People With One Watch, Part II

This is a continuation of the previous post. I want to look at elective ignorance and the stem cell controversy. However, there are some basic points I want to clarify in this post before I go on to the main point.

“Embryonic” stem cells are derived from the cells that make up the inner cell mass of a blastocyst. Although sometimes a blastocyst is described as an embryo in a very early stage, in fact it is a conceptus in a pre-embryonic state. In humans, a blastocyst develops in the fallopian tube from the fertilized egg (zygote) and then moves (usually) to the uterus, where it implants itself. A pregnancy begins with the implantation of the blastocyst, which then develops into an embryo.

Embryonic stem cells are controversial because acquiring new cells requires destroying a blastocyst. Research scientists want to use the excess blastocysts stored at in vitro fertilization clinics that are going to be destroyed anyway, so there is no need to fertilize an egg for the purpose of obtaining stem cells. Those who object say the blastocyst is a human life, so destroying it is murder. Eventually embryonic stem cells for research may be obtained by cloning, which of course is controversial also.

For the most part, blogosphere opinion on embryonic stem-cell research splits across right-left lines, with the occasional exception. The Right is certain that conducting embryonic stem cell research is immoral. The Left is certain that not conducting embryonic stem cell research is wasteful, and I would call it immoral. To the Left, the Right’s arguments are silly. To the Right, the Left’s arguments are sinister.

As many on the Right point out, the President’s recent veto of the stem cell bill does not result in a ban on embryonic stem cell research, but maintains a ban on federal funding for research. Research with other funding can still be conducted. There is even an exception — embryonic stem cell lines that already existed before August 2001 can be used in federally funded research. And federal funding is available for research on adult stem cells. The Right believes federal policy is an acceptable compromise.

The Left points out that the stem cell lines available for federally funded research have been contaminated with mouse cells, which limits their use. The Left argues also that the ban on federal funds is close to a de facto ban. As this PBS Nova report points out,

Most basic biomedical science in this country—the early, exploratory research—is funded by federal dollars, with the National Institutes of Health taking the lead (to the tune of $20 billion in research-related funding a year). Scientists say that no field of research can flourish without access to this kind of government support. Yet the Harvard scientists you’ll meet in our NOVA scienceNOW segment are barred from using federal funds for the research we describe. If they already head government-funded labs, none of the equipment they’ve purchased can be used to create brand new human embryonic stem cells, to work with any such cells created after 2001, or to create cloned human embryos for stem cell research. That means not a microscope, not a petri dish, not one glass beaker. Scientist Doug Melton, who receives private funds from the Howard Hughes Medical Institute, has gone so far as to equip an entirely separate lab, at an undisclosed location, for this work.

From the American Society on Hematology:

With fewer opportunities for federal funding in human embryonic stem cell research, private sector and state efforts are gaining prominence, outside of the federal government’s oversight, control, and peer review mechanisms. Furthermore, several foreign countries are encouraging and/or actively investing in stem cell research, thereby posing the potential threat of loss of American scientific prominence in this emerging field, possible emigration of the best and brightest American scientists, and definite diminution in the number of talented foreign graduate students, postdoctoral fellows, and senior scientists who otherwise would come to the US for their training and to conduct research in this important area of scientific inquiry.

Adult stem cells can be taken from many parts of a human body, but most come from bone marrow. Contrary to claims from the Right, adult stems cells are not a substitute for embryonic stem cells. Both types of stem cells hold therapeutic promise, but not the same promise. Adult and embryonic stem cells have different properties and different potentials. According to the International Society for Stem Cell Research, embryonic stem cells are pluripotent, meaning they can be developed into many types of cells. Adult stem cells have so far not been found to have this property. On the other hand, adult stem cells have been used successfully to treat blood disorders. There is ongoing research into their use in treating breast cancer, coronary artery diseases, and other conditions. Adult stem cell research is important, also, but claims that adult stem cells have the same potential as embryonic stem cells are simply not true, based on research so far.

