Making and Using Humans

 

 

Where are we now and where do we go from here?

 We already know how to reproduce (as opposed to procreate) humans.  The technology is called IVF (In Vitro Fertilization).  We reproduce 10s of thousands of humans every year using this process.  IVF is the main component of a $2 Billion industry today and growing rapidly.

 We have a well developed market for human sperm and human eggs.  We even have a market for womb rentals.  It is called surrogate motherhood.

 This human reproduction process includes a quality control system to prevent the reproduction of defective humans.  It is called PGD (Preimplantation Genetic Diagnosis).  Defective humans are discarded.

 We also reproduce more humans than we need (400,000 more) so those surplus humans are left in the embryo stage and frozen for future potential use.  One common use is research.  It is called Embryonic Stem Cell Research.

 That’s where we are today.

 The reproduction of human clones for research is not far in the future.  While the premature celebration of their  arrival in Korea turned out to be a fake, the progress in that direction continues.  Dolly the sheep was reproduced using that technology.  Success with human clones is almost certain and soon. 

 We already have the technology to adjust the genes (the DNA) of those clones when we can reproduce them. 

 So far we are only talking about microscopic embryos.  We could do much more powerful research and come up with many more cures and faster is we could work with humans that have already developed working organs such as hearts, kidneys, eyes, brains, etc.  By 10 or 12 weeks from fertilization human fetuses, cloned or non-cloned, would have developed all of those organs.

 While we cannot yet grow humans past the embryo stage to the fetal stage without the use of a live human womb we already have enacted laws (in New Jersey) which allow research on those fetuses.  Work on artificial wombs is also underway.

 Perhaps we don’t need artificial wombs to do research on living fetuses.  If women are prepared to go through the rigors of egg donations for a sum of money perhaps they would be willing to donate a live fetus as well. 

 Many of them were going to have an abortion anyway.  Over one million human fetuses are aborted every year in this country, most of them at that 10 to 12 week stage.  Shouldn’t we make some use of those fetuses that would otherwise be wasted?  Just like those 400,000 spare embryos. After all they aren’t persons.  Right? They are only human non-persons. 

 Human non-persons. Now there is a useful concept.

 But there are laws – the Born Alive Infant Protection Act.  But these are not infants.  They are only fetuses.  And they were not ‘born’.  They were ‘extracted’ or ‘evacuated’. 

 How soon might this be happening?  Might it already be happening? 

 It is known, but not widely, that researchers today work on tissues retrieved from aborted fetuses.  There is a market for these tissues.  There are known price lists for various fetal parts.

 Research on live fetuses?  Is it possible?

 And then what?  Organ donation?  Spare parts humans?

  Do we really want to go there?

 

Stem cell researchers are almost irrationally focused on their desire to do research on human lab rats, otherwise known as embryonic stem cells. The rationalization of ‘searching for cures’ continues in the face of mounting evidence that ESCs may never produce cures.

Legitimate research objectives do lie behind this false front but these objectives can be addressed without using human lab rats. In fact at this stage of scientists’ very limited knowledge of stem cells the real search is for a basic understanding of how they differentiate, what signals they use, where these signals come from, and many other very basic questions. Since these biological processes are basically the same in humans, sheep (See ‘After Dolly’), and flatworms, these processes can be researched just as well, and in many respects better, in these and other species.

In fact a recent announcement from Australia has plant researchers creating plant clones using stem cells just like ESCs. Even daffodils can answer some of these basic questions! Why do researchers insist on killing human beings?

 

Behold the lowly flatworm. This cross-eyed, ugly, little creature may be God’s (or evolution’s if you are so inclined) greatest contribution to our current thinking on biotechnology.

It has been known for centuries that the flatworm can be cut into pieces and the pieces can each then grow into a brand new flatworm. What has not been known until very recently is how the flatworm manages this trick.

The answer is stem cells. Adult stem cells.

Scientists at the University of Utah discovered that flatworms (Planarians specifically) have stem cells almost everywhere in their bodies and, more importantly, have factors – specialized proteins – which can enable these stem cells to continue to live as stem cells or to start producing other kinds of cells when and as needed.

The importance of this to humanity is that we too have adult stem cells in our bodies. They have been found and are active in skin, bone marrow, hair follicles, intestinal lining, nasal nerves, and other places. The flatworms are starting to show us how these and all of our other adult stem cells may be controlled and may produce the medical miracles so sensationally promised by embryonic stem cell research.

