Stem Cell Ethical Concerns

This particular post should be read after (at least!!) reading the previous 3 posts - Stems Cells 101, & the Potential Impact of Stem Cell Research Part1 & Part2.

I shall try to outline some of the concerns surrounding this issue. Again, this is done in a rather over-simplified manner.

Of course, I think almost everyone involved or interested in the whole debate, is hoping that the recent research where adult stem cells, or even cells harvested from the umbilical cord will prove to be a successful route in the future. This technique should remove many (but not quite all) of the concerns that people have on the issue. I promise you that no scientist is choosing to research this area because of the ethical issues, or merely to make use of spare blatocysts that there may be in his lab. Every researcher I have met in this field is fully aware of the sensitive nature of the research. Certainly none of them are the evil mad scientists, that some sections of the popular media try to portray them as! (Well OK, I cannot comment on some of the North Korean labs…)

The main concerns are:

• Human embryonic stem cell research involves the destruction of a blatocyst, which some people regard as a human life.
• Some people have an issue with creating a blatocyst with the sole intention of destroying it.
• A concern is that this research could lead to the exploitation of women, as more and more donor oocytes may be needed.
• Some people object to the mixing of human and non-human genetic material in the research.
• Some sections of society even have objections to any advances in not only stem cell research, but genetics, molecular biology, and many other similar medical interventions are manipulations which undermine human dignity.
• There are other concerns, certainly but I hope this touches on the main ones.

Any research on human embryos is going to raise profound questions about the status of the human embryo, the extent to which it is justifiable to use human embryos to expand knowledge and ameliorate human suffering, and the conditions under which these goals may be pursued. Many people hold the view that a human embryo (of any stage) is morally equivalent to a human life. Some claim that any manipulation of a human embryo undermines human dignity. These are philosophical views which should not just be ignored. However, these philosophical views do not always manifest themselves culturally in our societies. A natural miscarriage (which, I have had the misfortune to witness) is a harrowing experience, but we do not conduct a funeral afterwards. Similarly, for most couples, the excess blatocysts from IVF treatments can be disposed of without any need for ceremony or specific interventions that we may feel appropriate for, say, the death of a child. Many religions do not recognise the human embryo as human life until a specific stage (around 40 days after conception).

I do feel that any discussion on the ethics of stem cell research should respect these deeply held views. But I do not feel that these, alone, should bring all research in these matters to a complete halt, as the potential benefits to so many people are so huge. But I do feel that these views should assist us in developing workable ethical codes, which take into account the special status of the human embryo, and try to protect that status in a serious manner.

An excellent overview can be read at

http://books.nap.edu/openbook.php?record_id=11278&page=47

Potential Impact of Stem Cell Research (Part 2)

Right, so we have covered what stem cells basically are (Stem Cells 101), and I touched on their potential impact in the next post Potential Impact of Stem Cell Research Part 1. Now let's look at the more controversial issues of cloning. I think this is the area which is most misunderstood, and seems to cause most problems for many people.

There are two distinct subjects to cover:
a. Therapeutic Cloning.
b. Reproductive Cloning.

