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Jeffrey Kahn

Jeff Kahn (above), director of the University's Center for Bioethics, and Steven Calvin, co-chair of the Program in Human Rights in Medicine, recently engaged in a point/ counterpoint on embryonic stem cell research.

Point/counterpoint: embryonic stem cell research

embryonic stem cell research

From the Academic Health Center

In 2003, the University--already a leader in adult stem cell research--announced its plan to expand its human embryo stem cell research beyond the federally approved stem cell lines. To do so, the University will seek private funding to support this legal, but controversial, research. The Academic Health Center held a public forum--with a point/counterpoint discussion--on April 13 to explore the science behind and the policy implications of conducting human embryonic stem cell research.

Catherine Verfaillie, director of the University's Stem Cell Institute, provided a scientific presentation which was followed by a point/counterpoint discussion with Jeff Kahn, director of the University's Center for Bioethics, and Steven Calvin, assistant professor in the Medical School and co-chair of the Program in Human Rights in Medicine at the University. Frank Cerra, senior vice president for health sciences, moderated.

What follows is an abridged version of that conversation.

As promising as your work with adult stem cell research is, why pursue human embryonic stem cell research with all the moral objections raised? It seems to be a compelling argument that we instead pull out all the stops and place our money on a sure winner--your research with adult stem cells. Catherine Verfaillie: I'm flattered to hear that comment but I'm not sure that I include me in the same league and I don't know that we're winners all around. If you look at the adult stem cells in the culture dishes, it is still significantly more difficult to maintain these cell lines than embryonic stem cells. So even though I made it sound like they have eternal life like embryonic stem cells, time will need to tell how eternal or how young these cells stay. I've showed you the example of the beating heart cells in the culture dish, if you take embryonic stem cells and coax them to become heart muscle cells. With bone marrow cells that we have in the laboratory, we have tried pretty hard to try and make them into beating cells and so far haven't been successful at all. So I think there might be sufficient differences between adult stem cells and embryonic stem cells that some of the cells will be more amenable to generate one cell type, whereas the other cell--adult or embryonic (and I don't want to take sides here)--will be more amendable to make a second cell or cell type.

So I think you can say just well, let's just wait and see what the adult stem cell research shows and work as hard as you can, which we do, for the next five or ten years and then see what we have been able to do. However, if it turns out that indeed these cells are not quite as potent as embryonic stem cells ten years from now and then we pull out the embryonic stem cells at that point in time, then we still have five or ten years to go to actually find out how these cells will behave.

The second reason to not just do one or do actually both, is that's very clear to investigators who work with both cell types, and we do here at the University of Minnesota, so we can compare the two cells right next to one another, by the same principle investigators that what we learn in one system is very applicable to the other system. So it isn't like working on embryonic stem cells won't teach us about the other side or the other way around, so I think full-steam ahead for both systems will get us to answers much more quickly. That's the reason that even though I could stand up here and say our cells are the end-all and therefore we don't need embryonic stem cells, that's why I have been very outspoken that even though we have found these cells to be more potent than we previously thought that we shouldn't just put blinders on and say well, this will fix everything, so let's not worry about the other cell type.

Can you use embryonic stem cells to clone? Catherine Verfaillie: When we use the term "cloning," it is important to make the distinction between reproductive and therapeutic cloning. We are not doing nor would we allow reproductive cloning. Scientists are, however, engaged in researching therapeutic cloning for treating disease. The purpose of therapeutic cloning is to produce a patient's own embryo stem cells, not babies. In therapeutic cloning, the nucleus of a donor's unfertilized egg is removed and replaced with the nucleus of a patient's own cells, like a skin, heart, or nerve cell. No sperm is used in this procedure and the cells are not transplanted into a womb.

Who will stop a U researcher from creating a human from embryonic stem cells? Frank Cerra: Researchers and scientists around the world have condemned reproductive cloning. The University of Minnesota has stated publicly that it will not support reproductive cloning or allow it to take place at the University.

Is the use of embryonic stem (ES) cells for research morally preferable to disposing of them, assuming they already exist, for example for In vitro fertilization (IVF) purposes? Steve Calvin: The use of IVF derived human embryos in this research is certainly less morally objectionable to most people than other possible sources. There are some strict views, particularly those articulated by the Catholic Church, which object to IVF itself because deliberate destruction of some embryos is an inevitable part of the process. I believe that the intent of IVF is to reproduce without an intent to destroy embryos so I find it acceptable. However if IVF "spare" embryos become a widely used source for research material I believe that it will lead to further pressure to expand to other sources and quite possibly to the creation of embryos specifically for research.

