Hard Cell

President George W. Bush's August 9, 2001, address
to the nation on embryonic stem cells was an exercise in politico-moral bumper
bowling. He acknowledged the hopes of desperate patients and their families, then
bounced across the alley to embrace the moral arguments of right-to-life allies.
It was fascinating to watch this slow, lurching journey down the lane and to
wonder where the ball would actually strike. The biggest surprise was not that he
offered a compromise on research with embryonic stem cells but rather his claim
that 60 cell lines had already been created and were potential candidates for
research grants from the U.S. National Institutes of Health (NIH). Most
scientists were aware of only a dozen lines at most; hearing that there were many
times that number was startling.

The official number is now 64. Lana Skirboll, associate director for
science policy at NIH and a well-respected scientist and administrator, was
the source for the figure, which was based on an exhaustive worldwide search to
find any possible embryonic-stem-cell line. Dr. Skirboll found them in Israel,
India, Australia, Sweden, and the United States. Sixty-four lines met the
criteria set by the Bush administration: They were derived from embryos in excess
of those needed for a couple's reproductive purposes; the couple who authorized
their creation consented for the embryo to be used for research; the embryo had
not originally been created for research; and no monetary or other inducements
had been offered for the embryo. The president added an additional condition:
Destruction of the embryo must have been initiated by 9:00 P.M. on August
9, 2001.

The president's announcement did not please everyone. That was always an
impossibility given the mutually incompatible goals. On the side favoring
research funding were patients and their advocacy organizations, who see stem
cells as a bright new hope for afflictions like Parkinson's disease, spinal-cord
injuries, and diabetes. On the same side were scientists fiercely resistant to
what they view as politically inspired limitations on embryonic-stem-cell
research. Arrayed against them were the forces of the right-to-life movement,
some of whom saw in embryonic-stem-cell research an issue that might cause
Americans to think hard, perhaps for the first time, about the moral significance
of the earliest human embryos. As it happened, some of the Americans who engaged
in those reflections were reliably anti-abortion politicians; and so the debate
over embryonic stem cells has fractured the pro-life movement itself.

Whether Bush's announced policy was a political masterstroke, a muddled but
serviceable compromise, or a latent disaster waiting to unfold, time will reveal.
Whatever its apparent appeal, the president's policy has four significant defects:
It alters previously proposed ethical standards for embryonic-stem-cell lines; it
reinforces an oligopoly over the existing lines; it is inherently unstable given
likely scientific developments and the prospect of future experimental stem-cell
therapies; and it drives a wedge into the heart of the pro-life movement. (This
last will not be seen as a defect in all quarters.)

Make no mistake, there are vexing ethical questions concerning how we
treat human embryos and about the new powers our investigations into embryonic
stem cells may give us to manipulate or genetically select our future children.
But these moral misgivings would never have derailed the enthusiasm for such
research. Disease causes such misery and grief for so many families that research
on stem cells, with its great promise (though no certainty) of success, was
supported by most Americans--and passionately so by many. No, the principal
political roadblock to such research was fierce opposition by those in the
anti-abortion community for whom human embryos are full moral persons, end of
story.

Because most of the notable battles fought by right-to-life groups concerned
much later stages of prenatal human development--"late-term abortion," for
example--the right-to-life movement has successfully avoided calling public
attention to implications of its views about the earliest days of embryonic life.
Among these implications is the startling inference that common practices at
fertility clinics amount to mass murder (more about that later). Public support
for embryonic-stem-cell research posed a quandary for anti-abortion leaders: If
the president banned all public monies for the research, it would have been
inescapably clear that the right-to-life movement had imposed its minority view
on the majority of Americans--an obstructionism likely to anger many people. On
the other hand, if the president permitted any public funding, that would amount
to complicity with evil: If you believe that destroying an embryo is murder, and
if the creation of embryonic-stem-cell lines can only be accomplished by
destroying embryos, then it is difficult to see how you can escape the charge of
complicity with that murder, whether it was done before or after an arbitrary
deadline of 9:00 P.M. on August 9, 2001. A number of pro-life leaders
have already reached that conclusion.

An Ethics of Convenience

What the president offered allowed the pro-life movement to escape
public opprobrium for favoring a disputable metaphysical view that favored the
moral status of embryos over relief of palpable human suffering. Beyond that, it
is difficult to see what ethical reasoning would commend a policy that takes as
its central distinction the time chosen for political convenience to deliver a
presidential address. Human embryos will continue to be destroyed in large
numbers in fertility clinics. Some fraction of those will be donated to research,
and a smaller number still will be used to make stem cell lines, all with private
money. This would have been the case whatever the president had said. In any
event, imposing an arbitrary deadline has its own costs--moral, economic,
political, and scientific.

