only those stem cell lines that were in existence prior to Aug. 9 of that year — effectively restricting researchers to the use of 19 stem cell lines.

In 2009, President Barack Obama issued an executive order that opened new lines of embryonic stem cells to researchers. But prior bans on creating embryos for research and engaging in research that results in the destruction of an embryo remain in place.

Federal guidelines also ban the use of monetary or non-monetary incentives to encourage women to donate embryos. A 1993 law allows the use of human fetal tissue in research regardless of whether the tissue is obtained from a miscarriage, induced abortion or stillbirth. The law requires consent from the mother for use of the tissue and a paper chain documenting the source of the tissue.

States have their own rules. In 2008, Michigan voters approved a ballot measure that changed state law to allow people to donate embryos left over from fertility treatments for research.

kbouffard@detroitnews.com

Stem cells defined

There are different kinds of stem cells:

Embryonic stem cells are derived from pre-implantation-stage embryos and can differentiate into any cell type in the body.

Adult stem cells, also called somatic stem cells, can come from the tissue of a fetus, child or adult. They can develop into many cell types, but differentiation usually is limited to cell types found in the organ of origin.

For additional information, visit http://stemcells.nih.gov/info/basics/Pages/Default.aspx

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