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Stem Cell Research: Back to the Future

Editor-in-Chief

Last week, U.S. President Bush put forth his executive decision allowing U.S. government-sponsored research to utilize a list of 60 existing embryonic stem cell lines, but not to use or develop new ones. This puts the U.S. about where we thought we were last year, when then-President Clinton made a similar decision. President Clinton added new funding for stem cell research to the pot, and President Bush has added some stimulus to ethical studies. We support each of these endeavors. Nevertheless after all the hoopla, we had naïvely hoped for bolder leadership toward what we know can be an era of wonderful progress in the sciences.

In a previous issue of STEM CELLS, I opined that we scientists have exaggerated the immediacy of the prospects of clinical therapies using stem cells, and that this has led to public misunderstanding [1]. I continue to think that clinical application is a long way off for at least two reasons. Prior to clinical use of embryonic and fetal stem cells, it will be necessary to thoroughly investigate the malignant potential of embryonic stem cells. In addition, a much more comprehensive elucidation of the immune response is necessary to provide the basis to prevent transplanted stem cells and their progeny from being rejected by the transplant recipient. Although science is moving rapidly, these complexities of malignancy and immunology provide us considerable time to ponder the ethical considerations that would accompany clinical use of embryonic/fetal stem cells. This fortifies my belief that stem cell research can safely and ethically go forward, and must be done for the considerations of future children and adults in need of potential lifesaving future treatments. I can find only one right answer on this issue. My view is that such biomedical research is certainly for-life; for example, the Talmud says:

Whoever saves one life is as if he has saved an entire world.

I look with admiration at the homologous but fundamentally different policy decisions of Great Britain, where "reproductive cloning" will continue to be forbidden but "therapeutic cloning" permitted with careful monitoring [2]. U.S. policies achieve neither of these worthy objectives. Therefore, borrowing heavily from the British and to stimulate your responses in these pages of STEM CELLS, I propose that we continue to work toward a less conservative, more compassionate compromise policy. This proposal would enable "therapeutic cloning" to be investigated, without ethical slippage and within the confines of clear, bold-line policies and laws against "reproductive cloning:"

1. Allow U.S. scientists to obtain frozen embryos (and cells from legally aborted fetuses) that would otherwise be discarded, under Institutional Review Board-approved clinical research proposals that:
   • peer-reviewers believe have the potential to advance biomedical scientific understanding;
     
   • limit the numbers of embryos used to the numbers needed to carry out the research (as we do today with research involving human subjects or vertebrate animals), and
     
   • require that one, or ideally both parents grant signed informed consent after explanation of the research and alternatives.
     
   
   
2. Prohibit U.S. citizens from creating embryos for the sole purpose of research.
   • This would be considerably more conservative than current British policies, which allow creation of embryos for research, as long as they do not exist for more than two weeks, when the primitive streak begins to form. However, it is said that there are many thousands of embryos discarded each year in the U.S.
     
   • An exemption would be needed to clearly preserve the rights of parents and physicians to perform in vitro fertilization, including the situation where the placental umbilical/cord blood or a replaceable tissue (such as blood or bone marrow) of the resulting child might be used in treatment of an existing ill human (such as an existing sibling or parent).
     
   
   
3. Generously fund and otherwise stimulate studies on the ethical considerations that might be involved in future stem cell therapies, as well as current and future research.
   • Involve scientists, lay and religious philosophers, and a diversity of citizens in these research grant proposals. (It appears that a major reason that the British are comfortable with these issues is that they began to study and publicly consider the ethics of cloning in the late 1970s, with the first in vitro fertilization in Britain).
     
   • Debate the proposition that the future potential of a living thing with some human characteristics should not be the sufficient operational and legal U.S. definition of human life. (Clearly, I would personally only argue for this proposition. A reductio: Otherwise, how could a physician pronounce a patient dead, if still-living stem cells are potentially present somewhere in the patient's body?)
     
   
   
4. Generously fund research involving or relevant to embryonic, fetal and adult stem cells.
   
5. To accomplish the above, pass federal laws that apply to all citizens, not just federally funded researchers, in all states.
   

The biomedical issues around stem cell research are elegantly summarized in a document recently prepared by the U.S. National Institutes of Health (available at http://www.nih.gov/news/stemcell/scireport.htm). I hope you will read this, then weigh in here and in public with your ideas and views.

REFERENCES

1. Civin CI. Human Pluripotent Stem Cells: Science Fiction Poses No Immediate Dangers. STEM CELLS 2000;6:iv-v.

2. Wade N. "Stem cell studies advance in Britain," NY Times, Aug. 14, 2001:1.

This article has been cited by other articles:

				R. G. Hawley National Stem Cell Resource: Stem Cells Find a Niche Stem Cells, November 1, 2001; 19(6): 475 - 476. [Full Text]

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