Biotech New WorldWESLEY J. SMITH
The theme of Brave New World is not the advancement of science as such," Aldous Huxley wrote in the foreword to a new 1946 edition of his groundbreaking novel, but rather "the advancement of science as it affects human individuals."
Brave New World portrays a future in which science is not the savior of humankind, but our conqueror. The world of the novel is one in which human society has ceased to be truly human. People are no longer "of woman born" (to quote Shakespeare); they are hatched from artificial wombs in Hatcheries run by the World State. ("We decant our babies," explains the Director of Hatcheries and Conditioning to his students early in the book.) Families no longer exist because people do not have parents. The concept of the unique individual has been virtually eradicated. The "principles of mass production" have been applied to biology: standard men and women are manufactured in uniform batches.
The resulting human sameness is more than skin-deep. Through biological predesign, human beings have long since been stripped of their free will. People are genetically engineered not only to be members of predefined social castes, but by their very design to enjoy their biologically imposed straitjackets. The hero, who is naturally born and unengineered, is viewed as a freak the Savage and is eventually driven to suicide after being corrupted by the stultifying antihumanity in which he is forced to live.
When Huxley first published his masterpiece in 1932, the technologies he described seemed unbelievable. Babies gestated in artificial environments rather than in their own mothers' wombs? It could never happen. Genetic engineering to "predestine and condition" human life toward possessing pre-selected traits and attributes?2 What a vivid imagination! A world where applied science has alleviated all human suffering but also destroyed human aspiration and individuality? Preposterous.
Fast-forward only seventy years. Biological fatherhood is under threat of becoming superfluous: Australian researchers "may have found a way to fertilize an egg with cells from any parts of the body, rather than sperm."3 Women also may soon become dispensable to procreation: "Doctors are developing artificial wombs in which embryos can grow outside a woman's body," The Observer reported. "Scientists have created prototypes made out of cells extracted from women's bodies. Embryos successfully attached themselves to the walls of these laboratory wombs and began to grow" The scientist conducting the research hopes to create "complete artificial wombs" in only a few years.4
Scientists are currently hard at work on learning how to "extend, enhance, or augment human capabilities far more directly, personally, and powerfully then ever before." The technologies they have developed range from the sublime to the ridiculous. Some seek the capability of merging the human mind with machine. A new social movement arising in high academia, known as "transhumanism," advocates the moral right to extend "mental and physical (including reproductive) capacities" via genetic engineering and other technologies to permit "personal growth beyond our current biological limitations."5 The day when "a genetic vaccine that endows the user with bigger, harder muscles, with-out any need to break a sweat at the gym" may not be far off. Mice have already been genetically altered to develop "unnaturally muscular hind legs."6
The human genome has barely been mapped, but biotech companies are already developing biochips that are able to scan a person's genetic makeup in search of flaws. For both good and ill, within a few years biotechnologists will be able to map an individual's "entire human genome in 30 minutes ... cataloging the person's genetic idiosyncrasies," leading to vastly improved diagnoses and "designer" treatments as well, potentially, as a profound loss of medical privacy and the possibility of genetic discrimination.7
Biotechnology is moving at such breakneck speed that the dark vision of Brave New World has evolved from an imaginative literary figment and social satire into an ideology that sees biological transformation in an almost mystical light. A new bio-utopian mindset is emerging among futurists, bioethicists, life scientists and allied "transhumanists." These people are "committed to the process of human enhancement and self-directed evolution," which would not only embed "cultural distinctions . . . in our genetics" but eventually "increase the biological differences among human populations."8
The transhumanist ideology foresees a new eugenics in which parents would not only be permitted to "enhance" their offspring genetically, but in the interest of "justice" would be morally, if not legally, "obligated to do so."9 Some proponents even foresee a distant future in which these manipulations have become so radical and widespread that biotechnologists will blur genetic distinctions between certain humans and animal species by mixing in a hawk's DNA, for example, to improve eyesight. And others firmly believe that biological alterations will become as ubiquitous as tattooing and body-piercing are today, culminating eventually in a "posthuman" race in which some people will have such profoundly altered natures that they will be unable to procreate with others through sexual means.10