Yet another contribution of the flatworm is to the argument of when human personhood begins. One side argues that a human embryo is not a human person until after the possibility of ‘twinning’ has passed – a few days after conception. Prior to that point it is not a unique person. The ability of an individual flatworm to divide into many flatworms gives the lie to that argument.

Let’s hear it for the flatworm! A star at the ugly bug ball!

 The strongest argument presented in favor of embryonic stem cell research is that the lives of ‘tens of millions’ of Americans may be either saved or greatly improved by the ‘use’ (the word ‘killing’ is never used) of a few microscopic embryos. In this view the lives of these embryos, even if they are human beings, are much less important than the lives of the millions of people who may be saved.

Compare that with the argument against the ‘torture’ of captured terrorists who may have information about other terrorists’ plans to kill thousands of Americans. In this view the dignity or discomfort of these terrorists is much more important than the lives of the thousands of people who may be saved.

Moral relativism?

Oh, no! Say the arguers. We are only secondarily concerned with the terrorists’ dignity or discomfort. We are primarily concerned with what it would do to our own culture.

So torturing is worse than killing?

Oh, you just don’t understand!

You got that right!

The issue of Federal funding of embryonic stem cell research has been shamefully distorted by the press and has been turned into a very useful political advantage for the 'party of death'.  The recent vote by the US House of Representatives on S. 2754, the Alternative Pluripotent Stem Cell Therapeis Enhancement Act exposes their strategy.

National Review OnLine has a superb (as always) essay by Robert George and Eric Cohen on the politics which controlled the rejection of S. 2754.  Cohen and George make it abundantly clear that this rejection by the 'party of death', led by Rep. Michael Castle, was not a defense of science as claimed or even a means to obtain more funding for human cloning or embryonic stem cell research.  It was simply and obviously a blatant effort to keep alive a biased and undeservedly political issue.

 

The human body is a magnificent and complex piece of machinery. The more we learn about it the more we find how little we really know about it. One thing that we keep learning and relearning is that the body has a powerful set of mechanisms for protecting and healing itself.

Over the most recent centuries the science of medicine has been producing an increasing array of accomplishments. The greatest of these accomplishments have often been those which use the body’s own protection mechanisms. Vaccines for small pox and polio come immediately to mind as external stimuli for such built-in protection mechanisms. And there are also protection mechanisms which operate without external stimuli such as those which heal wounds and mend broken bones.

As medical research continues to expand our knowledge of this complex machine much of the attention is focused on some of its smallest elements, the cells. It is the operation of such cells, particularly those defined as stem cells, which power these protection mechanisms. How these stem cells know what to do and when and where to do it remains a mystery for now but their existence in most, and perhaps all, organs of the body is a known fact.

The search to find these stem cells, understand how they function, and how they can be stimulated when necessary is almost certain to deliver on some, if not all, of the promises already made for stem cell research.

The important point about these stem cells is that they are adult stem cells. They are stem cells that are already living in the body, either working or standing by to be summoned for work.

Medicine is already using some of these adult stem cells to treat patients, albeit very crudely and with only modest success. But, contrary to many statements attacking these treatments, there is success. Clinical doctors find these stem cells either in the patient’s bone marrow, hair follicles, nasal sensory tissue, or dozens of other bodily organs, remove some stem cells, stimulate them in vitro to grow them to some higher quantity, then reinsert them near the site of the health problem, be it blood, spinal cord, adrenal glands, etc. This finding, removing, stimulating, reinserting, is a series of non-trivial tasks but it is being done today. For example,bone marrow treatments for leukemia have been used successfully for decades.

To date these adult stem cell treatments have produced few cures but many improvements. In the future it is expected that the removing and reinserting can be eliminated by finding and using a stimulation that the body can use with its internal protection mechanisms in much the way that it now uses vaccines.

The point is that stem cell cures are going to come from adult stem cells, in vivo where we can and in vitro where we must.

What about embryonic stem cells and cloning? Basic research is clearly needed using pluripotent (equivalent to embryonic) stem cells but they need not be human and they will probably never be used directly as cures for humans. That is the subject for another blog.

Debora Spar, a Professor of Business Administration at the Harvard Business School has examined the modern processes of obtaining babies and evaluated them from a business point of view. While avoiding any significant moralizing she has concluded that market forces, greatly aided by modern technology, now dominate essentially all aspects of this industry.

Professor Spar’s basic conclusion is that these free market forces have been highly beneficial so far in developing a useful, amoral, and highly profitable industry but left alone these same forces will develop social inequities and risk situations beyond that which society would find acceptable.

