This is the second in a three-part series about health and science issues in the 2004 election.
Although today’s stem cell controversy is a mere echo of an age-old debate between science and religion, politics and public health, and even life and death, it has certainly planted its feet among the most important issues in this year’s presidential campaigns. Celebrities like Michael J. Fox, friends of Christopher Reeve and even Ronald Reagan, Jr., have positioned themselves on the front lines, making stem cell research a highly politicized election issue.
Instead of simply being a battle between moral perspectives, stem cell research has become an issue polarized along partisan lines.
“When this becomes a Democrat versus Republican issue, it is given incredible spin and impoverishes the debate. The first casualty is truth,” said Robert Cook-Deegan, a research professor in the Sanford Institute of Public Policy. “It is not a scientific discussion since we can’t prove the status of an embryo. Interpretation, not science, is the determining factor in regulation.”
What is the issue?
With the ability to benefit more than 100 million Americans, experts say stem cell research is one of the most promising new fields in modern medicine. Stem cell therapy relies on replacing diseased cells with healthy, functioning ones. This new technique is being applied experimentally to a range of human disorders, including many types of cancer, neurological diseases such as Parkinson’s Disease and Lou Gehrig’s Disease, spinal cord injuries and diabetes.
But because these cells are often derived from human embryos through somatic cell nuclear transfer, ideology has begun to interfere with science.
During President George W. Bush’s term in office, his administration had placed limitations on embryonic stem cell research, restricting scientists to the use of 78 existing cell lines that were created prior to a certain date. Twenty-two of these cell lines are being used. Although Bush has not completely banned ES cell research, federal funding cannot be used to support such endeavors.
“The country is left with an unstable solution, while the rest of the world has moved on,” said Cook-Deegan, who is also director of the Center for Genome Ethics, Law and Policy.
If Sen. John Kerry, D-Mass., is elected in November, it is expected that he will overturn Bush’s executive order and allow ES cell research to continue unhindered.
Although adult stem cell research has not been affected by any policy changes, ES cell research is in jeopardy. An adult stem cell is an undifferentiated cell found in a tissue or organ that can renew itself and can differentiate to yield the major specialized cell types of the tissue or organ. The primary roles of adult stem cells in a living organism are to maintain and repair the tissue in which they are found.
If scientists only use the existing cell lines, however, experts say they will never be able to develop better ones. Brigid Hogan, professor of cell biology, describes these existing lines as “completely inadequate for high quality research.”
When scientists achieve promising results, they cannot make their findings therapeutically useful since the current lines most likely cannot be used for transplants. New cell lines are inevitably needed.
“We are eventually going to need a new policy regardless of who is in office if ES cells are to be therapeutically useful,” said Assistant Professor of pharmacology and cancer biology Tannishtha Reya, who uses adult stem cells in her research at Duke. “To move this field in any major way, we are going to need government support and we can’t let the best scientists be left out.”
New cell lines would help research since they are easier to grow, have fewer mutations and are generated under newer conditions that will allow for accurate research. Even if these lines are available, however, they are so expensive that it is frequently not economically feasible for many laboratories to purchase them due to the current bans on funding.
Moral and religious grounds
The candidates also offer compelling moral issues on both sides. Although Kerry believes stem cell research will allow scientists to develop myriad cures for more than 50 human ailments and improve the quality of life, Bush supports a viewpoint shared by many religious groups.
“Bush is driven only by his ideological views,” Hogan said. “He does not take the advice of scientists. He is simply not interested in listening.”
The Catholic Church holds similar viewpoints to other Christian groups—life begins at conception—and therefore, the means to ES cell research is the problem. “We need to treat life with respect and let nature take its course,” Duke Chaplain Joseph Vetter said.
The potential of ES cells is only theoretical, Vetter added. “No one has proved it’s the best way to cure,” he said. “We don’t believe in achieving good at any cost. There must be a more creative way.”
The church remains in support of Bush’s policies. “Just because we are capable of doing it, that doesn’t mean it’s okay to do it,” Vetter said. “There should be limits to what we do and we are going beyond what is appropriate. We need consistency in approaching life with awe, reverence and dignity.”
David Pisetsky, professor of rheumatology and immunology, said he believes the presidential dialogues between the candidates have been too narrow and have not fostered a legitimate discussion of science. “The issue is just too lined up with abortion,” he said. “It is becoming a surrogate for the debate over reproductive rights.”
Christopher Conover, assistant research professor in the Center for Health Policy, also believes it is difficult to disentangle ES cell research from abortion. “If you believe life begins at conception—which many do on religious grounds—then this generally pushes you in the direction of opposing this research: Individuals cannot be used as a means to an end, no matter how noble,” he said. “Kerry would like to make this a big issue because he likes painting the president as a religious zealot who lets ideology trump science. But my sense is that at the end of the day he has not gotten a huge amount of traction out of it.”
The future of ES cell research
If Bush remains in office, ES cell research will increasingly fall into the hands of the private sector with the intent of commercializing any success. “The nature of research is such that if there are surprise breakthroughs, the benefits will flow to the winners, whether these be other countries without restrictions or private firms in the U.S.,” Conover said.
The issue is so politically charged that private foundations might stop ES cell research to prevent alienation of its philanthropists. “Instead of sending the wrong message, they would just rather avoid the whole issue,” said Reya, assistant professor of pharmacology and cancer biology.
Michael Murphy, a research associate who uses adult stem cells in his research, stresses the progress scientists, including those at Duke, would make if Kerry were elected. “I think that Duke would benefit as it is a recognized center for stem cell research and thus would be the potential recipient of more research funds,” he said.
Duke doctors and researchers agree that one of the major concerns is a flat budget and lack of grants from the National Institutes of Health. “Their large projects are very expensive and they probably won’t be able to continue without federal funding,” Pisetsky said.
Many more researchers could be doing ES cell research but are discouraged by the restrictive current policy. Reya cites Duke as one such example.
George Annas, one of the founders of the American Society of Law, Medicine and Ethics, does not support ES cell research as the responsibility of the private sector. “If research is worth doing, it should be done publicly, with public oversight and public money,” said Annas, professor of health law, bioethics and human rights at Boston University. “It may not be the best idea to have it in the hands of the private sector with no federal regulations.”
If Bush wins the election, the burden falls on California, where citizens will be voting on Proposition 71, a bond proposed by the state’s governor that could potentially allocate $3 billion to ES cell research.
Our options
As an alternative to ES cells, Pisetsky suggested using already existing embryos that are created by, but not used for, in vitro fertilization. ”As long as we can respectfully use embryos that were not intentionally created for research with informed consent, we are given another source of cell lines,” he said. “We can go ahead with research without violating ethical or religious views, but sometimes we just really need the unique embryonic stem cell lines.”
Although stem cell research may not be the deciding factor in peoples’ votes, it remains significant in a race that is so close.
“The bottom line is we just need to present the facts to the public about ES cell research,” Hogan said. “If we could educate, people would stop being so emotional and irrational, and minority religious views would not have to be imposed on us by Bush.”
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