Another difference is that, once established in culture, large numbers of stem cells from embryos can be grown for a long time — indefinitely, under the right circumstances — and these cells will retain their unique properties. This is not true of adult stem cells. Stem cells are also obtained from umbilical cord blood and the pulp under baby teeth, and these cells may survive culturing longer than adult cells. These cells haven’t yet been found to have the same pluripotent quality of embryonic cells.

Some on the Right claim there is no evidence whatsoever that embryonic stem cells hold any therapeutic promise. This claim is based on cherry-picked “facts” — see for example, this web page featuring some quotes pulled from newspaper articles — e.g., “Not a single embryonic stem cell has ever been tested in a human being, for any disease”; “‘No one in human embryonic-stem cells will tell you that therapies are around the corner”; etc. In fact, human embryonic stem cells have been successfully turned into insulin-producing cells, blood cells and nerve cells. As reported by Maggie Fox of Reuters (July 16):

“They hold promise in different areas today,” said David Meyer, co-director, of the Cedars-Sinai International Stem Cell Research Institute, which is set to formally open in Los Angeles on Monday

“Adult stem cells will lead to cures much sooner than embryonic. However, the potential for embryonic, once we understand the biology, will be the greater,” Meyer said in a telephone interview.

Groups such as the Juvenile Diabetes Research Foundation and the American Association for Cancer Research say work with embryonic stem cells is vital to understanding how to regenerate diseased or damaged cells, tissues and organs.

For example:

— On July 3, a team at the University of California at Los Angeles reported they had transformed human embryonic stem cells into immune cells known as T-cells — offering a way to restore immune systems ravaged by AIDS and other diseases.

— In June, a team at Johns Hopkins University in Baltimore transplanted stem cells from mouse embryos into paralyzed rats and helped them walk again. Researchers at the University of California at Irvine have done similar work using human embryonic stem cells in rats.

Weirdly, people opposed to embryonic stem cells on moral grounds often are compelled to lie about the research:

David Prentice of the Family Research Council, which opposes embryonic stem-cell research, issued a statement saying adult stem-cell research was actively helping, or close to helping, people with at least 65 diseases.

But in Friday’s issue of the journal Science, three stem-cell experts — Steven Teitelbaum of Washington University in St. Louis, Shane Smith of the Children’s Neurobiological Solutions Foundation in Santa Barbara, California and William Neaves of the Stowers Institute for Medical Research in Kansas City — wrote a detailed rebuttal of these claims and said at best Prentice accurately portrayed only nine of the studies.

What does it say when people lie to defend an opinion on morality?

Right now preclinical work with embryonic stem cells is moving slowly through animal testing, and there are some obstacles to overcome before human trials begin. It is true that one human trial on Parkinson’s Disease patients was stopped in 2001 when 15 percent of the patients developed side effects that were worse than the Parkinson’s. This illustrates the need for caution. However, preclinical research on embryonic stem cells and Parkinson’s disease continues and is showing some promise.

Some argue that because research on embryonic stem cells has yet to result in treatment for human disease, the research is worthless. They ignore the fact that embryonic stem cells were first isolated in 1998. Research on embryonic stem cells is still at an early stage. Studies on adult stem cells, on the other hand, began in the 1960s.

Most medical breakthroughs take a long time to develop. Researchers began trying to develop a polio vaccine in the early 1900s. Jonas Salk began his research in 1947. Human clinical trials began in 1954. The safer Sabine vaccine became available in 1963. It took this much time just to develop a safe and effective vaccine, which is something that had been done successfully before. Developing any new therapy takes time and is terribly expensive — “discovering, testing, and manufacturing one new drug can take between 10 and 15 years and cost nearly a billion dollars.” Stem cell therapy is a far more complex project than developing a new drug.

The naysayers are, essentially, arguing that because the research hasn’t yet developed therapies for human use it never will, even though the enormous majority of scientists believe otherwise.