Beneath the thorough and efficiently analytical tone of the book one gets the unmistakable impression of a utilitarian industry enabled by a self satisfying band of wanters who want a child even more than they want a mansion.

This well documented study – there are almost 600 reference notes – examines the businesses – the fertility clinics, the adoption agencies, the drug companies – the governments and government agencies, mostly US but also foreign, and most of all the customers, those anxious would-be parents ready and willing to spend enormous sums to have a child. The history and modern development of each of the components of the industry are described in easy reading detail. Infertility, the clinics, surrogacy, genetic diagnosis and modification, cloning, and adoption are each examined in turn both as a revenue business and as a function driven strongly by consumer demand. The study includes extensive data on prices and levels of availability and regulation in these.

The study points out that, while the “baby business” is a worldwide industry, the United States, as the most open environment for most aspects of the industry, has become its major driving force.

The commercial aspects of the industry, operating with few controls or oversights, has many benefits, not the least of which is enabling the various components to develop in the first place. However these same commercial aspects tend to drive the industry into some murky ethical and legal problem areas. (Many of these, such as sperm banks, started in such problem areas.) To the extent that the “baby business” remains in a free market mode it also has the potential to generate major societal problems such as a disparity of availability between rich and poor as well as the abuse of the poor, especially in foreign countries, for services such as surrogacy.

Professor Spar offers an analysis of four potential policy options which could be adopted by society. She terms these

1- Market forces

2- Prohibition

3- Insurance (My term)

4- Regulation

Left to market forces alone the study believes that the risks and inherent inequities would be too great. Prohibition is out of the question because this genie is already out of the bottle. Insurance (Spar calls this option the “hip replacement model”) would be difficult to extend over all of the suppliers already in place. That leaves Regulation.

At this point Spar chickens out on any specific recommendations but suggests five general principles which could form the basis for what she believes must be resolved by a political debate.

1- Expanded access to information by consumers

2- Equitable distribution of benefits

3- Some version of legal property rights

4- Recognition of the cost impact on society

5- Definition of the extent of parental rights

Overall the book does an excellent job of achieving its stated purpose which is to define "The Baby Business".  What it does not cover is the ethical and long range prospects and consequences of this increasingly tawdry business.

Of all of the many ethically questionable terms used in the bioethics debates (blob of tissue, pre-embryo, persistent vegitative state, therapeutic cloning, etc.) the most dangerous by far is that of “human non-persons. This is a term now being used to classify certain types of human beings, specifically human embryos, as non-persons.

Having grudgingly accepted the long established (1829) scientific fact that the fertilized human egg and its subsequent embryonic form is a human being the opposing forces promoting embryonic stem cell research are defining the embryo as a human non-person. Their basic principle is that it lacks certain characteristics which define a human person such as a working brain, size (they are smaller than--), sentience, appearance (they don't even have the beginnings of arms, legs,--), self-awareness, etc.

Therein lies the danger and it is extreme. If we can define “personhood” by its deficiencies – by what it lacks – how many of us are vulnerable? Terri Schiavo certainly was. Most brain injured persons are in danger. How about Alzheimer patients? The retarded? The paralyzed? Amputees? The blind? The deaf? (Careful now. That’s me we are talking about.)

Is this just paranoid thinking? Let’s look at what is happening today.

We have already referred to Terri Schiavo but there is mounting evidence that many doctors in the United States are already taking upon themselves the responsibility of ending lives which, in their estimation or that of relatives, have an inadequate “quality of life”. Human non-persons?

Today we are killing almost 90% of the preborn humans who are diagnosed with Down’s Syndrome. Human non-persons?  How many more human non-persons will we kill when Preimplantation Genetic Diagnosis (PGD) becomes able to detect more diseases?

Is this new bioethics new? Not really. In the second quarter of the last century (roughly 1920 to 1950) eugenics laws in this country enabled over 50,000 people to be sterilized if they were diagnosed as being mentally retarded. These laws, tested and approved by the Supreme Court of the United States, were not repealed until after similar horrors were uncovered in Germany. Human non-persons?  In some cases we don't even have to kill these human non-persons.  There are "other ways" to prevent them from burdening the rest of us.

Words mean things. The words “human non-person” means that society would be better off without that human being or, even more viciously, that society could use pieces of that human being to help more deserving human persons.

