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Stem cells: It’s all about life

Rights of embryos | Cell lines and other scientific issues | Are stem cells really that good? | Prop. 71.

[Written October 20th, 2004. The proposition passed, despite deficiencies in funding oversight, public ownership of eventual patents, and conformity to California’s sunshine laws. The industry, unfortunately but not unexpectedly, has jumped on these loopholes. Whether this ruins the whole initiative remains to be seen.] [Comment added approximately December 2004.]

Stem cells have become the umpteenth topic in the culture wars. The Bush-Cheney ’04 campaign made it something of an issue (although maybe they acted in haste and are now repenting at leisure, since it loses them more votes than it gains), and we Californians have a high-profile Proposition 71 on the ballot to kickstart research despite the lack of federal funds. Lives were always involved, but now money is part of the picture and the discussion has heated up.

What about the rights of embryos?

Part of the complexity is that a whole series of interdependent questions must be answered to come to an informed decision. They start with the big one of which lives are more important, embryos’ or patients’? That’s the way the question is usually framed.

And that’s why it is unanswerable.

The real first question is whether the early-stage embryos providing the stem cells are human beings. If they are, they can’t be used to save other lives, and that’s all there is to it. If they aren’t, there’s nothing left but a few technical issues and a lot of shouting about how much money to spend.

So, beginning at the beginning, consider the facts regarding human embryos. Biologically, early-stage embryos have less nervous system than a clam. Clams are sentient, but it’s hard to say a lot more for them. It has to be agreed that embryos don’t have a human mind, but at least they do have human DNA. However, every scraped knee leaves behind countless cells packed with human DNA, yet we don’t have funerals for them. Nor do we feel that a transplant recipient has turned into two people after the operation. Having human DNA is not enough.

The final refuge is to say that an embryo *could* become a human being, even if it isn’t yet. But potential humanity is not enough either. Given modern in vitro fertilization techniques, every human egg in the world could be fertilized and turn into a human being. Nobody regrets all the wasted lives because, really, they aren’t. Potential is not the same as actual, any more than my potential to win a Macarthur grant is equivalent to winning one.

The fact is that embryos are not recognizably human by any objective standard. We’re really arguing about something much harder to define. We’re trying to decide whether embryos have the essence of humanity. Call it a soul, for short.

Putting it in plain terms shows that we’re really arguing about a *belief*. Arguments about beliefs cannot be settled, and that’s why the argument about patients’ versus embryos’ rights keeps going around and around and around. That argument is pointless, and our personal beliefs about the embryo’s human status are relevant only to our personal behavior. What matters is that beliefs can legitimately conflict in a matter where the facts are unclear, and public policy has to be separate from the beliefs of any one group. In other words, beliefs and state must be separate. It’s the only way.

Nobody can prove that an embryo is or is not a full human being, so those who believe embryos are not yet human should be free to act accordingly, and those who believe they are human, likewise. Stem cell therapy shouldn’t be forced on anyone, but neither can anyone demand that it be banned.

A side issue is whether people can legitimately be asked to fund actions they oppose. For the large ethical questions involving life and death, the answer seems to me to be no. However, pacifists are taxed to fund wars. People who consider it state-sponsored murder are taxed to fund capital punishment. One group should not be given special consideration in taxation. Either all conscientious objectors should be free to withhold funds, or none should.

Research on stem cells is a legitimate endeavor, so lesser questions are not just a waste of time. Let’s go to it.

Stem cells, schmem cells. What are the scientists talking about?

First, why not use adult stem cells? Because, for the most part, we can’t yet reliably find them, grow them, or use them. Medical use of these cells is many more years in the future than is that of embryonic ones.

Another issue is that early-stage embryos don’t have much of an immune system. This means that there may be no rejection issues with embryonic stem cells. And that means those cells can be given to any patient who needs them, without having to tailor each therapy to a specific person. Given social realities, adult stem cell therapy would be so expensive and labor-intensive that, at least for the first few decades or generations when it was available, only the rich or well-insured would benefit.

Umbilical cord cells are harvested at birth, when the newborn has a well-developed immune system. (The umbilicus is genetically part of the fetus, not the mother.) Thus, without lifelong anti-rejection drugs, they will only be usable by that individual, the same as adult stem stem cells.

Second, what is “somatic nuclear cell transfer”? One side says it involves destroying embryos, the other says it doesn’t. Well, they are both right, in a way. The technique, like use of adult stem cells, is a therapy usable only by the person involved (without anti-rejection drugs). The patient provides a cell nucleus, which contains one copy of that person’s DNA, all 46 chromosomes. This is injected into an egg cell whose own nucleus has been removed. The non-nuclear part of the egg is what starts cell division, so the resultant egg+nucleus starts dividing and creates a small mass of cells which can be used as stem cells. In humans, there have been no documented cases of successfully getting these cells to organize into a healthy embryo that can develop to term. Human embryonic development turns out to be more complex than that of mice and sheep, so cloning Dolly is not the same as cloning people. Even when human cloning is eventually successful, use of this method is only objectionable if you believe embryos are human. That goes right back to the whole essentially philosophical argument about the status of embryos.