Here’s one interesting story, however

The story of Molly Nash illustrates how stem cell tools and therapies can work together to save lives. The Colorado child was born with Fanconi’s anemia, a genetic blood disease with an especially poor prognosis. Most patients rarely reach adulthood and die of leukemia. A bone marrow transplant from a healthy sibling with a matched HLA or immune profile can cure the disease, but Molly was an only child and her parents — both carriers of the deadly gene — were fearful of having another child with the disease. They used in vitro fertilization, pre-implantation diagnosis and a cord blood transplant in an attempt to save their child. PGD was used to screen 24 embryos made in the laboratory. One embryo was disease-free and matched Molly’s immune profile. The blastocyst was implanted and nine months later her sibling, named Adam, was born. The stem cells from Adam’s umbilical cord were given to Molly and today she is eleven years old and free from disease.

You can argue about the ethics of having a baby to obtain an umbilical cord to save a child if you like, but this case illustrates that the potential for stem cell therapies are very real.

There is a lot of confusion over stem cell cloning. When stem cell researchers talk about cloning, they mean therapeutic cloning, not reproductive cloning. In therapeutic cloning the cloned cells do not develop into an embryo but instead are used only to develop stem cells.

One other point — a South Korean scientist recently admitted to faking research on stem cell cloning. After this became news, a few on the Right came to believe that all research on embryonic stem cells throughout space and time was, therefore, faked. This is nonsense.

Of course, if the stem cells in question didn’t involve destroying blastocysts, there’d be no controvery. Which takes us back to the leftover blastocyst question.

Opponents of embryonic stem cell research argue that most embryos could be implanted in a uterus someday, which is absurd when you consider the cost and time and the fact that the number of blastocysts in storage is growing rapidly. Liza Mundy writes in the current issue of Mother Jones:

In 2002, the Society for Assisted Reproductive Technology—the research arm for U.S. fertility doctors—decided to find out how many unused embryos had accumulated in the nation’s 430 fertility clinics. The rand consulting group, hired to do a head count, concluded that 400,000 frozen embryos existed—a staggering number, twice as large as previous estimates. Given that hundreds of thousands of ivf treatment rounds have since been performed, it seems fair to estimate that by now the number of embryos in limbo in the United States alone is closer to half a million.

This embryo glut is forcing many people to reconsider whatever they thought they thought about issues such as life and death and choice and reproductive freedom. It’s a dilemma that has been quietly building: The first American ivf baby was born in 1981, less than a decade after Roe v. Wade was decided. Thanks in part to Roe, fertility medicine in this country developed in an atmosphere of considerable reproductive freedom (read: very little government oversight), meaning, among other things, that responsibility for embryo disposition rests squarely with patients. The number of ivf rounds, or “cycles,” has grown to the point that in 2003 about 123,000 cycles were performed, to help some of the estimated 1 in 7 American couples who have difficulty conceiving naturally. Early on, it proved relatively easy to freeze a lab-created human embryo—which unlike, say, hamburger meat, can be frozen, and thawed, and refrozen, and thawed, and then used. (To be precise, the technical term is “pre-embryo,” or “conceptus”; a fertilized egg is not considered an embryo until about two weeks of development, and ivf embryos are frozen well before this point.) Over time—as fertility drugs have gotten more powerful and lab procedures more efficient—it has become possible to coax more and more embryos into being during the average cycle. Moreover, as doctors transfer fewer embryos back into patients, in an effort to reduce multiple births, more of the embryos made are subsequently frozen.

And so, far from going away, the accumulation of human embryos is likely to grow, and grow, and grow.

The cold truth is that blastocysts generated in IVF clinics and not implanted into a uterus are often discarded immediately. Most of the blastocysts that are frozen will either degrade or be discarded eventually. A small number of available blastocysts have been implanted into adopting mothers, creating the “snowflake babies” — 110 have been born so far. A large portion of the blastocysts that are thawed and implanted will fail to result in a baby, however.

It should be obvious to anyone thinking clearly that “embryo adoptions” are not going to be the solution to the growing glut of frozen blastocysts. And if destroying a blastocyst is immoral, why is it more immoral to use it for potentially life-saving medical research than it is to send it straight to an incinerator? This makes no sense to me.

Now I can finally write about what I wanted to write about to begin with, which is looking at the “moral” issue of embryonic stem cells from many perspectives. I’m going to argue tomorrow that there is nothing at all immoral about embryonic stem cell research, but it is deeply immoral to deny medical researchers the use of surplus blastocysts.