 

Reviews of Ian Wilmut’s book, After Dolly, miss what I believe is its most important characteristic. The book is essentially two different compositions. The first of these parts is a superb narrative of the creation of Dolly the sheep which is then loosely integrated with the second part, a naive or perhaps single-minded defense of further research on human cloning and embryonic stem cell research. Concealed in this loose integration is the clear but unintended message that the research which Ian Wilmut so passionately advocates can be accomplished by means that do not involve the killing of embryonic human beings.

The narrative covers both the detailed research work which resulted in Dolly as well as the background leading up to that work. Wilmut has done a superb job in describing this exquisitely complex task in a highly readable style (no high tech jargon, no distracting footnotes, real people). The narrative illustrates the grinding, repetitive, work involved in this kind of research as well as the random insertion of flashes of genius and the critical importance of the worldwide, often informal, links among the scientists. He provides generous recognition to his predecessors and collaborators.

Perhaps most importantly for that hidden message Wilmut’s narrative points out the value of research on animal embryology because of the genetic similarity between animals and humans.

Wilmut’s disputation on future research on human embryology is more of a random walk through a variety of the arguments for and against such work. While Wilmut is a staunch supporter of this research, and properly so, his arguments are often morally naive (“Do the ends – new treatments for horrific diseases – always justify the means?” page 34), contain a number of misstatements or unawareness of facts (“In the United States, under President George W. Bush, federal funding was withdrawn from studies with human embryos ---“ page 199) , and are often self contradicting (“No matter how slippery the slope, it is easy to draw a well defined line on it—“ page 220,”However laws forbid; they do not always prevent.” page 224).

More importantly he gives little attention to other forms of human stem cells (“ -side-by-side comparison of adult and embryonic varieties of stem cells must be done—“ page 166) They have been done. ASCs beat ESCs 72 to 0 in the last such comparison.

In spite of the weakness of Wilmut’s arguments he presents more than sufficient grounds to justify proceeding with research in this area of biotech albeit with more societal controls than implied by Wilmut. His narrative section not only establishes clearly the advances which can be accomplished by dedicated researchers but it also establishes the existence of a vast chasm of missing knowledge. In animal research he and others developed alternative paths or ‘workarounds’ for these gaps. In human research such workarounds would be unacceptable.

Wilmut’s objectives, the unarguably valuable search for improving human health, can be achieved by continuing with the discovery power of animal research so dramatically demonstrated in his narrative of the Dolly achievement and by research on adult and other forms of human stem cells which do not involve the killing of human embryos.

 

In the bioethics of new human life there are two closely related but separable issues – stem cell research and babies in test tubes. In one of these, that of stem cells, the trends point to an ethically more promising future. In the other issue, that of babies in test tubes, the future looks much, much, darker. In both issues major aspects of the future are already upon us and are rapidly engulfing, not just our medical and scientific communities, but much of the daily lives of our families.

The stakes are high in both of these issues. They involve the kind of humans we will allow into our world and indeed the very definition of what is means to be a human being.

Stem Cell Research

By now most people paying any attention to this issue are aware that there are two kinds of stem cells – embryonic and adult. They are probably also aware that research on stem cells is, in fact, a very promising technology for improving medical care. The major problem is, of course, that in order to obtain embryonic stem cells for this research the embryo must be killed.

One such ethically favorable trend is that adult stem cells – the kind that can be obtained without killing an embryo – are currently being used to treat or cure a rapidly increasing number of medical conditions. Research based on embryonic stem cells has yet to cure any condition and is, in fact, still too dangerous to even be used in clinical tests on humans. The suppression of these facts by the media, the abortion industry, and leaders in the bioscience community, while reprehensible, is slowly coming to light.

Another favorable trend is that adult stem cells – the kind found in bone marrow and used for decades to treat leukemia and other blood diseases – are being found in a widening range of other body tissues. These include hair follicles, fat, intestinal linings, and others. They are also found in large quantities in umbilical cord blood, placentas, baby teeth, and other “non-adult” sources of “adult” stem cells.

In fact “embryonic” and “adult” are inadequate labels for defining types of stem cells. The term “embryonic’ is used to define early stage or pluripotent stem cells which in normal human development and in the hopes of researchers, can become any of the 210 types of cells in a human body. The term “embryonic” was applied because such pluripotent stem cells were first found, and until recently were only found, in embryos.

“Adult” stem cells refers to later stage or multipotent stem cells which normally can become only a limited number of cell types.

A third favorable trend is that scientists have discovered that “embryonic” or pluripotent stem cells can be found in or developed from other tissues of the human body, albeit in much lower concentrations. The expected development of tools to harvest these cells and use for research will further obviate the need to kill human embryos.

