Chris Mooney on the Rice Stem Cell Conference

Here's one for the political junkies amongst you. Chris Mooney has penned a host of informative posts on the recent politics of stem cell research conference at Rice University.

Talking about the science basics:

Goldstein gave a primer on the field, helpfully explaining why stem cells--and especially embryonic ones--are so medically promising. He noted that these cells could help us get past four major "bottlenecks" in the development of medical therapies: 1) there aren't enough sources of tissue for transplantation at present, but we might grow vast amounts of transplant tissues from stem cells; 2) drugs are very expensive to make because of the cost of human trials and because animal trials can lead scientists down the wrong road, but we might do better by testing drugs in human stem cell preparations; 3) we have an incomplete understanding of disease mechanisms, but research on stem cells with specific disease fingerprints will allow greater understanding of the development of many conditions; 4) we have enormous variation among individuals in terms of their response to various drugs and therapies, but down the road stem cells derived by nuclear transfer (or adult stem cells) could lead to patient-specific therapies.

I thought this "bottlenecks" approach provided a great way of explaining all the different reasons for doing stem cell research. Stem cells are "not a one trick pony," Goldstein explained; rather, the field should be thought of as a "broad enabling technology." Unfortunately, this point is frequently lost in the debate.

Moving on in his presentation, Goldstein talked about the limitations of adult stem cells, so beloved by the religious right. He noted that these cells: 1) are promising but have limited applications, and are poorly understood except in the case of the much-studied hematopoietic stem cells; 2) have restricted potency and growth potential, according to most studies. On the second point, Goldstein added that studies suggesting otherwise have not yet been independently reproduced and tend to suffer from "flawed designs, flawed assays, [and] poor data quality." To top things off, Goldstein concluded that even the scientists who specialize in adult stem cells think embryonic research should go forward as well. You will find "no strong scientific opinion that says you can do one to the exclusion of the other," he said.

Finally, Goldstein talked about Alzheimer's disease. Conservatives have argued that stem cell research has nothing to do with Alzheimer's, but this would come as surprising news to Goldstein. He noted that the disease has two basic forms--hereditary and sporadic (the most common human version)--and that embryonic stem cell research promises to be useful in each case.

For hereditary Alzheimer's, Goldstein explained, we could 1) genetically screen IVF-derived embryos for those that have the condition; 2) derive stem cells from these selected embryos and grow those cells into brain cells; 3) use these brain cells as a screening tool to test for new drugs. For sporadic Alzheimer's, on the other hand, Goldstein noted that the disease has complex origins and cannot be detected simply through genetic screening of embryos. Nevertheless, he continued, scientists might: 1) create cloned embryos containing the DNA of grown adults who have developed this condition; 2) extract stem cells from those embryos and grow them into brain cells; 3) conduct drug testing in these cells. In short, embryonic stem cell research could tell us a lot about Alzheimer's.

Chris Mooney makes the point that this sensible sort of presentation of research, potentials and what it all means doesn't seem to be making it into the mass media. Well, this is a (very) small start.

Regulation of embryonic research in the UK:

How does the UK regulate embryo research? Well, all research is approved on a case-by-case basis and those submitting applications have to show that the work is necessary medically, for one thing. No one can use embryos older than 14 days, genetically engineer human embryos, or implant them in wombs. For each line, researchers also have to put a sample in the UK Stem Cell Bank to be shared with other scientists. Britain has also, more recently, allowed "therapeutic cloning" or cloned embryo research to go forward.

From the chair of the NIH's Stem Cell Task Force:

First, Battey directly addressed President Bush's August 2001 claim that "more than 60" genetically diverse embryonic stem cell lines existed at the time of his speech. Saying this statement had generated "confusion," Battey blankly noted, "There weren't 60 lines. There were more than 60 derivations." See here for my explanation the crucial distinction between derivations and lines.

As if this isn't outrageous enough, Battey added that back in 2001, there was probably only one well-established embryonic stem cell line. Looking forward, he also noted that, with 22 actual lines currently available, there's only one more line that's well along in development and might be available to researchers at some point in time--leaving the likely final total under the Bush policy at 23.

What would be the results of a Federal ban on therapeutic cloning?

Attorney Gregory Glover, of the firm Ropes & Gray, took a first crack at this question. He said that there are differing interpretations of the constitution's Commerce Clause and often, the clause's scope ends up being decided on political grounds. I didn't find this particularly useful, but in the question and answer period Glover went further. He noted that should the Brownback bill pass Congress, California could be expected to file an injunction against it, asking for constitutional review. At that point, there would be a legal limbo, allowing research to continue in California until the case is heard. But after that, the state could have to fall in line if the law was deemed constitutional.

