June 29, 2005,
Getting beyond stem-cell ethics obstacles.
In a recent Wall Street Journal opinion piece (registration required), Princeton's Robert P. George teamed up with Dr. Markus Grompe "a professor of genetics at the Oregon Health and Science University, director of the Oregon Stem Cell Center and a member of the International Society for Stem Cell Research" to herald the promise of an alternative to ethically challenged embryonic-stem-cell research.
NRO Editor Kathryn Lopez recently asked George, a member of the President's Council on Bioethics, to talk a little about the future of stem-cell research and some of the heated rhetoric surrounding the issue.
National Review Online:Last week in the New York Times, Mario Cuomo wrote "So far neither Mr. Bush nor religious believers have convinced a majority of Americans that the use of embryonic stem cells inevitably entails the murder of a human being. Most Americans, vividly aware of the millions of tragic victims of Alzheimer's, Parkinson's, cancer and spinal cord injuries, believe that embryonic stem cell research may provide cures. They will demand that Congress act to realize that potential."
You must have been fuming.
Robert P. George:One really does wish that Governor Cuomo would defend his views with arguments. If he really thinks that human embryos are something other than human beings at the earliest stage of their natural development, he should state his reasons for believing such a thing. He should explain to us the basis of his judgment, if it is indeed his judgment, that every major text in the field of human embryology is simply in error on the point. After all, the question of whether a human embryo is or is not a whole living member of the species Homo sapiens is not one to be resolved in the mind of any conscientious citizen or morally serious policymaker by examining public-opinion polling data.
At the same time, it should be noted that Cuomo doesn't even manage to do justice to public-opinion polls on the question of embryo-killing. For what it is worth, polls stating the question in an unbiased fashion tend to show that a majority of Americans do not support the practice of destroying human embryos for biomedical research, and certainly oppose the creation of embryos by cloning for research so-called "therapeutic cloning" or any other purpose.
NRO: Is he just ignoring reality ?
George: Yes. In dodging the moral argument against embryo killing, he is ignoring the basic facts of human embryology and developmental biology. There is no mystery about when the life of a new human individual begins. It is not a matter of subjective opinion or private religious belief. One finds the answer not by consulting one's viscera or searching through the Bible or the Koran; one finds it, rather, in the basic texts of the relevant scientific disciplines. Those texts are clear. Although none of us was ever a sperm cell or an ovum, each of us was, at an earlier stage of development, an embryo, just as each of us was an adolescent, a child, an infant, and a fetus. Each of us, by directing his own integral organic functioning, developed himself (sex is determined from the beginning) from the embryonic, into and through the fetal, infant, child, and adolescent stages, and into adulthood with his unity and determinateness intact. One's identity as a human being does not vary with or depend upon one's location, environment, age, size, stage of development, or condition of dependency.
Of course, science cannot by itself settle questions of value, or dignity, or morality. And there are, to be sure, people such as my colleague Peter Singer who understand the science, but who deny the ethical proposition that human beings have inherent dignity and equal rights. They are willing to license the killing of certain innocent human beings (the very young, the severely retarded, the gravely debilitated), distinguishing those whom they regard as "persons" from those whom they believe are not, or are not yet, or are no longer "persons." Hence, Singer's notorious advocacy not only of abortion but of infanticide and euthanasia as well. But I would have thought that Mario Cuomo would want to stand with those of us who affirm the inherent and equal dignity of every member of the human family. Surely he would wish to uphold against the Singers of the world Jefferson's "self-evident" proposition that all human beings are created equal. But that leaves him with only one option if he is to rationalize his support for abortion, embryo-destructive research, and their public funding: He must disregard scientific reality and pretend that basic embryological facts remain shrouded in mystery.
There is another piece of reality that Cuomo is ignoring. He is imagining or at least encouraging others to imagine that embryo-destructive research holds the key to curing horrible diseases, such as Alzheimer's, Parkinson's, and cancer. The truth is that we do not know when, or even whether, embryonic stem cells will prove to be useful in treating any disease. Leading authorities on Alzheimer's disease, including many scientists in the field who personally favor embryonic-stem-cell research and its public funding, say that Alzheimer's will almost certainly never be treated (much less cured) by embryonic-stem-cell therapies. A recent story in the Washington Post quoted a leading Alzheimer's researcher as saying that the belief that embryonic stem cells will be used to treat Alzheimer's is a "fairy tale."