Posthumanity is at present a fantasy, thank goodness. But the values underlying the transhumanist movement and the public policies likely to be implemented in attempts to reach the promised land threaten to cause great harm in the here and now. Some bioethicists and bioscientists, for example, are pushing for society to initiate a "process of redefining ourselves as biological, rather than cultural and moral beings.' Undergirding this dehumanizing agenda is an almost religious belief in biotechnology as the source of human well-being. In the words of Leon Kass, chairman of the President's Council on Bioethics:
[I]t is a way of thinking and believing and feeling, a way of standing in and toward the world. Technology in its full meaning is the disposition rationally to order and predict and control everything feasible in order to master fortune and spontaneity, violence and wildness, and leave nothing to chance, all for human benefit.12If allowed free rein, where could such bio-absolutism take us? Those who have thought extensively about these issues differ. Kass warns of a "soft dehumanization of well-maning but hubristic biotechnical 're-creationism.'"13 He and others, such as the liberal social critic Jeremy Rifkin, predict that not only is the ideal of human equality at risk, but human life itself may be reduced to the status of a natural resource or a mere product. Yet others see these possible changes as truly beneficent, perhaps even utopian, culminating in a species devoid of imperfections. Princeton University biologist Lee M. Silver, for instance, one of the world's most enthusiastic advocates of human cloning, ecstatically predicts that bioengineering could make our distant progeny akin to gods:
A special point has been reached in the distant future. And in this era, there exists a special group of mental beings. Although these beings can trace their ancestry back directly to homo sapiens, they are as different from humans as humans are from the primitive worms with tiny brains that first crawled along the earth's surface.... It is difficult to find the words to describe the enhanced attributes of these special people. "Intelligence" does not do justice to their cognitive abilities. "Knowledge" does not explain the depth of both their understanding of the universe and their own consciousness. "Power" is not strong enough to describe the control they have over technologies that can be used to shape the universe in which they live.14Of course, it's a long way from here to there. But events move ever faster, and Brave New World has become a looming reality. In 1946, Aldous Huxley was already warning, "All things considered, it looks as though Utopia were far closer than anyone, only fifteen years ago, could have imagined. Then, I projected it six hundred years into the future. Today, it seems quite possible that the horror may be upon us in a single century."15
Opening the Door?
Huxley never described the events that led to the end of history as portrayed in his novel. Had he written a prequel, he might have given us a sense of what had originally induced humanity to unleash a biotechnology so powerful that it eventually resulted in a "Brave New Man .. . so dehumanized that he doesn't even realize what has been lost."16 Perhaps the ancestors of Huxley's characters were driven by an ardent desire to exercise godlike control over human health and mortality. The author might even have attempted to imagine the one technological discovery that began the process of "paving the road to hell with good intentions," culminating over centuries in an unintended biotechnological night-mare.
Perhaps Huxley's prophetic imagination would have led him to conceive of a scientific discovery similar to the isolation of the human embryonic stem cell (ESC) in 1998, which sparked the drive to harness and exploit nascent humans as sources for new medical treatments. This is not to say, of course, that ESC research is de facto a precursor of a morally numbed Brave New World. After all, researchers are seeking cures to serious degenerative diseases and injuries such as Parkinson's, multiple sclerosis, stroke and spinal cord trauma; they have no desire to take humanity into a dystopian future.
Still, the recent discoveries have raised very consequential moral and public policy questions that we dare not ignore. For now, I ask you to ponder a crucial question that the discovery of the human embryonic stem cell, I believe, compels us to confront head on: Does individual human life have ultimate value simply because it is human?
How we answer this fundamental question will determine the extent to which our future world becomes Brave and New in Huxley's ironical sense. If our answer is Yes, then I believe we can pursue advanced medical and biotechnological research, discovering "miracle" cures with the use of human cells, without engaging in morally degrading activities that thinkers from Aldous Huxley to Leon Kass have repeatedly warned against. If, however whether implied through our conduct or explicitly through ideology we answer No to the question posed, then, as Nietzsche said after postulating the death of God, everything is permitted. (author's note: But the thought was perhaps pronounced most famously by Ivan Karamazov, a character in Dostoyevsky's The Brothers Karamazov).
Stem Cells 101
Before tackling the hard philosophical issues and trying to connect the dots, let's pause for a moment to explore some basic facts about biotechnology.