Paradoxically, getting to 64 actually required the administration to loosen
ethical constraints recommended by the National Bioethics Advisory Commission and
the National Institutes of Health. Rather than limiting researchers to frozen
embryos left over from in vitro fertilization after a couple had had ample time
to reflect on their decision to give them up, the president's policy would simply
permit federal funding of all previously created stem cell lines from embryos
created in excess of clinical need, whether or not they were frozen. The
requirements for the embryo donors' "informed consent" were loosened in two ways:
Rather than listing the specific information that had to be given to prospective
donors, the new policy simply required "informed consent." Nor does the
retroactive policy require researchers to have waited until after the embryos had
been created to approach the donors; they could be asked before. (Without these
more relaxed ethical standards, the University of Wisconsin's pre-existing stem
cell lines, among others, would not be eligible for federal research funds.)
Finally, the new policy does away with an ethics review panel for stem cell
research, replacing it with a more generic Council on Bioethics that will not
have oversight powers.

Said Richard Doerflinger of the U.S. Conference of Catholic Bishops: "It's very
troubling to find that this policy may actually grandfather in cell lines that
were ineligible on ethical grounds even under the Clinton guidelines." Nor is
there any guarantee that the committees reviewing the ethics of research with
human subjects will accept the informed-consent statements accompanying each cell
line, especially from countries whose cultural practices of informed consent may
differ from the United States'.

Another irony of the Bush policy, coming from an administration fervent
about the virtues of competition, is that by limiting federal funding to the 64
lines in existence by August 9, 2001, it locks in an oligopoly. Those few sources
that hold stem cell lines and can defend their intellectual-property claims in
court are assured of no new competition. NIH is the engine that drives
biomedical research in the United States; researchers vie for federal funding,
which has three great virtues: prestige, reasonable coverage of the actual costs
of research, and enormous intellectual freedom. Other embryonic-stem-cell lines
will be created with private money, but researchers likely will prefer to use
lines approved for federal funding. Some subset of the 64 lines will probably
become the dominant models for basic research in embryonic stem cells for the
near future, bolstering the oligopoly that this policy reinforces.

Scientists have complained about barriers to research, too few cell lines, and
the uncertainty about how many of the 64 lines will be scientifically useful and
practically available without unacceptable conditions. Scientists, it should be
noted, hold a wide range of political views. But when it comes to research, a
bipartisan community of scientists rallies reliably in favor of more funding with
an absolute minimum of strings. Both Republicans and Democrats have
supported--and funded--an evergrowing National Institutes of Health.

If there are many scientists opposed to funding embryonic-stem-cell research,
they have been fairly quiet--with one exception: David Prentice, from Indiana
State University, was plucked from obscurity to became a regular at hearings, on
television, and in print reports, insisting that stem cells from adults were
every bit as promising as those from embryos. One of the researchers cited in
support of this claim is Baylor College of Medicine professor Margaret Goodell,
who reported in 1999 that stem cells derived from muscle were able to produce
blood cells. This study and similar ones suggested that adult stem cells, rather
than being committed to a particular tissue type, might be more versatile.
Subsequent research by Goodell, however, has demonstrated that she had discovered
an unanticipated type of blood stem cells that happen to reside within muscle. In
June she said: "The science doesn't justify ... saying 'adult stem cells can do
anything.'"

Misrepresenting Science

There is an interesting lesson here about science and public policy.
Taking a cue from the tobacco industry, pro-life operatives learned that you do
not need masses of scientists on your side. For decades tobacco lobbyists trotted
out a handful of scientists who were willing to express their doubts about one or
another facet of the scientific evidence linking smoking with illness and death.
The industry could then say, see, even scientists disagree. They did not bother
to inform policy makers and the public that the overwhelming consensus among
scientists was that the connection was long since proven. For any given hearing
or public forum, they had only to produce a scientist to say what they wanted the
audience to hear, even if the opinion was far off the mainstream scientific map.
Opponents of embryonic-stem-cell research hoped to impress policy makers and
influence reporting by having even one scientist to provide "balance," much the
way the tobacco industry salted hearings and occasionally the scientific
literature with their smattering of scientist allies.