We cannot say with certainty that embryonic cells will never prove therapeutically useful in treating other diseases, but as a matter of sheer fact not a single embryonic-stem=cell therapy is even in clinical trials. No one knows how to prevent tumor formation and other problems arising from the use of embryonic stem cells. No one knows whether these problems will be solved or solved before other research strategies render embryonic research obsolete. Like John Kerry, John Edwards, and Ron Reagan, Cuomo is elevating the hopes of suffering people and their families who are desperate for cures and eager to believe that if only embryonic-stem-cell research were federally funded they or their loved ones would be restored to health.
Indeed, Cuomo supposes that the American people are about to rise up and demand that the Congress open the money faucet. He imagines that the voting public will not tolerate politicians who stand their ground against the funding of embryo-destructive research. But, again, the former governor is disregarding reality. Kerry, Edwards, and company made the issue of embryonic-stem-cell-research funding a central feature of their campaign. They hammered President Bush on the issue at every campaign stop and, via Ron Reagan, in prime time at their national convention. They thought they could ride the issue to the White House. They lost.
NRO: Cuomo aside, is a silence starting to be broken about adult-stem-cell research and other alternatives to embryonic-stem-cell research?
George: Yes, the word is getting out about actual therapeutic breakthroughs using non-embryonic stem cells, such as cells harvested from umbilical cord blood, bone marrow, fat, and other sources. There are people suffering from a variety of diseases who have been helped and even cured by adult-stem-cell therapies. Many such therapies are well along in clinical trials. Word is also getting out about alternative methods of obtaining pluripotent (i.e., embryonic-type) stem cells. Even those of us who oppose embryo killing and reject the hype about possible embryonic-stem-cell therapies recognize that research involving pluripotent cells is desirable if the cells can be obtained without killing or harming human embryos or violating any other ethical norm. Even if they do not someday prove to be therapeutically useful, pluripotent cells may nevertheless be used in basic science and the construction of disease models. Recently, the President's Council on Bioethics issued a white paper outlining several promising avenues for obtaining these cells without violating the ethical norm against taking innocent human life. I joined the overwhelming majority of my colleagues on the President's Council, including many who do not share my ethical objections to embryo killing, in endorsing further exploration and research into some or all of these methods. There are some exciting possibilities here, especially those involving epigenetically reprogramming ordinary body cells to the pluripotent state.
NRO: What has been keeping the media from talking about these ethical alternatives?
George: Most people in the mainstream media favor embryonic-stem-cell research and have no objection to killing human embryos to obtain the cells. They are in the Cuomo camp. They view the opponents of embryo killing as "religious conservatives" and even "fundamentalists" who are trying to "impose their morality" on others and who are, in this case, trying to block advances in biomedical science. They think that talking about alternatives to embryo-killing (or successes with adult stem cells) only serves the interests of their political opponents. So many simply keep mum. There are, however, honorable exceptions. Neither Rick Weiss of the Washington Post nor Gareth Cook of the Boston Globe would appear on anybody's list of reporters secretly harboring sympathy for the pro-life cause. Yet both have published important, carefully researched stories telling the truth about possible alternatives to embryo-destructive research.
NRO: In layman's terms, what is OAR and what is the big deal about it?
George: Oocyte assisted reprogramming (OAR) is among the most exciting proposals for obtaining pluripotent stem cells without killing or harming human embryos. OAR is a variation of a broader concept known as "altered nuclear transfer." It combines basic cloning technology with epigenetic reprogramming.
In cloning, the nucleus of a somatic cell (such as a skin cell) is transferred to an egg cell whose nucleus has been removed. An electrical stimulus is administered in a way that, if all goes as planned, triggers the development of a new and distinct organism, an embryo, that is virtually identical in its genetic constitution to the organism from which the somatic cell was taken. In OAR, however, the somatic-cell nucleus or the egg cytoplasm or both would first be altered before the nucleus is transferred. The modifications would change the expression of certain "master genes" transcription factors that control expression of many other genes by switching them on or off. These genetic alterations would permit the egg to reprogram the somatic-cell nucleus directly to a pluripotent, but not a totipotent (i.e., embryonic) state. The altered expression of the powerful control gene would ensure that the characteristics of the newly produced cell are immediately different from, and incompatible with, those of an embryo. For optimal reprogramming, master genes known to control the pluripotency of embryonic stem cells would be used, for example the transcription factor known as "nanog." Thus, we would reasonably expect to obtain precisely the type of stem cells desired by advocates of embryonic stem-cell research, without ever creating or killing embryos. The cells used would not be embryos and would at no point go through an embryonic stage. Embryogenesis would never occur. (A technical description of OAR is posted on the website of the Ethics and Public Policy Center here.)