What is a stem cell?
A stem cell is the popular name for a cell that is undifferentiated. (Another adjective that's sometimes used to describe such cells is immature.) If a cell is undifferentiated, it has not yet begun to develop toward maturity to differentiate as one of the more than two hundred types of tissue found in the human body, e.g., blood, bone, fat, brain. Thus a differentiated cell is a "specialized cell type that carries out a specific function in the body, such as heart muscle cell, a neuron in the brain, or a red blood cell carrying oxygen to other cells in the body."17 Until differentiation occurs, a cell is commonly referred to as a stem cell.
Where do we find human stem cells?
Human embryos are the most publicized sources of stem cells. Embryonic stem cells (ESCs) are derived from human embryos approximately one week after their conception. At this stage of development, the embryo is called a blastocyst. Under the microscope, it looks like a tiny hollow ball with a cluster of cells inside it. It has an outer lining, the trophoblast, which develops into the placenta in the womb. Inside the lining there are between 100 and 250 cells. Some of these no one knows exactly how many are the stem cells that will eventually differentiate into every tissue in the body as the embryo develops.18 ESCs are often called pluripotent because, theoretically, in culture they can be transformed into any body tissue.
The process of differentiation takes place in an embryo at an astonishing pace. By the fourteenth day, the primitive streak the beginning of the brain and spinal cord takes form. As gestation proceeds, some stem cells speedily differentiate into heart muscle cells, which then repeatedly divide until a working heart emerges. Generally, by the twenty-sixth day, the heart thus created is actively pumping blood which also somehow matured, but along a different pathway, from former stem cells.
The longest-lasting stem cells are those that eventually differentiate into germ cells (ova in females, testes in males). These don't trans-form fully until about nine weeks of gestation, by which time the embryo has developed into a fetus. Consequently, embryonic germ cells are obtainable through approximately the ninth week of gestation.
But embryos are not the only source of human stem cells. Scientists have discovered that they are found in many body tissues through-out life. These stem cells are popularly known as adult stem cells (ASCs), even though they exist in fetuses, infants and children.
ASCs, while relatively few in number, appear to be ubiquitous. They have been discovered in bone marrow, blood, brain, fat, skeletal muscle, esophagus, stomach, liver, pancreas, nasal tissues, hair follicles and most recently, even in the pulp of lost baby teeth.19 Apparently these cells are part of the body's ability to heal after injury or illness and play crucial roles in the constant regeneration of body tissues. ASCs are often called precursor cells because they are undifferentiated but may not be capable of transforming into every type of body tissue.
There are also human stem cells found outside human bodies, specifically in umbilical-cord blood and placentas. The so-called after-birth may provide a rich source for obtaining human stem cells that researchers hope can be transformed into medicines. If so, we may have a virtually unlimited supply of stem cells derivable from morally uncontroversial sources.
Why are some researchers committed to stem cell research?
Scientists hope that stem cells will provide medical treatments for degenerative conditions in which an organ or other body system ceases to function properly because of a breakdown or death of cells or tissues. According to the National Academy of Sciences, tens of millions of Americans people with conditions such as heart disease, diabetes, serious burns, spinal cord injuries, Alzheimer's and others have degenerative afflictions.20
Parkinson's is a common degenerative disease. (Approximately one million Americans have Parkinson's.)21 In this brain disorder, the patient progressively loses control over body movements as a result of "degeneration of or damage to nerve cells within the basal ganglia in the brain."22 The condition affects the ability of the body to produce a sub-stance called dopamine that helps the nervous system control muscle movement. A lack of dopamine causes victims to experience progressively worsening stiffness, muscle tremors and weakness; these symptoms may become so severe that the patient becomes substantially disabled unable to walk and speak, perhaps losing even the ability to eat. Death may come from complications after many years of increasing debility and physical decline.