Therapeutic Cloning
This is where cloned tissue is used to "grow" replacement organs for people who have sustained damage to their organs (through disease, or injury, for example). It so happens that this month (August) is organ donors month. I would encourage everyone to consider signing up for organ donation. Discuss it with your family, as obviously your decision will effect them. But organ transplants are becoming more commonplace (as we know, the first heart transplant was performed in SA). Transplants are held back for 2 main reasons; the availability of organs, and also the fact that the human body tries to reject foreign tissue. To get around the second problem, the recipient has to be pumped full of very strong anti-rejection drugs (which also leaves the person with vastly weakened immune systems). This can often lead to complications, other infections and death. Our knowledge is increasing in this though. The concept of therapeutic cloning is to use (ideally stem cells derived from that person, from potentially umbilical cord cells, or from adult stem cells) tissue that has been grown from stem cells that have had the recipients own DNA introduced into them (by the use of Somatic Cell Nuclear Transfer - SCNT). This would negate the rejection problem. Recently, in Imperial College London, a heart valve was produced and transplanted into a patient. Because stem cells have the ability to grow into any cell, then it is hoped that almost any tissue or organ could be produced in this manner. The potential of this is huge, and could dramatically improve the survivability of people who are severely injured in car accidents, properly functioning pancreases may be grown for people with diabetes, brain tissue producing the right amount of dopamine for people with Parkinson's Disease, new kidneys for people in renal failure, eye tissue & retinas for people with different conditions causing blindness such as RP, the list is very long… Of course we have a long way to go, and it may well be that we have some more huge hurdles to overcome. The mass media has overplayed the timings (and ease) of this science. It is hugely complex, and the likely benefits are still some time away.

Reproductive Cloning
Reproductive cloning is where a completely genetically identical embryo is produced. Think Dolly the sheep (whose stuffed body can be viewed in the Museum of Scotland), or Booger the pitbull. Again, I feel that the mass media are at fault in badly reporting the issues around reproductive cloning, with visions of armies of identical Aryan peoples. The media has also falsely reported that human cloning has already happened in some countries, but a more detailed look at the evidence would suggest that this is very unlikely. Reproductive cloning is also fraught with complex problems (aside from the ethical considerations). There is also a complete misunderstanding about what a clone is. A clone is a genetically identical twin. But this would not mean that the clone would think exactly alike to the donor. But, as we know in the nature / nurture observations, genes are only part of the make up of any characteristics. Identical twins, that have been separated at birth, while still displaying obvious visual similarities, can often grow up to have completely different characters, molded by the environments in which they grew up in. Dolly would not have had the same thought processes as her donor animal. Very few people see any benefit of producing human (or indeed any animal) clones, as there is no increase in the genetic profile. There is the theoretical possibility of producing a reproductive clone with the sole purpose of harvesting donor organs, but there are obvious moral & ethical issues to this. But nevertheless, it is important that any discussion on ethics and morals around this subject must also consider this possibility.

Potential Impact of Stem Cell Research (Part 1)

Stem Cells 101 gave a very brief, simple look at stem cells. Now we will look at the possible areas in which they may be used. I really want to unpack this before touching on the ethical issues. In this post I am concentrating on impairments and diseases. Part 2 will look at the potentially more contentious issue of cloning.

It is important to realise that while there are applications were adult stems cells are being used in medical procedures to good effect (in particular bone marrow transplants to treat Leukemia, and one of my friends is alive today because of that particular procedure!), presently there are no medical procedures being used based on Embryonic stem cells. So is all this noise a waste of time? Well, no. Research is still in the early stages. Indeed the first time that human stem cells were first derived was only in 1998. In the 10 years since then a lot has been found out, but this has also been hampered by restrictions, many political in nature. Certainly no one is doubting that this is a complex part of medical science. The mass media has not helped, by some of the very poor reporting, and exaggerated claims that they have fed the general public. Even if this research will produce cures & applications (which I am confident they eventually will), these are not "just around the corner", as has been reported in many instances in the previous decade. The reality is that I shall keep my wheelchair for the time being, and my father is probably too old for him to receive any cure for his Parkinson's Disease in time.

But the potential of stem cell research is enormous. Not only for the number of diverse conditions that may finally have a cure (or even a prevention), but also because of the nature of many of those diseases. Medicine has made some amazing advantages over the last century, and probably each of either would be, or have a close family member who would have died, if it were not for some medical intervention or other. Certainly 75% of my immediate family would be dead, including me. But there are still many really serious conditions and impairments that we just have no answers for yet. Many of these have a profound effect on peoples' lives. The possible diseases and impairments that stem cell research has the potential to effect includes (this list is not meant to be exhaustive!):

