Stem cell treatments for neurodegenerative diseases: challenges from a science, business and healthcare perspective

Profits in medicine are typically justified by the notion of a ‘social contract’ between sci- ence and society: pharmaceutical and biotech companies are permitted to charge high fees, because revenues are reinvested into research and these investments result in new drugs and the improved health of citizens. A central premise of this model is, however, that the development of novel medicines is financially sustainable: new drugs must be sold in high quantities and be subsidized by welfare state arrangements, so that development costs can be transformed into surplus and future discovery. In the emerging field of stem cell medicine, though, it is still uncertain whether these aims can be achieved. In this article I will discuss this situation with a particular emphasis on neurodegenerative disease research. Although the development of marketable stem cell treatments for neurodegenerative and other neurological diseases is now within reach, it is an open question to what extent these emerging therapeutic strategies can be translated into affordable and widely accessible routine applications. The successful marketing of these treatments and, in particular, the facilitation of widespread and equitable access by patients are affected by various challenges. In this article, three central factors that hinder the translation of the therapeutic potential of stem cells into routine, reimbursable healthcare practice will be discussed: unresolved scientific challenges, the risk of unsustainable development costs and the problem of integrating expensive stem cell treatments into national healthcare portfolios.