The illness takes a terrible physical and emotional toll. In Saving Milly, the journalist Morton Kondracke wrote poignantly of the grief and horror experienced when Parkinson's devastated his wife Milly's health:
Milly functioned, but the life we had known helot' her diagnosis was over. Friends still came to call, but they want invited to say over. Parkin-sons disease had moved in, invading our home. It was a malevolent presence that became the preoccupation of our lives, crowding everything except our love for each other and our kids. The definite diagnosis shattered Milly psychologically. She often clung to me and sobbed piteously, sometimes several times a day, saying that her life would be terrible. "Why is God punishing me?" she cried. "I've always been good. What did I do that was bad?"23While the illness can be held at bay for a period of time with medication and other therapies, until recently there was no treatment on the horizon capable of grappling with the root cause of this devastating condition. But today it appears that we may be able to harness stem cells as a cure for Parkinson's, as well as for other degenerative diseases.
This is the theory: Stem cells could be transformed from their undifferentiated state into the tissue types affected by the degenerative condition. The hope is that these cells, when injected into the body, will continue to divide and grow, eventually regenerating the damaged organs and body systems, easing symptoms and perhaps even effecting a cure. This kind of treatment, now in the experimental stages, is generically known as regenerative medicine because it consists of using stem cells, tissues or body chemicals to regenerate damaged structures. For example, in one experiment, mice with end-stage juvenile onset diabetes (type 1), an immune-system malady, were cured using human spleen cells.24 The authors hope that their findings "may have implications for treatment of diabetes or other autoimmune diseases in humans."25
Imagine the possibilities! Brains damaged by stroke, injury or disease could be restored to proper function. Spinal cord injuries that once caused a lifetime of disability could be healed. Diabetics dependent on insulin for life might be able to wean themselves from the drug as a result of regenerated pancreases, now able to produce sufficient insulin on their own.
Why are stem cells controversial?
Not all stem cell research is controversial. No one opposes regenerative medicine with ASCs or those extracted from other nonembryonic sources such as umbilical-cord blood. There is, however, great controversy over ESC research. And for good cause: the embryo is destroyed in the process of extracting its stem cells. Some opponents believe that this constitutes the taking of human life, and others, myself included, Irony that destroying embryos for the purpose of harvesting their parts reduces nascent human life to the moral status of penicillin mold.
This worry is highlighted by the wording of a press release from Geron Corporation, one of the biotech companies engaging in ESC research. In announcing a purported breakthrough, Geron bragged:
The finding greatly facilitates the development of scalable manufacturing processes to enable commercialization of hES [human embryonic stem] cell-based products.26Meanwhile, a proposed ballot initiative in California intended to create a constitutional right to conduct ESC research and research into human cloning explicitly labels unused embryos (leftovers from fertilization procedures, a source for ESCs) as "surplus products."27 Here embryonic human life is reduced in status to a mere commodity a necessary legal demarche before taking the next step, namely the harvesting of its body parts into marketable items of manufacture. No wonder this technology raises moral hackles.
Many biotech boosters and members of the bioethics intelligentsia, emphasizing that embryos are not sentient and cannot feel pain, believe that the potential benefits of this research knowledge about early embryonic development, the ability to study disease models, medical treatments outweigh the ethical problems. Some, as will be described more fully in the next chapter, even assert (unscientifically) that a human embryo isn't really human life.
But there is little question that to condone by law the destruction of human embryos for research purposes is a critical step for us to take. Even the National Bioethics Advisory Commission (created through executive order by President Clinton in 1995), which was favorably disposed toward embryo research, asserted that "most would agree .. . embryos deserve respect as a form of human life."28 While recommending that the federal government fund ESC and fetal tissue research, this commission proposed certain restrictions: it did not recommend funding the manufacture of embryos for research purposes as opposed to the use of embryos left over from IVF fertility procedures and it proposed laws prohibiting the buying and selling of human embryos for research.29 And the NBAC explicitly admitted that destroying human embryos for the sake of medical progress is highly questionable:
In our judgment, the derivation of stem cells from embryos remaining following infertility treatments is justifiable only if no less morally problematic alternatives are available for advancing the research.30The NBAC's challenge is actually being met by "less morally problematic alternatives" for creating a vibrant regenerative medicine sector in the form of ASCs, umbilical-cord blood stem cells, and other sources such as olfactory tissues. This removes the principal excuse not to take the NBAC's caveat seriously.
Are embryonic stem cells the same thing as fetal tissue?