Also: Alternet, “Stem Cell Research Could Make Miracles Happen“; Bob Geiger, “Right wing should adopt 400,000 frozen embryos.”

24 thoughts on “People With One Watch, Part II

  1. Good post and links.

    You’ve got a typo in your statment about polio vaccines “early in the 1990s” should be “early in the 1900s”.

  2. Another awesome post. Very well researched and articulated. One thing I never see mentioned in these discussions is the cost of IVF to the prospective parents. Many insurance companies don’t cover these procedures or else have a maximum dollar limit as to how much of the clinic’s costs will be covered, which is usually only enough for a couple of attempts. The point is that a vast amount of money is being spent by the insurance companies, or the parents, to produce the blastocysts, and I believe that as a part of the research effort for diseases we need a national program that will do a better job of covering all the necessary costs for prospective parents. It’s just a sensible national investment, like cancer or HIV research.

  3. Brilliant as usual, maha. Having said that….

    Anyone remember that old Far Side cartoon: “What we say to dogs/What dogs hear”? Maha writes hard science: “Blastocyst… conceptus… pre-embryonic state… zygote… PBS Nova report,” and the Fetus People hear white noise: Fssssssshhhhhhh. They lack understanding of human reproduction, general biology, and even the concept of linear time. All creations of their Intelligent Designer, btw.

    I suspect the stem-cell issue is going sift the nuts from the granola, if you will. The Fetus People’s extreme nuttiness on this issue will marginalize their entire movement into a tiny minority.

  4. Great post!!!It’s about time someone spoke up on this issue…leave it to you to be the voice of reason ….

    I have a neighbor going thru this for the second time.Later I recall thinking about the”leftovers” so to speak, and what the pocedure is for dealing with them.

    Do the donors have a say in what happens to the remaining sample?Maybe we are reaching a point where we should treat it like organ donation and give people the choice.Doctors would sit down with parents before treatment and give options.1.Discard 2.Freeze(is preserve a better word?) or3.Donate….I think people who are having vitro are prepared to understand …I also think if given the chance they would want to extend the miracle science bestowed upon them to further it, and I would think doctors would have a stake in explaining to parents what their donation could some day mean to others.For example my family may not want to donate my organs when I die at first thought, but if someone else could live, or see..that makes it worth it..
    If the parents intend to use the remaining,then do they now pay to “store ” them?..
    These “snowflake” babies….Did they come about by taking some unknown persons sample and implanting it into subjects? Can anyone just take Your “leftovers”…or are these snowflake babies a result of women going back for product that had already been stored by themselves?I would not be comfortable with some woman I didn’t know TAKING my store product without permission to create a kid for a bush photo op….I would thank you to keep my blastocysts away from bush…geez! Really how do such things work?
    I am terrified by the thought of the right wing marching into clinics and demanding the embryos be freed….holy crap!!! They are unfit to pick a president let alone be given children.
    It makes me wonder.If abortion were made illegal nation wide would the nut jobs who now stand outside abortion clinics just move down the road to where these embryos are stored and call the people who go in murders for leaving “lives” in limbo?
    Only yesterday I read a story from texas about a group taking a 18 week abortion around in a jar to show people(don’t even get me started on all the ways this is just wrong)…But soon they will be dragging a unused embryo around showing it to people .. perhaps they will name it, create a fictional life for it,,maybe even a composite of what the little pile of goo may have looked like.. if the evil people had just let it live!GASP!!!”They wanted to use little(enter embryos name here) for research, and his greedy donor parents didn’t think they could raise 500 children….won’t you look in your heart and send a few dollars so others like this child might live?”
    I still think that the only hope for finding a cure for the repulicon brain defect is stem cell research… wonder bush co doesn’t want to fund it.. if they were cured bush would be unemployed.

  5. It occurs to me that a thorough investigation into the money behind the ‘private’ groups who are doing blastocyst stem cell research might reveal some surprises for the one-watch people.