In a later session, lawyer and ethicist John Robertson of the University of Texas went further. Without discussing the Commerce Clause, he argued that the Brownback bill would be unconstitutional under the First Amendment, and might also be unconstitutional under the Fifth and Fourteenth at some point in the future. Why? Well, as far as the First Amendment goes, Robertson thinks that banning research would amount to a content-based restriction, which would be an unconstitutional interference with free speech. As far as the Fifth and Fourteenth Amendments go, meanwhile, Robertson thinks that as soon as life-saving therapies from this research are available, it would be unconstitutional to deprive people of "life" and "liberty" by blocking them from getting these treatments.

Ugh. Based on the results of conflict between the states and Federal government over medical and drug policies, I don't see the resulting fight over therapeutic cloning being pretty. This is why it is very important to continue to loudly oppose the pending criminalization of therapeutic cloning in the US.

It has to be said, based on those last three posts, that watching the regulatory impulse in action is distressing. So many people so desperate to exert control that they would damage and destroy valuable progress in medical science rather than see it succeed. The irony is, of course, that the success or failure of any distributed activity (like medical research) is beyond the ability of any politician or regulator to control - all they can do is slow the rate of progress and impose additional costs.

The best thing that all these folks can do is to get out of the way. Real progress requires freedom.


>The irony is, of course, that the success or
> failure of any distributed activity (like
> medical research) is beyond the ability of any
> politician or regulator to control - all they
> can do is slow the rate of progress and impose
> additional costs.

> The best thing that all these folks can do is
> to get out of the way. Real progress requires
> freedom.

Actually, I disagree, but only slightly. The extension of this argument is that there is no place for ethics in medicine. I think there is a middle ground.

The real issue isn't whether bio-ethicists can stop research and forever prevent whatever awful ethical crisis they foresee. Obviously they can't, and as you point out, all they do it delay the inevitable and add costs, both after the final emergence of the technology, in terms of financial costs and legal restrictions, and in up-front costs in terms of lives and suffering (suffering being pain, as well as damage to medical researcher's careers!)

However, that's not to say that ethicists, if citing a truly egregious situation, can't hope for a better outcome. If instead of stem cells we were talking about using Iraqi women and children as live unwilling medical donors, I think we could appreciate that the ethicists would be justified in their fight, even if it is accepted in the medical community as a given that Iraqi Civlian medicine will be practiced freely at some point in the future, and all the ethicists did was add costs and regulatory hurdles, and the suffering of millions of Americans...

Yes, a ridiculous example, but it underscores the need to appreciate that not all the ethicists are concerned simply because they are anti-medicine. I have no doubt that the Bush administration and his Bio-Luddi... er, Bio-Ethics Council are stonewalling for political and religious reasons completely beside the issue of whether an embryo truly has a soul.

But let's not get into a quibble over such details as whether ethical objections are justified. Let's look at something more pragmatic: If the "ethical" and "moral" objectionists truly want to prevent a medical practice from becoming a common procedure, what can they hope to do?

I think the obvious answer is not to prevent the research, but to offer a better alternative. They tried this with adult stem cells, but it's just not there yet. But I could envision a world where embryonic stem cell research is outlawed worldwide. And a decade or two down the road, the adult stem cell research becomes advanced enough that adult stem cells can be regressed to the "embryonic" stem cell state, without the need for an embryo.

This is probably what the "honest" opponents of embryonic stem cells were hoping for. By honest, you can bet that I'm disqualifying most of the Republican opponents of ESC research, and most particularly President Bush and Leon Kass, et al.

But for people like my colleague John at work, who has a master's degree in theology, I believe he honestly opposes embryonic stem cell research. Sure, we could make the argument that denying the research is costing lives. But what if it were a matter of allowing unwilling Iraqis, or black people, or homeless people, to be used as live donors to save lives. Wouldn't the argument be that by denying this research, we're costing lives?

Ethicists have their place, and we should not bag on them simply by virtue of the fact that we disagree with them. The more important issue, I think, is whether they are honest. The move to block stem cells was largely a political one, designed to appease the uneducated masses. A more "honest" politician--i.e., Bush need not apply--would have taken the step of putting policies and organizations in place to properly educate the public. If Bush had spent his four years in office educating the public about stem cells rather than vilifying them, he would been able to convert public opinion overwhelmingly, even among many of his "conservative base".

The few votes he would have lost to fundamentalist Christians wouldn't have been enough to outweigh the votes he could have picked up from parents of children with diabetes, and wives of men with heart disease, and children of parents with Parkinson's and Alzheimer's, etc., and probably even a few "liberals".

Instead, Bush took the easy route. Educating the public is hard, especially when your administration is based largely on the premise that an ignorant public is a public ripe for the picking.

Posted by: Jay Fox at November 24th, 2004 9:48 AM

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