Third, why not use the existing cell lines? The federal clampdown on research happened at such an early stage that there are nowhere near enough different embryonic lines for medical use. In a very loose analogy, it’s as if kidney transplants were the only ones doctors could study. There’d be no liver, pancreas, heart, or lung transplants.

Even worse, the existing lines were intended for research, not direct medical application. As such, they were grown using mouse feeder cells, and may contain mouse DNA and mouse viruses. Consider that HIV is a virus that crossed species from monkeys to us (most likely while butchering bushmeat), and it becomes obvious why nobody in their right minds would use those cell lines in medicine.

Are stem cells just another big scientific pie-in-the-sky?

The puncturing of the high tech bubble has left many people with the feeling that biotech is all hype. Genetic engineering didn’t make us all tall and thin and blond. It didn’t even give us immortality.

There is a big difference between stem cells and genetic engineering, even if both are done by people in white coats peering into petri dishes.

Genetic engineering involves fiddling with an individual’s actual DNA. DNA is very resistant to fiddling. If it wasn’t, you’d be dead. Viruses are the only natural method of interfering with it, which is why genetic engineers use a form of weakened cold virus to insert the bits of DNA they want into the cells. But that’s not all because the bit has to go into the *right place*. That’s largely a matter of luck. Then, cells die. The new cells are made according to the original (faulty) template, and need to be engineered all over again. This sequence of events describes what happens when everything is working perfectly. Anyone who knew anything about it knew that genetic engineering was being wildly overhyped among non-scientists.

(This is not to say genetic engineering doesn’t hold a lot of hope for the future. It does. It’s our only real chance to cure the common cold, for one. But, as the scientists say, much work remains to be done.)

Stem cells are a different matter. There is no messing with intricate cellular processes. On the contrary, the stem cells do their own thing without assistance. All they need is to be given the conditions for growth, whether that’s in a petri dish or inside a person. The situation is much more analogous to an organ transplant, except that the organ is tiny, and doesn’t even need to have blood vessels hooked up. We know how to transplant organs, and we know how to transplant stem cells. What we don’t know is exactly how to use them (although in some applications, we do know that at this point). The methods to learn how to use them are pretty well worked out by now.

So, yes, stem cells are extraordinarily promising. And yes, there will be many needed applications in the near future. Some recent examples are regrowing heart tissue and regrowing retinal tissue in certain kinds of blindness. Cures for diabetes and Parkinson’s are straight matters of transplanting the necessary cells into the relevant organs. Farther down the road, stem cells will allow improved nerve growth and hence cures for spinal cord injuries. Furthest of all, they’ll eventually allow lost limbs to be regrown. Stem cells are the biggest thing in medicine since the invention of antibiotics. Come back and talk to me in five years, if you don’t believe me now.



Coda for Californians: Are stem cells worth the money?

California is the place currently struggling with this issue because Proposition 71 is on the November 2nd ballot. Prop. 71 gives three billion dollars to fund stem cell research, the idea being that California will reap gigabucks from becoming a biotech mecca. Singapore has already done something similar by throwing two billion dollars at stem cells, which has made it one of the foreign destinations draining away scientific brains who can’t do their work in the US federal climate.

Several questions arise. For instance, if stem cells are so marvelous, why does the taxpayer and our government need to get involved? Why aren’t the venture capitalists funding the research? I think it’s simply because of the vast sums involved. The task is to launch a new industry whose startup costs are on the order of a few billion. Even Bill Gates might hesitate. It’s a project of a magnitude that can really only done by a large, technologically advanced society. California is one of the few entities smaller than a nation that even has a hope in this regard.

One flaw of Prop. 71 is that the state government provides seed money, but there is no provision for a cut of subsequent royalties. If stem cells are going to be lucrative, why isn’t the taxpayer getting a return? Why indeed. Taxpayer-funded development without any subsequent return to the government is an entrenched idea at this point, even though it shouldn’t be. It’s part of the whole ethos of socializing risk while privatizing profit. It would be a good topic for the Legislature to act on, or, failing that, for yet another initiative. But voting down this initiative for that reason alone will do nothing but accelerate the brain drain we’re already suffering to other countries with stem cell-friendly policies.

There are other, less valid, objections to financial provisions of Prop. 71. There is, supposedly, not enough oversight. Fraud must be rigorously and totally guarded against. But to suppose that desk jockeys or committees have a better understanding than scientists of how and where to spend stem cell research money is simply delusional. Federal funding of research has shown how easy it is for bureaucrats to push research into pet projects that go nowhere. We need less of that, not more.

The exceptions to sunshine laws are because of the extreme financial incentives to rip off this type of research. If everyone knows what’s going on, some people are going to take dishonest advantage of it. Things shouldn’t work that way, but it is a reality we have to deal with.

So, to put it in a nutshell, stem cells do hold enormous promise. The payoff is likely to be vast, especially because stem cells will also open whole new ways of making money that didn’t even exist before. The human benefit is incalculable. The earliest applications are very few years, not decades, away. I’m a biologist, and to me the financial arguments against Prop. 71 sound just plain silly.

Technorati tags: stem cells, ethics, human life,

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Losing it in Iraq

Is anyone else boggling?