• Neurological
• Parkinson's Disease (think Michael J Fox, Muhammad Ali)
• Spinal cord injuries (Think Superman…and...dissol!!?)
• Retinal disorders (Stevie Wonder)
• Multiple Sclerosis (up to 150 out of every 100,000 of the population)
• Alzheimer's Disease (26.6million people worldwide think Ronald Reagan, Terry Pratchett), although it has to be said that some recent research in this particular field is painting a less promising picture than we had thought...
• Motor Neurone Disease (Prof Stephen Hawking, David Niven)
• Muscular Dystrophy
• Huntington's Disease
• Spinal Muscular Atrophy

• Others (Blood & Pancreas mostly)
• Leukemia (2% of all cancers)
• Sickle-cell Anemia (especially important to us in sub-Saharan Africa)
• Immunodeficiency (including HIV & AIDS)
• Lymphomas (5% of all cancers)
• Lupus (Michael Jackson, Elaine Paige Seal)
• Arthritis (Nelson Mandela)
• Bone Marrow Failure
• Diabetes (171million people or 2.8% of the global population, and rising, rapidly)

Of course, I am not claiming for a moment, that stem cell research will find absolute cures for the above, or any of the above. That is a common mistake made by the mass media. It may be, that some of the hurdles that researchers are finding out about, that they are insurmountable. But the research is looking very exciting in many of these different areas. I doubt we shall see any cures in widespread use soon. The best estimates seem to be looking 3 - 10 years ahead. That is also sometimes used as a argument against stem cell research; they ask "where are the cures?" This is not unreasonable, but the reality is that we do have some (small) cures and advances already, but also that this whole area of research is very complex, and by the nature of the research much of it is slow moving. Remember human stem cells were only first isolated in 1998…a mere 10 years.

Next post will be looking at the more contentious (and I would suggest less well understood) issues of cloning, both therapeutic and reproductive cloning. Only then, once we can agree some baselines, should we begin to think about some of the ethical issues around this research.

Stem Cells 101

This post is an attempt to explain what stem cells are, and the differences between the different types. I am not going to touch on the ethics of stem cell research in this post, but leave that for a later discussion. I do think it is important that people understand what a stem cell is before they are able to make a judgment call on the ethics surrounding the subject. That may sound obvious; but experience has shown me that again, and again, people (including very powerful people) will make a really serious decision, without fully understanding the issue behind stem cells.

I am also going to try to keep this short and therefore I may be accused of over-simplifying. I apologise in advance for that, and should be able to give more information if anyone requires it. I am not going to talk about the research at this stage either. It is just looking at the stem cell themselves, what they do, and where they come from.

Almost all living organisms have stem cells. The name comes from the fact (like a plant) these are the stem, that have the capability to produce different types of cells & therefore tissue. They are of course the cells which allow animals to grow (both in the womb, and later in life). They are also the cells which allow our bodies to repair damage. So if you want to see them at work, then you can cut yourself. Eventually the cut will heal over, and new tissue will be grown to heal the cut. Clever things…we would be in trouble without them.

Now there are different types of stems cells, and they are identified by the number of different types of tissue that they are able to produce.

• Totipotent - can produce any cell within the body
• Pluripotent - can produce almost any cell of the 3 germ layers.
• Multipotent - can produce any cell of a particular family of cells
• Unipotent - is only able to produce one type of cell

The potentially most useful cells are the ones that can produce the most type of cells - the first 2 (actually the focus is mostly on pluripotent) groups. And indeed it is these cells (and how they are harvested) that cause almost all the controversy.

In humans, pluripotent stem cells are taken from blastocysts, which are 3-5 day old embryos. The embryos are provided by fertility clinics. When females are receiving certain fertility treatments then they are given drugs to cause them to super-ovulate (or to produce many eggs). These are removed from the uterus and fertilised with the sperm. In other words, these embryos have never been inside a human body and would never go on to produce a foetus. If they were not to be used for stem cell research then they would be discarded, thrown out with any other organic waste.