The bottom line on adult stem cells is that they are promising, and research
on them should be funded as well. But they are more difficult to gather in large
numbers, more difficult to grow in the laboratory, and--so far at least--less
versatile. Adult stem cells may turn out to be clinically important. But
knowledgeable scientists observe that research on embryonic stem cells is
necessary to learn how to grow, channel, and perhaps ultimately use adult stem
cells.

Will 64 embryonic-stem-cell lines be enough? Will these lines be safe and
function correctly? We will begin to know in the next few years, once studies on
human subjects get under way. It will not be sufficient merely to have "good
enough" stem cell lines: Scientists and the people into whose bodies these cells
are placed will want to know that they are the very best we can design.

Imagine a government edict that prohibits drug companies from creating
or testing any new compounds and limits them to the ones they've already created.
Even if research shows that tweaking the chemical structure a bit would likely
yield a better drug--fewer side effects, better therapeutic value--the
government's response is: "That's tough." The pressure to lift such a ban would
be nearly irresistible. The Bush administration must be hoping that progress is
slow enough to avoid such pressures--at least until the next presidential
election.

Behind the Lines

While there is no reason to doubt the existence of the 64 stem cell
lines reported by NIH, nothing guarantees that all the lines will be suitable
for research or that those who control the lines will be able and willing to
provide them to U.S. researchers. An embryonic-stem-cell line can lack some of
the properties researchers require. The NIH list of eligible cell lines,
released on August 27, shows Sweden with the most--24--and the United States with
20. It is now clear that the scientific barriers set to declare a particular line
as a genuine embryonic-stem-cell line were very low. This confirms concerns
expressed by scientists that not all of the 64 eligible lines may be stable and
useful for research.

Cell lines can also come with too many strings attached. Late last year, it
was reported that Doug Melton, who works at Harvard and is supported by the
prestigious Howard Hughes Medical Institute, was unable to use stem cells from
the WiCell Research Institute, a subsidiary of WARF, the Wisconsin Alumni
Research Foundation, because of two conditions rejected by both Harvard and
Hughes. One gives Geron Corporation the rights to certain discoveries that arise
from Melton's research using these cells. The other--even more unpalatable, I
suspect--gives WiCell the authority to order Melton to destroy the cells and any
experiments using them within 90 days. Harvard, with the support of the Howard
Hughes Medical Institute, has since struck a deal for embryos with Boston
IVF, a fertility clinic.

Geron funded the work at Wisconsin and at Johns Hopkins University that opened
the door to human-stem-cell research. Wisconsin holds the key patent on human
embryonic stem cells, and has granted exclusive rights to Geron for
commercialization of six cell types: blood, bone, liver, muscle, nerve, and
pancreas. Nerve cells will be of great interest to people suffering with
Parkinson's disease or from a spinal-cord injury; islet cells in the pancreas
fail in people with diabetes. The Wisconsin Alumni Research Foundation filed a
lawsuit against Geron in August. Geron wants exclusive rights to an additional 12
cell types; WARF argues that Geron was obligated to make substantial progress
on the six types for which it already holds the rights and has not done so.
Geron, by the way, has doubters in other corners as well. A recent column posted
on the Motley Fool, a popular finance Web site, was less interested in the ethics
of stem cell research than in Geron's balance sheet, which showed the company
burning through its remaining cash at a fair clip with little evidence of a
breakthrough product in the near future. Scientists are understandably concerned
that disputes such as this will make it more difficult to gain access to embryonic
stem cells.

Another legal morass also looms. The Wisconsin patent is very broad; it
covers both embryonic stem cells and the process for deriving them. The legal
status of stem cell lines from other countries will need to be clarified. WARF
will want to protect its patent rights from infringement, and the holders of
lines outside the United States may not want to risk costly legal battles.

At least one notable U.S. researcher, Roger Pedersen of the University of
California San Francisco, has announced his plan to leave for Cambridge
University and the more politically hospitable environment of the United Kingdom.
If additional scientifically valuable lines are created, or if researchers find
ways to create lines without infringing Wisconsin's patent, then scientists
working in the United Kingdom and other nations will have an edge over their
American counterparts. Other U.S. scientists may follow Pedersen's lead.

There are two additional reasons to worry whether the 64 cell lines are
adequate. Pedersen points out that mouse "feeder" cells and bovine serum have
been used in developing current cell lines, thus creating the possibility that
animal viruses or proteins may have contaminated those lines and made them unfit
for transplantation into humans. It will be difficult to prove that cell lines
created in this manner are free of contaminants.