    I wonder if the rovian Repugs are publically/politically playing up their opposition for their base…. while their buddies are privately working to corner the market, so to speak, on a wave of the future in promising medical breakthroughs. Just a thought…..

  6. If I understand them correctly, the quotes above do not support your claim that David Prentice of the Family Research Council lied. He might simply have misunderstood or mis-summarized research, or not known of contrary research. Of course, in my ignorance of any of the factual details about Prentice’s statements, I’d bet that Prentice was willfully ignorant, or something. But even if you’re right — that he lied — you need to support that, and not just fling that charge of lying at Prentice — there are too many worthless name-calling blogs out there already.

  7. He might simply have misunderstood or mis-summarized research, or not known of contrary research.

    He either lied or he’s willfully ignorant, which is also lying.

    I’d bet that Prentice was willfully ignorant, or something.

    Exactly. Elective ignorance. That’s the whole point of the series. Read Part I.

    you need to support that

    The facts that I presented support the statement.

  8. Prentice’s lies don’t need to be supported..they stand on their own. The name alone..Family Research Council is a lie designed to decieve and mislead from their true agenda. Deception is a lie, and Prentice is a liar..

  9. Thank you for this, Maha. Been a while, but its time for me to express my gratitude for your excellent work. I read you every day, and usually send links all around.

  10. Why don’t we let the drug and biopharma companies pay for their own research?
    I might be convinced to support govt funding if if any discoveries,treatmens or cures that arose from such publically funded research was made availabe to all US citizens at no charge.
    I’m not holding my breath.

  11. What is funny is to hear the word murder bandied about when invitro must be murder by their definition and yet it is legal- making life and destroying life to make one life ok here but bad there. Their situationalism is beyong bounds

  12. Why don’t we let the drug and biopharma companies pay for their own research?

    Clue: the drug and biopharma companies do not want to underwrite embryonic stem cell research, because it’s going to cost billions and will be several years — decades, maybe — before any marketable therapies are in widespread use. Also, scientists all over the world are working on this, so it’s not likely any one company will get the patent.

    Big expense, not enough profit, in other words.

    I might be convinced to support govt funding if if any discoveries,treatmens or cures that arose from such publically funded research was made availabe to all US citizens at no charge.

    Most of the basic, primary research upon which medical technology, drugs, and other advances are based are paid for through government grants. Again, this is because it costs a ton of money and there’s no profit in it. The pharmaceutical companies build upon the basic research to develop medications from which they can profit. In other words, public funding of research makes private enterprise profitable and possible.

    It’s probable that every drug and medical technique that doctors have ever used on you were made possible by public funding of basic research.

  13. Maha, Before reading your latest essay, I hadn’t given much thought to the stem cell issue because I always regarded it as a “proxy war” (to borrow a phrase) for the abortion issue. So, thank you! I feel more grounded in the science of it and can more clearly see the comparisons and contrasts with related moral/political questions.

    Your comment on Thursday about elective ignorance not being a conscious choice, necessarily, but something people fall into out of fear was correct, but I think the “unconsciousness” of it is distributed unequally. In other words, I think the word “liar” might describe David Prentice more accurately than the phrase “electively ignorant.” He grossly distorts scientific research for non-scientific audiences to bolster a particular public policy outcome. I have an easier time affixing the EI label on a random rightie who gets all their information from Christian talk radio; I wouldn’t call that person a liar, per se. Ultimately, I really like the “elective ignorance” concept because it explains how people can resolve their cognitive dissonance between seeing the world ablaze and somehow not holding those in power accountable for it.

  14. I think government should defintiely be in the research funding business, but it shouldn’t be so eager to give away the results. This is true not only in medical research, but things like hybrid corn and such, among many other types of research. How about instead of giving away the results — as I understand it we now give it away but get a minor deal on government buying of the resulting products — we get, say, a 5% royalty on each. Talk about your tax cutting — the royalties would bring in billions, many billions. We don’t we do this? Why do we instead give it away as corporate welfare?