Although not everyone would agree, the short answer, at least from my perspective, is No. While both fetal tissue experiments and ESC research use tissues that are derived from unborn human life, and while both inject tissues for the purpose of regenerating a patient's dysfunctional body systems, let's not lose sight of a clear distinction: in ESC research, the embryo is destroyed for the purpose of harvesting its stem cells. Leaving aside the morality and propriety of abortion for the moment admittedly something that many of my readers won't be inclined to do fetal tissue experiments use material obtained from cadavers resulting from abortions (or natural miscarriages) that were not undertaken for the purpose of obtaining such material. Thus, it seems to me that fetal tissue experiments are analogous to organ procurement and transplantation from already dead donors. In contrast, ESC research undertakes to destroy living humanity.
This crucial difference established, it's worth recalling that a few years ago we heard the same promises about the potential of miraculous medical cures from the tissues of aborted babies that we hear today about ESCs. But that particular will-o'-the-wisp has proved elusive. Indeed, as we will describe later on, fetal tissue experiments in humans have generally produced negative results.
Would ESCs work better than ASCs?
The jury is still out. Many biotech researchers believe that ESCs offer the better hope; or at the very least, that they should be pursued in parallel with adult cells. An article in the journal Science put it this way: "Most scientists ... including those who work with adult-derived cells, caution that recent [adult stem cell] advances, although promising, do not mean that adult cells can replace the need for those derived from embryos or fetal tissue. For some diseases, they say, adult cells may indeed turn out to be the better choice. But for other applications, embryo-derived cells have some distinct advantages.31
According to this view, ESCs are far easier to find, given that every human blastocyst has them in an isolated packet; ASCs, in contrast, appear to be far fewer and more scattered, requiring technicians to meticulously sort them out from surrounding differentiated cells, and they are difficult to culture. In addition, ESCs are intrinsically more "active" that is, their reproduction cycle is shorter and theory dictates they are thus more likely to produce vigorous regeneration. (But as we'll see, this may also make them unusable if their proliferation cannot be controlled.) Better yet, proponents of ESC research claim, embryonic cells are theoretically capable of transforming into any bodily tissue (pluripotency), while adult cells may have a more limited repertoire. Finally, ESCs in their undifferentiated state are immortal that is, they can be maintained indefinitely allowing stem cell lines to be kept for use when needed.* It is worth noting, though, that some proponents of ESC research don't expect these cells to be sources of actual therapies: they think it's more likely that their role will be to assist scientists in gaining an under-standing of the latent powers of adult cells.32
But before ESCs call be used in humans, two major problems must be overcome: tumor formation and autoimmune rejection, problems that do not appear to exist with ASC therapies. Animal studies have demonstrated the significant danger that ESCs can cause tumors. As reported in the Proceedings of the National Academy of Sciences in December 2000, researchers at Harvard Medical School and McLean Hospital in Belmont, Massachusetts, injected mouse embryonic cells into rats in an attempt to alleviate Parkinson's-like symptoms. Of the twenty-five rats receiving the injections, fourteen showed modest improvement, six showed no benefit, while five died of brain tumors caused by the ESCs. In other words, the treatment actually killed one-fifth of the animal subjects, even though the researchers reduced the number of injected cells from 100,000 to 1,000 just 1 percent of the usual dose.33 A later Parkinson's experiment showed similar results, although in this case the dosage was higher.34
*The immortality argument may be weakening. James Thomson, who first extracted human embryonic stem cells, now reports that cell lines grown over several months in the laboratory "can develop genetic abnormalities, " such as gaining bits of chromosomes changes found in "some types of cancer." This worry was confirmed in 2004 when Harvard researchers reported that seventeen embryonic stem cell lines they had created developed chromosomal abnormalities "after prolonged culture." Another 2004 study published in Nature Biotechnology noted the same phenomenon.