At this moment, no one knows how the problem of immune rejection will be
handled when embryonic stem cells are placed into the human body. Each of our
cells carries a set of markers--flags, if you like--on its outside. Our immune
system uses these flags to tell friend from possible foe. Preventing such
recognition and the subsequent attack on tissue identified as foreign is a
lifelong problem for people who receive transplanted organs. Researchers will
have to find ways to tame or eliminate immune responses to transplanted stem cells
if they are ever to become useful treatments. One of the most likely ways to
accomplish this is to create a catalog of stem cell lines representing all the
sets of flags (or, if you want to be scientifically precise, the major
histocompatibility complex alleles) likely to be found. This might require
hundreds or even thousands of lines.

We do not yet know how broad an array of flags is represented in those 64
existing lines, but there is no guarantee that they cover a broad spectrum. With
the current limited set, some Americans might be fortunate enough to find good
matches; many others might not. And because particular flag combinations show up
with predictable frequency in different populations, it could be that the
out-of-luck folks are disproportionately from specific ethnic groups. Imagine the
outcry, the deep feeling of injustice, if Americans whose ancestors came from
southern Europe, or Africa, or Asia found that there were no good matches for
them in the available pool. Depending on the extent of the mismatch, they might
nonetheless be offered stem cell transplants; but they might have to take higher
doses of drugs to ward off immune rejection and endure all of the side effects
such higher doses bring. In this scenario, entire groups of Americans would be
condemned to inferior therapies, solely as a consequence of the president's
policy dictum. Any or all of these factors may challenge the stability of the
White House policy on stem cell research.

An Embryonic Split

The most significant and lasting political effect of the debate over
embryonic stem cells may be its role as a wedge dividing usually reliable allies
in the anti-abortion camp. Conservative commentator George F. Will hailed the
address as one that "changes American politics profoundly." Will may be more
correct than he realizes. In lofty language more suited to a college commencement
address than a political column, he applauded Bush's "measured and principled"
position as far better than any compromise. Rather, he wrote, it is nothing less
than a "solution ... in strict fidelity to his campaign promise" not to fund
research "that involves destroying living human embryos." He further asserted
that the president's critics are "in danger of embracing extremism." In his
applause for Bush's statement, Will has plenty of company on the right, including
Pat Robertson, Jerry Falwell, and James Dobson of Focus on the Family.

But there is serious grumbling in the right-to-life camp. Columnist Cal Thomas
composed a screed condemning the Bush policy as "fruit of the poisoned tree"--a
door opened on a culture headed to perdition ever since Roe v. Wade. Thomas
compared Europe's exterminated Jews to the "millions of unborn babies" who "had
the bad luck to be conceived in the anti-life era that began in 1973 ... but had
its roots in an anti-God culture which began decades earlier." Why not, Thomas
wonders, kill the elderly and the infirm, or the relative whose estate you are
tired of waiting to inherit? The logic, he writes, starts with using embryos for
research and carries us relentlessly onward to euthanasia and beyond. The Roman
Catholic bishops have been consistent in their criticism, and the editor of a
Catholic magazine laments the decision to fund embryonic-stem-cell research as a
"descent into chaos, barbarism, anarchy, tyranny and death." So much for unity
within the pro-life movement.

It was no accident that one of the earliest important voices among
abortion opponents to support embryonic-stem-cell research was a Mormon,
Republican Senator Orrin Hatch. Mormon theology holds that all of us begin as
spirit children of God; our earthly lives begin when our spirit is united with
our physical body, and that may not coincide with conception. (It is misleading
to refer to the "moment" of conception, as the actual process is complex,
involving multiple steps over a period of time.)

Doerflinger, of the U.S. Conference of Catholic Bishops, derided as
"amateur theology" the efforts of another Mormon senator, Gordon Smith of Oregon,
to distinguish between the flesh and the spirit in the creation of life. In a
similar vein, he ridiculed Senator Hatch as claiming that there is "something
magical about the mother's womb," alluding to the Utah senator's argument that an
embryo frozen in liquid nitrogen is different from one implanted in a woman.
Doerflinger said one more thing worth noting. Acknowledging that he cannot
persuade Senator Hatch to abandon the tenets of his faith, he concluded
nonetheless: "I don't think he should make the rest of us fund this research
based on them." Or refuse to fund it?

It isn't only Mormons within the nominally pro-life camp who support
embryonic-stem-cell research. Just as defenders of a woman's right to abortion
found that not all who shared their general view were equally ardent in their
defense of late-term abortion, not all abortion opponents are equally convinced
that the (relatively) clear and bright line of fertilization marks the
indisputable beginning of a human person. Whatever your stance on abortion, you
can believe that human embryos even in their first few days of development are
much more than mere pinpoints of human tissue, though not identical physically or
morally with children or even fetuses. Indeed, that statement, vague as it is,
probably describes roughly what most Americans believe.