  15. Pingback: The Mahablog » People With One Watch, Part III

  16. The phamaceuticals want their cake and are also desirous to eat it. Govt supported Medicare B… non negotiable drug prices, vaccines… insured by the govt. If they want stem cell research, do their own and reap the financial rewards, that’s capitalism. If they want the govt to invest in their research then as with any investment in private enterprise, the govt should expect a fair return, otherwise it becomes a form of socialized medicine (not that there’s anything wrong with that)

  17. “And if destroying a blastocyst is immoral, why is it more immoral to use it for potentially life-saving medical research than it is to send it straight to an incinerator? This makes no sense to me.”

    The only thing I can come up with (imagining a blastocyst to be equivalent to a human life in any meaningful way): the fear that benefiting from blastocyst destruction by getting to carry out – and eventually use – potentially life-saving research just trips over a ethical line re: the value and sanctity of human life, and starts sliding down that infamous slippery slope to death camps and who knows what, in a way that simply trashing them without benefit doesn’t. Or even without considering such consequences, that simply benefiting from a wrong is wrong. In this view, such waste is morally superior for being a waste, a refusal to benefit. The closest analogy I can imagine is with the idea that killing soldiers or perhaps death row inmates is (generally) acceptable, but using them for scientific experimentation and organ harvesting isn’t, even if it would save lives. Or perhaps the controversy over using medical research or (iirc) medical illustrations deriving from Nazi concentration camps. (But temperance sounds sorta on the right track too, in that I don’t think most folks woulda had this frame if they hadn’t been producing and consuming all this culture of death stuff for some time as part of the anti-abortion mindset.)

    But of course, this is ridiculously incoherent, unless one starts to view ivf as some sort of vast and vital War on Blastocysts (we’re freezing them over there so we don’t have to freeze them over here?). The logical thing for them to do (given that initial conviction), as endlessly pointed out and as you show, is to oppose ivf as equally benefitting from the destruction of invisible babies. But mostly they can’t seem to do this, presumably because they feel ivf to be a good thing (or understand that the public does). And I’m sure they’re not comfortable with the idea of people suffering, even as a result of what they see as a moral good (or realize the public isn’t).

    Hence the myths (in the technical sense of resolving contradictions) of snowflake babies as a viable solution, of embryonic stem cells not really being all that useful, of adult stem cells being just as good. Or, to use your much clearer and more focused phrase, elective ignorance.

    Or, to use a much vaguer and less useful term, people are really frickin’ stupid.

  18. Maha –

    Thank you for clearing up that blastocyst stuff. Governor Romney (R-Mass) made me dizzy with this info last year while attempting to explain his flip-flop on this subject. He was for it before it he was against it, ie. for it pre-election and against it post-election. ***Also people, take heed, this guy is running for president in ’08 and not only is he one of the biggest flip-floppers on stem-cell research, he also changed his mind on emergency contraception. He’s a wolf in sheep’s clothing and shame on us because we fell for it – but that’s a story for another day.

    Speaking of flip-floppers, it would be interesting to know how many would save their loved ones if they knew that the ‘cure’ was a result of this research. Probably the same percentage of anti-choice people who rationalize that it’s OK for them to get an abortion when they find themselves in the unfortunate position of an unwanted/dangerous/result-of-rape or incest pregnancy.

  19. I just had to add a response to Bob Geiger’s great comments. I have always wanted to stand up in Congress and/or be face-to-face with these religious right hypocrites and ask: How many children have you adopted or are you willing to adopt? How many children have you adopted that have been born with HIV, drug-addicted or with severe physical deformities. Did you promise the victims’ of rape that you would adopt and provide for any resulting offspring? How many unwanted and uncared for children did you adopt Senator Santorum, Senator Brownback, etc? That’s what I thought!

  20. Speaking as someone who has been through infertility treatment, and I blog about it and this issue today, btw, I hope that if I had leftover embryos I would have the strength to donate them to help others. Just as I would hope to have the strength to donate a kidney if a loved one needed it.

  21. Pingback: The Mahablog » Being Good

  22. Pingback: The Mahablog » Shameless

  23. Pingback: The Mahablog » The Wisdom of Doubt, Part II

Comments are closed.