Stem cell research has been highly publicized and discussed in the last ten years. Much of this is due to the fact that useful human embryonic stem cell lines were only recently established in 1998 (International Society for Stem Cell Research, 2008). The existence of stem cells for use in experimentations led to ethical dilemmas with political implications. Notwithstanding political and ethical debates, the use of stem cells for treating many diseases and disabling conditions has continued to increase. The related literature regarding music therapy and patients being treated with stem cells is small, but music therapy has been shown to have promising potential.
In order to understand the possible ways music therapy may benefit patients receiving stem cell therapy, it is important to define stem cells and review the current state of research and treatment. Stem cells are building blocks of life since they are unspecialized cells that can turn into many different types of cells as they develop. Stem cells can turn into muscle cells, red blood cells, brain cells and any other cell in the body. The National Institutes of Health (2009) primer on the subject of stem cells further explains that stem cells can divide without limits into more unspecialized stem cells. Embryonic stem cells begin dividing into different types of cells as the embryo grows into a fetus. In adults, stem cells located in the gut and bone marrow produce a replenishing supply of specialized cells that replace and repair damaged tissue (National Institutes of Health, 2009).
Embryonic and somatic (adult) stem cells present important differences for researchers studying different ways to utilize them in experiments and therapy. Embryonic stem cells, discovered in 1981, are produced from embryos that have been created through in vitro fertilization (National Institutes of Health, 2009). Embryonic stem cells have been considered unique because they can proliferate for many years in the laboratory without changing into specialized cells. Adult stem cells, however, usually generate the same type of cells for the tissue where they reside. Researchers have also found it difficult to make adult stem cells proliferate in the lab, and even when they do, it is for only a short time (National Institutes of Health, 2009).
Researchers aim to establish pluripotent stem cells, which mean that the cells can produce any cell in the body (International Society for Stem Cell Research, 2008). Embryonic cells are cultured and then subcultured until the cells have proliferated for more than six months. This establishes a “stem cell line.” The first human embryonic stem cell lines were created in 1998 (International Society for Stem Cell Research, 2008). Stem cell lines are useful to scientists because they have an abundant supply of unspecialized stem cells that can be used for directed differentiation.
Embryonic stem cells that are allowed to clump together and form embryoid bodies can start differentiating spontaneously. Researchers can direct this differentiation by adjusting the chemical composition of the culture medium or inserting certain genes. The eyes, ears and heart are common destinations for these cells. Adult stem cells can be differentiated into cells that are common to their origin such as skin cells, neural cells and hematopoietic cells (National Institutes of Health, 2009). Sometimes adult skin cells have been able to transdifferentiate into cell types other than expected, but these occurrences have been isolated in non-human vertebrate. One exception to this is the induced fluripotent cells (iPSCs). These are adult stem cells that have been turned into embryonic stem cells by introducing embryonic genes. Although these stem cells offer great hope to researchers in expanding stem cell lines, scientists do not know if iPSCs and embryonic stem cells are exactly the same (International Society for Stem Cell Research, 2008).
Stem cells offer great hope for treatment of disease and use in the lab for drug trials. Embryonic stem cells can become any type of cell and can be produced with relative ease compared to adult stem cells. Adult stem cells, however, are thought to be less likely to cause rejection by the immune system in a patient because they can be created from the patient’s own cells. By overcoming the problems with rejection stem cell therapy has been used successfully to place new cells in the spinal cord, repair burns, and aid in fighting heart disease and arthritis (International Society for Stem Cell Research, 2008). Stem cells in the lab have been used to learn how cell division occurs in cancer and birth defects. Researchers have also been able to test drug effects on differentiated cells.
The usefulness of stem cells is sometimes overshadowed by ethical questions surrounding the use of embryos and their destruction to create embryonic stem cells. Many people have asked whether embryos should be considered people or property. Even if embryos are considered property concerns have been raised that women could become commercially exploited for their eggs (Hollowell, Coelho, Weldon, & Moffit, 2005). Cord blood stem cells may offer an alternative to embryonic stem cells since they do not require an embryo to be destroyed and offer some potential for undifferentiated cells. The current dependence on embryonic stem cell lines for most of the research and therapy will continue to cause ethical debate, but has also been a catalyst for political battles.
The political debate over stem cells has centered around the use of federal money for research on embryonic stem cells. George W. Bush established an executive order allowing for funding of ongoing research on embryonic stem cell lines that had already been established, but did not allow for additional funding to destroy new embryos and create new stem cell lines (The White House, 2001). In March of 2009, President Barack Obama issued an executive order to allow embryonic stem cell research to be funded by the National Institutes of Health (Stout & Harris, 2009). His order makes it possible for federal spending on new embryonic stem cell lines.