The anti-abortion movement has been able to escape confronting latent
disagreements over the moral standing of frozen in vitro human embryos--until
now. The debate over embryonic stem cells has brought the fate of excess in vitro
fertilization (IVF) embryos before the public as people are increasingly
aware that embryos are routinely created through IVF, frozen, and discarded.
Some are flushed down the drain, some taken out as medical waste, others thawed
and permitted to expire on their own. The precise number of embryos destroyed in
the United States is not known, in part owing to the astonishingly minimal
regulation of IVF and related reproductive technologies. Britain has recorded
some 50,000 IVF births since 1991, with nearly 300,000 embryos discarded. The
American Society for Reproductive Medicine estimates that roughly 100,000 babies
have been born through IVF in the United States. If the same ratio holds here
as in Britain, approximately 600,000 embryos would have been destroyed in the
last decade.

Where, you might ask, is the outcry over the mass murder taking place in
infertility clinics? The moral logic seems inescapable: If you believe that human
embryos are persons, then their intentional destruction is a grievous moral
offense. Disposing of an embryo after five years in the Deepfreeze is morally
indistinguishable from aborting a mid-trimester fetus, or killing a child or an
adult. Yet there is no broad social movement to condemn in vitro fertilization,
to close the clinics performing it, or to harass or intimidate the physicians who
work there. Nor are there crowds of demonstrators accusing couples who enter such
clinics of being murderers.

The Catholic Church has been consistent in its disapproval of IVF
but has not chosen to highlight its position to the American public or to expend
political resources to try to stop the practice. The National Right to Life
Committee has gone lately from saying that IVF "is outside our purview" to
refusing to comment in a recent Christian Science Monitor story on the
increasing calls for regulation of fertility clinics.

The truth is that most Americans probably do not agree with the founder of the
Snowflakes Embryo Adoption Program that frozen embryos are "pre-born children,"
nor with his employee who asserted, "We believe life begins at conception, so
every one of these frozen embryos is a baby waiting for a home." In his August 9
address, the president borrowed the snowflake metaphor to describe embryos.
According to the Snowflakes Program, eight children have been born thus far from
its "adopted" embryos, with seven more on the way (being carried by four women).
We can take delight when people have a wanted child, rejoicing for them and for
their baby. But that does not oblige us to believe that every single one of the
150,000 or 200,000--no one knows the actual number--frozen embryos in the United
States must be placed in a womb, or that choosing to thaw an embryo without
implanting it is murder.

Ethical Threads

Thinking responsibly and sensitively about human embryos is not easy.
Some years ago, when I was writing The Worth of a Child, I tried a thought
experiment: Imagine some new fact or argument so utterly persuasive that it
caused virtually all persons on one side of the moral-status-of-the-embryo divide
to acknowledge that they had been wrong all this time and that, yes, the other
side was correct.

Maybe my imagination is defective, but I don't see that happening. For one
thing, there seems little or nothing new to be said. For another, there is faint
prospect that great masses of people would turn 180 degrees on a metaphysical
dime.

Note that I did not say which side was changing its mind. A philosophical
conversion is equally unlikely for both. You can recruit a variety of scientific
evidence, moral arguments, or metaphysical claims to support whichever position
you hold. Treating folks who disagree with you as mental (and moral) midgets
accomplishes nothing worthwhile. It would be far better to reflect on the central
threads of the tapestries formed by our images of good lives for women, children,
and men, the reasons we value families, and the losses we most fear. I believe
that we would find important differences between the threads of those who assert
that embryos, even those immersed in liquid nitrogen, are morally identical with
born children and adults and the threads of those who discern a distinction.
These differences likely will have to do with whether good lives for women and
for men are fundamentally similar or distinct; whether men are capable of
nurturing and women of competing; whether women are meant to raise children while
men, in Newt Gingrich's unforgettable description, are meant to hunt giraffes.

If the dispute over funding research on human embryonic stem cells brings to
light some of the implications of the view that embryos are full and complete
moral persons and holds those implications out for public inspection, that will
be useful. If it leads to closer scrutiny of the infertility industry, that will
be good. If it prompts us to look deeply into the tapestries that inform and
order our lives and examine their relationship to public debates over abortion,
affirmative action, and family policy, that will be an extraordinarily valuable
outcome.

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