Just because something is legal doesn't mean it's right. (I look no further than segregation and slavery.) Similarly, someone else's decision--and the fact that it is made [on embryonic stem cells research, for example]--doesn't necessarily mean it is correct. How do you defend the idea that someone else's decision to destroy an embryo somehow leaps us past the question of whether that decision is right or wrong on its own merit? Jeff Kahn: I hope and believe that our laws reflect what we think is morally right. Laws permitting slavery were based on the (erroneous) view that slavery was morally acceptable. That's why we need to argue and discuss matters of great social importance and ethical disagreement before making laws about them. Individuals may disagree with the outcome of the debate--think not only about stem cell research, but abortion, the war in Iraq, capital punishment, etc. All of these are moral issues where there is great disagreement. We will never achieve consensus on such controversial issues, so we instead need to encourage discussion and debate and make decisions by accountable processes that everyone can see and understand.

Jeff Kahn put the "moral status" of the embryo/blastocyst somewhere on a scale between tissue and people--exactly where seemingly vaguely determined by public opinion. Isn't this too important a question to be so vague on? Steve Calvin: There are some moral boundaries that are so important that they should be honored even when public opinion supports crossing them. The destructive use of early forms of human life is one of those moral boundaries.

Jeff Kahn: I'm not sure it's as vague as the question suggests. There is a very long period between fertilization and possible birth. Research on embryos takes place before 14 days after fertilization. For me, the beginning of personhood and therefore the beginning of moral status occurs substantially later than this point in development. So while we may not be clear on exactly when personhood begins, in my view it is substantially later than the point of development at which embryo research is performed.

What are the sources for funding stem cell research? Frank Cerra: The University put private funding in its policy for a variety of reasons. If you're going to make new embryonic stem cell lines other than those that are approved for federal funding, the guidelines that were put out by President Bush and subsequently taken up by the NIH say you have to use private funding. So we adopted that and the source of private funding is private citizens or private companies. In either case, the advantage is the research is being done in the light of the day of the University.

In your opinion, are the politicians making these decisions, well enough educated in the sciences to have such an impact on the future of this research? Frank Cerra: The short answer is yes and my long answer is this: What I'm impressed with in spending time in the state legislature or with the various components with our executive branch of government, is that when there's a public policy issue on the table, the elected people take the time to understand the issue. They ask questions, they hold hearings, and our role as the people proposing this research is to educate them about the science, about the issues that the science results in, and to provide them with whatever other kind of information they wish to have. They, then, make policy. That's how the country works. I happen to like that.

One last comment, from each panelist? Steve Calvin: In thinking this through and trying to come to a conclusion, one of the things that has been very striking to me is that there is compassion on both sides of this issue. I appreciate the fact that no questions were raised saying don't you have compassion for people with illnesses. People with chronic debilitating illnesses, and most likely all of us will face them, want cures and want treatments down the road and I do think there is great promise in much of the work that Catherine and her colleagues are doing. So, it's not for a lack of compassion. But it's because of the fact that there are certain boundaries; once we cross them, sometimes they're hard to go back to. Andrew Sullivan, a writer whom I appreciate, has said that in federal law, it's against the law to kill a bald eagle; it's also against the law to destroy a bald eagle's egg. Now obviously that's a much more unique thing, but difference between a human and a bald eagle, the point is, why can't we make that kind of connection, even given all of the promise and all of the potential good that can come of this.

Catherine Verfaillie: First, I think I probably indicated my passion about the research that is going on and the potential payoffs that will come from this. I hopefully also have convinced you that even though here in Minnesota we have identified adult stem cells with great potency it's research really in its infancy. I don't say that this is the cure-all for everything and therefore I do strongly believe that we need to continue both avenues, comparing the two cell types, adult versus embryonic, and at the end of the day whether that's five years or ten years from now, make scientifically correct decisions as to which of these cells is the right cell to use for whatever disease. The last comment I would like to make is that embryonic stem cell research currently here at the University of Minnesota is done exclusively with the federally approved lines, but we're hoping to move forward using new embryonic stem cell lines, and I think that is important for multiple different reasons that I already pointed out to you. Even though there is some moral objection to using these cell lines, I still strongly believe that is these are generated from left-over fertilized eggs that will not be used for creating a human being and they will eventually be destroyed whether it's because they remain in the freezer and they will no longer be viable 10, 15, 20 years down the line, or they will be destroyed just because the couples are no longer willing to pay for the fertilized eggs to be in the freezer, then in my mind, using them for maybe a much greater good, which is understanding how cells differentiate, what stem cells are all about, and maybe creating therapies that will benefit probably lots of us in this room once we become older, I think that is the right way to go about this.

Jeff Kahn: The crucial thing in controversial research is that there be thoughtful controls in oversight. Where they actually might best come from, believe it or not, is more federal funding for embryonic stem cell research. And that's because when we leave research like this in the private sector, it generally means there are no rules at all. People can do whatever they want so long as they're using private money. By spending federal dollars, come federal rules and because we have such limited federal money so far, we have very limited federal rules. So, the best way to get control and oversight and adequate accountability is actually to increase federal funding for this area of research where we can bring it into the daylight, as Dr. Cerra said, and really control in the way we think best.

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