Babies in Test Tubes

A more serious long term issue is that of human beings in test tubes. This technology, deriving from In Vitro Fertilization or IVF, was developed to enable couples with fertility problems to conceive and bear children. The first test tube baby, Louise Brown, was born in 1978. Since that time it is estimated that over one million children have been so developed.

While the Catholic Church teaches that IVF is immoral (for reasons similar to contraception) the ability of IVF to address human aspirations make it extremely seductive for childless couples.

Of much greater concern is the widening array of parenting alternatives, human experimentation, eugenic control, and even human design being made possible by this IVF technology. Given the huge potential for understandably desirable human improvements one can foresee a veritable explosion of the use of IVF.

The basic IVF process places a female egg (typically multiple eggs) in a Petri dish with male sperm. This mixing and merging results in one or more fertilized eggs. These fertilized eggs, termed zygotes, are universally recognized by knowledgeable scientists, that is embryologists, as the beginning of new human life. There is no honest disagreement on this point.

Allowed to grow for a few days into the embryo stage this embryo(s) can be implanted in a woman’s uterus and grown naturally to a full term baby. If more embryos were grown than were implanted these “spare” humans are potential resources for medical experimentation much like laboratory animals.

Parenting Alternatives

In the IVF process the eggs, the sperm, even the uterus need not be related to the childless couple. Indeed there need not even be a childless couple. Technically, and probably legally, a single man, a same sex couple, a medical research company, perhaps even a government (see Brave New World) could be the “owner” of the resulting child.

Human Experimentation

Today that experimentation is the Embryonic Stem Cell Research describe above. However in the New Jersey act funding stem cell research provision is made to allow research on human embryos and fetuses up to the moment of birth. While today human embryos can only be kept alive in a Petri dish for a few days New Jersey researchers are looking forward to the development of an artificial womb.

Eugenic Control

While we tend to think of eugenics in terms of a Super Race (e.g.Nazi Germany) or a reduction of imbeciles (e.g. US Supreme Court) we are already practicing a form of eugenics with the abortion of Down Syndrome and other womb-detectable defects. (87% of Down Syndrome diagnosed babies are now being aborted). IVF is already enabling such “quality control” inspections for more complex genetic diseases such as Tay-Sachs, Lou Gehrig’s, and others by a technology called Pre-implantation Genetic Diagnosis (PGD).

Given that most if not all parents desire “the best” for their children a natural aspiration is for children without defects. IVF provides an increasingly capable tool to achieve that but only by diagnosing and discarding “defective” children from the Petri dish.

Human Design

Another natural parental aspiration is to have children with some specific superior capability. To a certain extent some parents already “over-design” their children. Think Stage mothers. Jock fathers. IVF lets us expand those options. For example couples desiring “high quality” children can buy eggs and or sperm from high IQ or exceptionally attractive women or men. IVF embryos can be selected for the desired sex. It’s called “Family Balancing”.

At this point in time selection of enhanced (as opposed to defective) capabilities in the embryos is not technically possible. It is very likely that some such technology may become possible.

What Can We Do?

1- Learn enough about the basics of the technology that we cannot be snookered by hype and false promises. The basics of the technology are not that complex for any layman to understand.

2- Challenge the media when false or misleading information is presented. While the media is fully on board the “pro-science bandwagon” they do also understand the term “backlash”.

3- Challenge lawmakers on their false or misleading statements or on their acceptance of such statements by others.

 

One of the main advantages presented in favor of embryonic stem cells (ESCs) over adult stem cells (ASCs) is that ESCs can potentially become any of the 210 different types of human cells whereas ASCs can only become a limited number.

I am a hobby woodworker and I probably have over 100 tools ranging from a bandsaw down to a tiny screwdriver. I also have a Swiss Army Knife that can do a wide range of tasks. I have yet to find that knife as good as a more specialized tool for a given task.

Similarly with health treatments. If a doctor treating a patient with, for example, a blood disease such as leukemia, has available an ASC which cures blood diseases and an ESC which cures blood diseases as well as nerve, kidney, and skin diseases that doctor will choose the SC which works best for his patient’s specific disease. The ability of the ESC to cure other diseases is not only irrelevant but, because most medical treatments, but especially SC treatments, are likely to have poorly understood side affects, the doctor is most likely to choose the less complex, blood-oriented ASC.

The Swiss Army Knife is a good tool in an emergency but it will be many decades, if ever, before SC treatments become an emergency treatment.