NRO: Is this in any way similar to Dr. Hurlbut's research? Is that something science should also be pursuing with policymakers' backing?
George: William Hurlbut of Stanford University and the President's Council on Bioethics has been the leading voice urging scientists and policy makers to explore altered nuclear transfer as a possible method of obtaining pluripotent stem cells in an ethically unimpeachable manner. OAR represents a variation of Dr. Hurlbut's basic proposal. It emerged from discussions involving Dr. Markus Grompe of the Oregon Health and Science University, Dr. Maureen Condic of the University of Utah, and others. It represents an important step forward because it does not involve the production of non-embryonic entities from which stem cells are harvested; rather, it employs techniques of epigenetic reprogramming of somatic cells to produce stem cells directly. Previously discussed versions of altered nuclear transfer left some pro-life advocates with concerns about whether we could really know whether altered nuclear transfer was producing truly non-embryonic entities as opposed to damaged or defective human embryos or human embryos pre-programmed for an early death (because, for example, they could not implant). OAR relieves that concern. Still, I and others advocating exploration of OAR want to begin with research using animal cells and proceed to the use of human cells only after OAR is proven to be technically feasible and ethically beyond reproach. We believe that this can be accomplished quickly and at modest cost. I certainly hope that policymakers will back this exploration.
NRO: When you advocate "creative science" as you did in the headline of your recent Wall Street Journal can't that get dangerous? I mean, we don't have a ban on a lot of stuff, especially when it comes to private research.
George: Science is a wonderful enterprise. It has served the cause of humanity in myriad ways. It has improved the average length and quality of our lives, and will continue to do so. Like countless others today, I'm a cancer survivor. Science made my survival possible. I can't begin to tell you how grateful I am for that. Yet, every sober person recognizes that great harm can also be done in the name of science and even in the cause of science. As in every other domain of life, in the sciences people can be tempted to do things that are morally wrong for the sake of what advocates of the wrongdoing will present as a "greater good." That kind of utilitarian thinking should always be resisted. Good ends do not justify bad means. The fact that a particular practice or strategy promises to advance scientific knowledge or even lead to cures for dreaded diseases cannot in itself justify otherwise unethical conduct. Even science is subject to moral norms. These norms including above all the norm against killing innocent human beings at any stage or in any condition place rational limits on what science may legitimately do. Killing, even in the cause of healing, compromises the moral foundations of biomedical sciences and cannot be justified.
NRO: Where would you specifically like to see attention focused? On one type of research in particular or spread out a bit?
George: Various areas of adult-stem-cell research are clearly promising. As I mentioned earlier, some have produced actual therapeutic results already. The cord-blood-stem-cell-research bill recently passed in the House of Representatives is a good thing, and I hope that the Senate will now pass it and send it along to the president for his signature. I'm hopeful about the research being done by a team at Griffiths University in Australia using stem cells obtained from nasal mucosa. In addition, I'm very interested in Dr. Catherine Verfaille's research on multipotent adult progenitor cells obtained from bone marrow and in Dr. Yuri Verlinski's research using embryonic stem cells derived from existing stem-cell lines approved for research under President Bush's funding policy to reprogram somatic cells to the pluripotent state. As I've already mentioned, I certainly want to see research into OAR and similar epigenetic reprogramming strategies generously funded. But I'm optimistic about other possibilities, too.
I would urge people who are interested in this general question to look at the White Paper issued by the President's Council on Bioethics and the Council's Report on Monitoring Stem Cell Research. Both are available online at www.bioethics.gov.
NRO: Does the federal government need to finance this OAR or other research? What are the rules you'd advocate for private research?
George: Because of its proven therapeutic promise, a great deal of adult-stem-cell research is being funded by private investment. That's great. But, as a practical matter, in the system we have developed over the past several decades, government funding particularly federal funding plays a major role. That's reality. So I would like to see NIH funding for OAR. The initial round of funding to test the method would, as I said earlier, involve only modest amounts of money. If everything checks out, a bigger investment would be required, but it would be an investment we should be happy to make.
NRO: Most people's eyes glaze over when the topic of stem-cell research comes up. Are there just a few basic fundamentals people can grab onto that will serve them well in the midst of spin and worse?
George: Don't trust claims about magic cures.
NRO: You don't seem as anti-science as I'm told you (and I) are what's that about?
George: The claim that people like you and me (and President Bush and Leon Kass and Charles Krauthammer) are anti-science is all about politics. It is so manifestly silly, though, that it can be safely ignored.