Ethical and political debates may continue until consistent methods are found to produce pluripotent stem cells without destroying human embryos. Although private research was not directly affected by the political debate and continued producing stem cells for medical use, President Obama’s new executive order will surely spur more federal help. Stem cell transplants and therapies that have been successful over the last decade have presented patients with challenges in healing and coping with the invasive procedures. The American Cancer Society (2009) cites high fever, infection, cramps, diarrhea, mouth sores and pain from needle sticks as only a few of the adverse symptoms and side effects from stem cell transplant. Health care workers will have to put effort into treating the physical and psychological side effects of stem cell therapy and transplant.
Music therapy has already been involved with some of the patients in this new frontier of medicine. Music therapists have been using music to help with pain and nausea (Sahler, Hunter, & Liesveld, 2003), improving mood (Cassileth, Vickers, & Magill, 2003), and decreasing anxiety (Robb & Ebberts, 2003). The research conducted by Cassileth, Vickers and Magill (2003) looked at the effect of music therapy on mood disturbance during autologous stem cell transplant for 69 patients divided into two groups. Music therapy interventions were determined by trained music therapists according to the needs of each patient and the interventions ranged from music assisted relaxation to active music making with instruments and song-writing. The researchers found that patients in the group receiving music therapy indicated a 28% lower score on an anxiety/depression scale and a 37% lower score on a total mood disturbance score when compared to the group that did not receive music therapy. The score for total mood disturbance for the group receiving music therapy was significantly lower than the total mood disturbance score for the control group. Music therapy was helpful in this instance where drug therapy might be less effective or contraindicated due to medical circumstances.
More research will need to be conducted with regard to music therapy and the therapeutic use of stem cells. The research literature about music therapy to help with relaxation (Sahler, Hunter, & Liesveld, 2003) and reducing anxiety (Robb & Ebberts, 2003) were pilot studies with very small numbers of subjects. These studies are important in establishing the feasibility for future research using music therapy with patients undergoing stem cell transplant and therapy, but the experimental results cannot yet be generalized to larger populations.
Opportunities for music therapy will increase as more options for stem cell transplant become available. One exciting new development is the discovery of stem cells that can turn into hair cells in the inner ear (International Society for Stem Cell Research, 2005). Successful transplants of stem cells for hearing loss would be a huge step forward and could benefit from specially developed music interventions during hearing rehabilitation. Overall, music therapy is well positioned to help patients before, during and after stem cell therapy. There already exists a large research base describing music therapy for pain management, relaxation and psychosocial support for patients undergoing similar procedures. Transfers can be made between existing practice and work with patients who are meeting the challenge of stem cell therapy.
References
American Cancer Society. (2009). Detailed guide: Multiple myeloma stem cell transplantation. Retrieved October 30, 2009, from http://www.cancer.org/docroot/CRI/ content/CRI_2_4_4X_ Stem_Cell_Transplantation_30.asp
Cassileth, B. R., Vickers, A. J., & Magill, L. A. (2003). Music therapy for mood disturbance during hospitalization for autologous stem cell transplantation: A randomized controlled trial. Cancer , 98, 2723-2729.
Hollowell, K., Coelho, P. H., Weldon, D., & Moffit, R. E. (2005). Federal stem cell research: What taxpayers should know. The Heritage Foundation, Washington, D. C.
International Society for Stem Cell Research. (2008). Stem cell facts: The next frontier? Retrieved October 31, 2009, from http://isscr.org/public/ISSCR08_PubEdBroch.pdf
International Society for Stem Cell Research. (2005). Stem cells and the inner ear. Retrieved October 28, 2009, from http://www.isscr.org/public/ear.htm
National Institutes of Health. (2009, April 28). Stem cell basics. Retrieved October 27, 2009, from http://stemcells.nih.gov/info/basics/defaultpage
Robb, S. L., & Ebberts, A. G. (2003). Songwriting and digital video production interventions for pediatric patients undergoing bone marrow transplantation, part I: An analysis of depression and anxiety levels according to phase of treatment. Journal of Pediatric Oncology Nursing , 20, 2-15.
Sahler, O. J., Hunter, B. C., & Liesveld, J. L. (2003). The effect of using music therapy with relaxation imagery in the management of patients undergoing bone marrow transplantation: A pilot feasibility study. Alternative Therapies in Health Medicine , 9, 70-74.
Stout, D, & Harris, G. (2009, March 7). Obama reversing stem cell limits Bush proposed. The New York Times, p. A1.
The White House (2001, August 9). President discusses stem cell research. Retrieved November 1, 2009, from http://georgewbush-hitehouse.archives.govw/news/releases/2001/08/ 20010809-2.html.
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