In another animal experiment in 2003, Japanese researchers trans-planted ESCs into the knee joints of mice to determine whether the cells can grow cartilage. Unfortunately, instead of growing cartilage, the cells caused tumors, "destroying the joints." The study's conclusion: "It is currently not possible to use ES cells to repair joint tissues."35 More recently, as reported in the February 2004 issue of the journal Diabetologia, researchers from the University of Calgary found that insulin-producing cells obtained from ESCs caused tumors known as teratomas in mice.36
Tragically, a patient was apparently killed by an inadvertent injection of embryonic cells. As reported in the medical journal Neurology, Chinese doctors were attempting a fetal cell experiment to treat a Parkin-son's patient. The patient died when anomalous tissue developed in the ventricles of his brain, perhaps as a result of stem cells differentiating indiscriminately.37
The second major problem confronting ESC research is the worry that patients' bodies might reject ESCs extracted from in vitro fertilization (IVF) embryos, just as the body tries to destroy transplanted organs. If true, this would mean that patients receiving ESC therapy could be forced to spend a lifetime taking strong drugs to suppress their immune system response.
Researchers have developed several proposed solutions to this potential problem, such as genetically engineering the cells so that they do not stimulate the body's defense system. Another approach would be to manufacture cloned embryos of patients needing stem cell therapy, and then extracting the ESCs at the blastocyst stage of development for use in regenerative therapy. This prospective approach known as therapeutic cloning will be defined and discussed extensively later in the book.
In contrast, ASC research has advanced to the point that regenerative therapies have been attempted in human experiments. Here are just two examples:
On February 1, 2003, a nail gun accidentally discharged, driving a three-inch nail through sixteen-year-old Dimitri Bonnville's heart. The injury was severe. And then Bonnville suffered a serious heart attack, causing his heart further damage.
From the time his doctors began treatment, Bonnville's heart showed progressive degeneration. His "ejection fraction," a common measure of the heart's function, fell from a normal value of more than 65 percent to a mere 25 percent. (Ejection fraction measures the amount of blood pumped out of the left ventricle with each beat.) But Bonnville's physicians were already planning to begin a clinical trial using adult stem cells to repair damaged hearts. Being young and otherwise healthy, he seemed the perfect subject. So his doctors developed a "one patient protocol," in which they undertook to treat the teenager with his own tissues.38
Stem cells were first extracted from Bonnville's blood. Then the stem cells were isolated and cultured. Finally, they were injected into the coronary artery that supplies blood to the heart. A few days later, doctors noted an astonishing improvement: Bonnville's ejection fraction had risen to 35 percent, despite previous tests revealing that Bonnville had "no viable heart muscle" in the affected area. It could have been a coincidence, but the improvement seemed to indicate that the stem cells might have begun to rebuild heart function something that had been accomplished previously with bone marrow stem cells in human experiments in France and Hong Kong.39
At this point it is important to emphasize that one patient does not a new cure make. Only time wilt tell whether Bonnville was rebuilding heart muscle. Moreover, even if it is proved that Bonnville's stem cells helped regenerate heart muscle, it will take much more research with animals and in human clinical trials before such ASC therapies will be added to medicine's arsenal as a treatment for heart disease. Still, this experiment and others appear to demonstrate that ASC therapy has the capacity to be of significant benefit in the treatment of coronary maladies. (After the Bonnville story was widely publicized, the U.S. Food and Drug Administration ordered doctors not to repeat it until extensive animal testing is performed to demonstrate its safety and efficacy.40 However, in April 2004 the FDA did approve a human trial using bone marrow stem cells to treat heart disease.41)
In April 2001, the California neurosurgeon Dr. Michel F. Levesque told the American Association of Neurological Surgeons how he had treated a man named Dennis Rimer for his worsening Parkinson's disease: he had used the patient's own neural stem cells. A pea-sized sample of tissue having been removed from Turner's brain, stem cells in the tissue were isolated and cultured into the mil-lions. Then these cells were injected back into Turner's brain. One year after the procedure, the patient's symptoms were reduced by more than 80 percent even though Turner was treated in only one brain lobe.42
I interviewed both Turner and Dr. Levesque about this astonishing experiment. Both told me that had Turner's disease progressed as expected, by the time of my interviews he would have required heavy medication to treat his symptoms and would likely be using a wheel-chair in which he would have to be strapped. Instead, he takes only minimal medication less than when he received the experimental treatment and his symptoms remain mild. Indeed, Turner is thrilled that he experiences only minor trembling of the hand, and then only when he's under stress or very tired.43 (When I called in late spring 2004 to follow up on his condition, the woman who answered his phone told me he was still doing well enough to be traveling in Africa.)
