11 September 2017
ByAppeared in BioNews 917
Is using and destroying a human embryo for medical research ethical? This question is constantly considered in our newspapers, courtrooms and research labs. You almost certainly have an opinion on it. But it opens the door to many other questions you may not have considered; such as, is it better to create an animal-human hybrid embryo, and destroy that instead? What is personhood, and when does it start? Is stem cell research 'eggsploiting' women? Should clinical trials be more regulated, or less?
As stem cell research marches inexorably on, these questions demand urgent answers. 'Stem Cell Dialogues' will undoubtedly help you form opinions on these difficult questions and more. Philosophy, politics, theology, and of course a large serving of science are all spliced into this fascinating chimera of a book.
Stem cell therapy has caused a flurry of excitement and investment in recent decades. But like gene therapy before, so far it has not delivered the promised medical revolution to the masses. Yet with huge potential for regenerative medicine, many stem cell therapies are still in development. Apart from umbilical cord-derived stem cells, the US Food and Drugs Administration (FDA) has not yet approved any stem cell-based products. However, some unethical clinics are using stem cells dangerously, as various horrifying stories show (see BioNews 898). Another key ethical issue questions the use of human embryos to obtain stem cells or carry out research, as covered in the PET 2016 annual conference.
The author, Professor Sheldon Krimsky, is a trained physicist and philosopher and currently the Lenore Stern professor of humanities and social science at Tufts University, Boston. He is also a fellow of the Hastings Centre, a bioethics research institution, and his previous books include titles such as 'Genetic Alchemy', 'Biotechnics and Society', and 'Science in the Private Interest'. His background makes the focus of this book primarily American, but there is enough European law to satisfy a UK reader.
Taking inspiration from Plato, Professor Krimsky has constructed a series of twenty-five dramatic Socratic dialogues with titles such as 'The President's stem cells' and 'My embryo is auctioned on the Internet'. It is an ambitious yet effective way to summarise important modern debates. But the dialogue style is less effective when it comes to believable character development. For example, every non-scientist character in the book, from patient to priest, nonetheless seems to know even more about cells than a third-year Biology student! The central protagonist is Dr Franklin, an ethicist and scientist with a tragic backstory, who appears in every dialogue. She is meant to be our moral guide yet she rarely expresses an opinion. When she finally unleashed some personality during a debate on feminism, I actually cheered aloud.
Still, although frustrating, Dr Franklin's moral ambiguity is understandable. Many of the issues in this book have no easy answers, and the reader must ultimately come to her or his own well-informed conclusion. Indeed, Professor Krimsky states his interest is in the 'middle ground of controversy' – the grey zone.
The content is wide ranging and comprehensive. I particularly enjoyed the reconstructions of real-life court cases, such as United States v. Regenerative Sciences LLC (see BioNews 667), and the discussions of companies such as Geron. It received FDA approval in 2009 for the first clinical trial to treat human spinal cord injuries with embryo-derived stem cells, but controversially terminated the trial in 2011 (see BioNews 634) when it became too expensive. Professor Krimsky also does not shy from including murkier moments from the history of stem-cell research, such as the notorious STAP, stimulus-triggered acquisition of pluripotency, cell research scandal (see BioNews 757).
I began reading this book with definite views on the ethics of stem cell research. From my days working in cancer research laboratories, I was well aware of the unique medical value of (adult) human cell samples, as well as the importance of patient safety in clinical trials. However, I was flabbergasted to find some of my views completely changed while I read this book. Who was this person suddenly cheering for deregulated clinical trials? For example, in the dialogue 'How my cells became drugs', I found myself agreeing with Regenerative Sciences:
'If the FDA is given regulatory authority over autologous stem cell treatments, the costs of such procedures will skyrocket… the costs will become out of bounds for all but the very rich.'
However, the dialogue 'Stem cell tourism' eventually pushed me back towards my original standpoint, arguing:
'We do not want stem cell therapy to follow the path of human gene therapy – test on humans before animals. Stem cell treatments must have a rationale in the peer-reviewed literature, preclinical evidence of efficacy and safety, and animal data. Experiments without these safeguards should be banned.'
My previously black-and-white opinions now contain a lot more grey, and you too will find your views challenged and changed by this book. Plato's dialogues made complex philosophy accessible and gripping, and this approach also works for science. These dilemmas are not abstract and theoretical, they are real, current, and will eventually affect every reader in some way. In particular, this book will be of interest to many couples undergoing IVF who may be considering what is the most ethical thing to do with their unused embryos. I can thoroughly recommend this enlightening book to everyone with an interest in ethical science.