A really exciting recent development from 2 separate pieces of research from last year, is the possibility to use adult multipotent skin stem cells, and alter them so that they could become pluripotent. Should this technique be fully successful, then it may remove almost all of the objections that people may have against stem cell research.

In the next post I would like to discuss the different research areas, and the lists of diseases / impairments / medical advantages that may be possible through this research. I think only when there is a full understanding of the facts, and issues that we can then go on to discuss the ethics.

BBC NEWS | Health | Stems cells 'slow nerve disease'

More interesting news on Stem Cell research, but the scientists rightly warn that the clinical use is still a long way off.

BBC NEWS | Health | Stems cells 'slow nerve disease': "Stems cells 'slow nerve disease'
Stem cells show potential for treating the debilitating nerve condition motor neurone disease, research suggests. A US team found injecting rats with stem cells delayed the onset of MND. Writing in the Transplantation, the researchers from Johns Hopkins Medical Institutions warned clinical use of stem cells was still a long way off."

Stemblog � What YOU Can Do!

I really hope that the Bill passes through this time with enough of a majority so that the Idiot in Charge cannot veto this again, and limit this really important research. I hope that there can be enough public support, and people do contact their senators in the States to get that important 66%.

Stemblog � What YOU Can Do!: "We need the Stem Cell Research Enhancement to pass, and to pass with a 2/3 majority, because President Bush has declared that he will veto this bill, once again."

BBC NEWS | UK | Heart valve grown from stem cells

I try to track confirmed news about Stem cell research and developments, as opposed to the many unconfirmed claims that appear on the Internet from time to time. This is a very exciting development, and I expect to see more of there developments in the next few years.

BBC NEWS | UK | Heart valve grown from stem cells: "Heart valve grown from stem cells
Entire organs could be grown from stem cells
British scientists have grown part of a human heart from stem cells for the first time.

Heart surgeon Sir Magdi Yacoub, who led the team, said doctors could be using artificially-grown heart components in transplants within three years."

Catholic official asks legislators not to fund stem cell research - The Business Review (Albany):

Catholic official asks legislators not to fund stem cell research - The Business Review (Albany):: "New York state's Roman Catholic church Wednesday urged the state Legislature to reject Gov. Eliot Spitzer's proposal to invest $2.1 billion in stem cell and other biomedical research over the next decade.

Richard Barnes, executive director of the state's Catholic Conference, said church leaders are opposed to embryonic stem cell research. He said the proposal for the research fund is vague about what kinds of stem cell work would be funded if the Spitzer plan is approved."

How dare these religious egomaniacs interfere in science that could be the answer so many conditions? If they have a personal moral problem with it, then fine; but I believe that they have absolutely no right to dictate and try to enforce their code on others. They just don't understand the science or issues.

Stem Cell Research

I am firmly of the opinion that Stem Cell research will eventually produce cures for many diseases and impairments. But I also believe that we are still a long way off and there needs tobe much more work done, all around the and before we will see the results. It is not going to come quickly, or cheaply.
BUT we have (as a civilized society) to support the scientists and technicians working in these areas. One thing that we all need to do is to empower ourselves by reading up on the science involved, and then trying to get our mind around the ethics. I get quite angry with politicians (such as Bush Jr.) and their various 'ethics' advisors (such as the idiot Charles Krauthammer) who appear to assume that these leading scientists, some of whom will represent the most brilliant minds on our planet, will have NO morals or ethics themselves. Therefore, Bush and his cronies, try to impose their own restricted, rightwing, religious view on the world. And, yes, I do mean the world. The various underhand methods to put forward blanket bans and restrictions through UN resolutions is deplorable. I urge everyone to do some research on this important topic to enable each of us to reach an informed decision. I have been shocked at the lead of ignorance displayed by some of the most vocal objectors to Stem Cell Research. Read what Bush, Krauthammer, and cronies have to say about it too - but their make your own mind up.