Once again, it must be stressed that one patient does not a cure make.44 It's possible that Turner's disease would not have followed the usual progression; furthermore, there may be another reason for his apparent remission. Still, there's no denying that Turner's improved health is reason for measured optimism and further research on the use of a patient's own tissues as a potent medicine.
Those who believe that ASCs offer the best hope for a viable regenerative medicine point out that using them comes without moral bag-gage; and they are far less dangerous than ESCs since they do not appear to cause tumors. (There have, however, been reports that ASCs may "fuse" with other body cells, leading to cells with abnormal DNA content.45) And while it's true that cases such as Bonnville's and Turner's are isolated, they are becoming increasingly common; tremendous strides are being made in studies with animals and now with human patients. ASC and related therapeutic approaches are currently undergoing clinical trials or being used in the treatment of cancers, stroke, autoimmune diseases, anemia, bone and cartilage deformities, corneal scarring and skin grafts, to name a few.
Moreover, since stem cells exist in many organs and body tissues, there is probably no need for them to be pluripotent, that is, capable of transforming into every kind of tissue. (It seems, however, that a form of bone marrow stem cell may be pluripotent.) More importantly, unlike embryonic stem cells from 1VF embryos that could be rejected by the patient's immune system, ASCs are genetically identical to the patient's since they are autologous; i.e., they are the patient's own cells. Last, it should be pointed out that ASC regenerative medicine, in the form of bone marrow transplants, has in fact been used to treat leukemia and certain cancers for many years.
So which is better? As I said earlier, the jury is still out. But the evidence is beginning to accumulate.
Are the debates about embryonic stem cells (and human cloning) really about abortion?
No and yes. Factually, abortion is quite irrelevant. But the politics of abortion definitely affects the debate.46
Pro-lifers oppose most abortions because they believe that "innocent human life" is sacrosanct from the point of conception until a natural death. Pro-choice adherents believe that laws preventing abortion (at least before fetal viability) violate a woman's human right to personal autonomy and self-determination. Thus, they support the legal right of abortion in order to ensure that pregnant women aren't forced to do with their bodies some-thing they might not wish to do specifically, gestate and give birth.
This dispute is irrelevant to ESC research and human cloning since applying these technologies would not force women to do anything with their bodies; "choice," as the term is understood in the abortion issue, is not involved at all.
What does human cloning have to do with ESC research?
Many biotech researchers believe that human cloning may be a necessary adjunct to harnessing the healing potential of ESCs in order to over come the tissue-rejection problem. The idea behind therapeutic cloning is "to generate a customized embryonic stem cell that carries the genetic blueprint of a specific patient."47 When the cloned embryo reaches the blastocyst stage, it could be dissected for its ESCs. These, in turn, could be proliferated in culture and eventually injected into the patient. In theory, because the genetic makeup of the ESCs would be virtually identical to those of the patient, immune rejection would not take place. (There are significant moral and abundant practical problems with this technology, but we will defer that discussion until a later chapter.)
How is human cloning performed?
Somatic cell nuclear transfer (SCNT), the kind of cloning procedure by which Dolly the sheep came into being, is the primary form of human cloning that we'll be addressing in this book.48 There are, it is said again and again, two kinds of SCNT human cloning: one that we have already identified as therapeutic cloning, a term sometimes broadly used to include the cloning of human embryos both for regenerative therapies and for use in medical research; and reproductive cloning that is, human cloning undertaken for the purpose of bringing a cloned baby to birth.
This supposed distinction is spurious. These terms do not describe different types of procedures. There is only one act of cloning, generally SCNT. Thus rather than describe different techniques, the terms actually identify different hypothetical uses for human cloned embryos.
How does SCNT work? Generally, mammalian cloning which of course includes human cloning involves the following easy-to-describe but difficult-to-accomplish steps. Let's assume for our discussion that I wanted to clone myself:
The cloned embryo containing my DNA would be my near identical twin genetically. I say "near" because the mitochondrial DNA about 1 percent of the total DNA in the embryo would consist of genetic material that came from the egg. Thus, unlike natural identical twin brothers or sisters, the SCNT clone made from my DNA would not be 100 percent genetically identical to me, and hence he would not actually be my "clone" in the literal sense of the term.
What are the correct terms to describe the products of SCNT?
One of the main causes of confusion in the debates over biotechnology has been our inability or refusal to define terms accurately and use them consistently so as to keep the discussion intelligible.
This is why the President's Council on Bioethics a panel of experts created by President George W. Bush in 2001 to advise him on biotechnology focused at length upon the issue of definitions in its first report to the nation, Human Cloning and Human Dignity.49 Despite being deeply divided over the propriety and morality of human cloning as it would be applied to medical research, the council unanimously agreed that the life brought into being via a successful SCNT cloning procedure is a "cloned human embryo."50 This conclusion is based on sound biological analysis. The "organization and powers of this [cloned] entity, and the crucially important fact of its capacity to undergo future embryological development," the council concluded, would be "just like a sexually produced embryo."51 In other words, the human organisms created by SCNT and those created by fertilization would be biologically the same and would develop in the same manner: "It hence deserves on functional grounds to be called an embryo."52
Since SCNT is the same procedure whether the cloned human embryo is to be used for research purposes or for reproduction, and since the embryos that SCNT produces are essentially the same regardless of how they are to be used, the council determined that the accurate terminology should be as follows:
"Production of a cloned human embryo, formed for the purposes of initiating a pregnancy, with the (ultimate) goal of producing a child" would henceforth be known as "cloning-to-produce-children" (CPC).53With one exception, these will generally be the terms I use in this book. However, because CBR covers so many different uses of cloned embryos, I will also employ the term "therapeutic cloning" when describing human SCNT to be employed as a means of producing embryonic stem cells or other tissues for use in regenerative medical therapies.
Let me briefly summarize the reasons why I worry that, if we don't regulate the emerging power of biotech wisely, the discovery of the ESC could become the stimulus that sets us on the road to a Brave New World. First, as a general matter, when we countenance the destruction of embryos in order to harvest their body parts for research or medical therapies as opposed to creating them for the purpose of helping infer-tile couples to procreate, during which some are lost we cross a line of no return. We are abandoning the outlook that holds all human life to have intrinsic value simply because it is human; one subgroup of human life becomes, in effect, dehumanized and reduced to the moral status of a mere natural resource. To subject human embryos to such uses is to exploit nascent human life in the same way that we do non-human organisms.
More importantly from my perspective, the objectification of human life inherent in the ESC research enterprise would not mark the finishing line but the shot of a starter's pistol to begin the race. In just a few short years, ESCs have sparked an energetic drive by Big Biotech to legalize and legitimate research into human cloning, the essential biotechnology capable of igniting the "really revolutionary revolution" against which Aldous Huxley warned us. This accelerating effort to learn how to clone human life reliably and efficiently could well lead to the very biological transformation that Huxley predicted would occur, "not in the external world, but in the souls and flesh of human beings."55
Wesley J. Smith "Biotech New World." Chapter 1 in Consumer's Guide to a Brave New World (San Francisco: Encounter Books, 2004), 1-18.
With permission from the publisher of Consumer's Guide to a Brave New World, by Wesley J. Smith. All rights reserved. ISBN 1-893554-99-6. Order it here.
Wesley J. Smith, a senior fellow at the Discovery Institute, is an attorney and consultant for the International Task Force on Euthanasia and Assisted Suicide and a special consultant to the Center for Bioethics and Culture. He is an international lecturer and public speaker, appearing at political, university, medical, legal, bioethics, and community gatherings across the United States, Canada, Europe, South Africa, and Australia.
In May 2004, National Journal named Smith one of the nation's top expert thinkers in bioengineering because of his work in bioethics.
Wesley J Smith's writing and opinion columns have appeared in such national and regional news publications as Newsweek, the New York Times, the Weekly Standard magazine, National Review, the Wall Street Journal, USA Today, the New York Post, First Things, Forbes magazine, the San Francisco Chronicle, and the Detroit News among many others. Smith has appeared internationally on the electronic media, including such programs as CNN Crossfire, Larry King Live, Good Morning America, Nightline, and the Sunday Program on BBC 4 radio. Wesley J. Smith is on the advisory board of the Catholic Educator's Resource Center.
© 2004 Encounter Books
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