Here we are, in a country founded on the separation of church and state, yet we can’t figure out how to balance a Shia majority in Iraq against the minority neighbors they would like to overrun. (Because, let’s face it, the sudden Shia commitment to elections is not a symptom of conversion to democratic ideals.)

Granted, the idea of separating church and state is “out there” for some Middle Easterners. It is also out there for an administration that hopes to be re-elected with the help of fundamentalists. But these aren’t the only available voices. Where are the constitutional scholars, the journalists, or the ninth grade civics students who could point out that this is a problem with an obvious solution?

There’s a good bit of talk about the impossibility of keeping religion out of politics because the “Iraqi people” want Islamic government.

I hadn’t realized we cared what the Iraqis want. We invaded their country because it suited us. We killed thousands of their citizens. Yet now we’re saying it would be too rude to tell them they can have any government they want, so long as it’s secular. I know nation-building is for softies, but this is ridiculous.

And, furthermore, who are these “Iraqi people” who want things? Almost two thirds of the Iraqis, two thirds, are women. They can’t all be like Ann Coulter. Many of them are on record as being quite progressive. Obviously, these women are not “Iraqi people” since what they want doesn’t enter the picture. I’m not even talking about how Iraqi men feel. I’m talking about a two thirds majority that doesn’t seem to exist for Bremer and Bush.

It’s also unclear why we’re ignoring our own democratic principles when they could address so many problems for us. Separating church and state and paying attention to a two thirds majority could reduce the influence of fanatical Islamists, which we say is our goal.

Mysteries are supposed to be solved by considering motives, and the effects of US occupation in Iraq are clear enough, even if the rhetoric makes no sense. Oil installations are the only things protected from looting. Taxpayer money flows to crony corporations. It all feels like a bad echo of the attempts in the 1950s to install puppet dictators in Central America. Now, it’s not cheap fruit we’re trying to extract, but cheap oil. The “unforeseen” consequences won’t be illegal aliens. Instead, we’ll have our hands full of illegal terrorists.

How long can we sustain this planet-sized gap between what we say here and what we do there? When the terrorists refuse to seethe quietly in their own part of the world, will we boggle again about why they hate us so much?


(Written March 19, 2004, but misposted.)

Technorati tags: Iraq, Islam, Christianity, terrorism, violence, religion, separation of church and state

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A Choice or a Child?

Maybe the search for middle ground in the abortion debate is doomed. Maybe there is none. What do two sides have in common, when one sees babies being murdered and the other sees women demoted to walking wombs? Polite people want the decencies of debate preserved, but on the rare occasions when it happens, that achieves only less shouting, not a solution.

Abortion is supposed to be a complex issue, fraught with emotional, ethical, legal, social, and religious problems. Approaches that try to address the complexity have, so far, led nowhere. Instead of trying to deal with the issue in its full-fledged form, a better approach might be to simplify its terms as much as possible.

At its heart, abortion is a very simple problem. If we’re killing babies, it has to stop. If we’re not, we don’t.

The first question is whether an unborn “baby” really is a baby, that is, a human being in her or his own right. That leads directly into the question of what it means to be human, one of the thorniest problems people grapple with, even though humans should be the experts on the subject. Deciding on the relative merits of women versus babies is easier, which may be why people concentrate on that.

Science is the one method capable of finding objective proof for an idea, but it can only work its magic on objective data, and hence it can’t answer the big questions. It can tell us that human beings have forty three chromosomes, and that there is 95% similarity between our DNA and that of chimpanzees. The growing combination of egg and sperm is not called a baby in biology. It is a zygote, morula, blastula, gastrula, embryo, or fetus, depending on its stage of development.

Few people would feel that the purely physical parameters are very important. Human DNA in a petri dish isn’t exciting (except to biologists), and a corpse looks much more human than a zygote. Qualities of feeling and mind are really what we’re thinking of when we say that humans are special.

Science can actually provide some data for the discussion of feelings and mind. Nerves, for instance, become myelinated beginning around the fourth month of development. Myelination gives nerves the ability to transmit the sensations we traditionally associate with feeling. Unmyelinated nerves provide that curious awareness of touch and pressure that you can feel under local anesthetic. It is the degree of sensation found in clams.

Thus, one can say with certainty that the developing embryo’s unmyelinated brain is not thinking or feeling in a way that we could recognize. The process of myelination continues after birth, and if the process is disrupted, as for instance in fragile X syndrome, severe retardation can result. That is how far away a fetus is from having a mind like ours, so it is perhaps best not to lean too heavily on the human mind to define humanity.

There are other problems with relying on brain power as a defining characteristic. It is not unique to us. Animal behavior studies have shown that many animals can reason, and once the decision point depends on the degree of reason, fetuses won’t do particularly well.

The only mental skill that has not yet been found in the rest of the animal kingdom is grammar. Bees can say, “excellent flowers, southeast, five miles,” but they can’t distinguish between, “Fly southeast for five miles to find excellent flowers,” versus “Toward the southeast there are five miles of excellent flowers.” Of course, if grammar is to be the hallmark of humanity, it will be a bit of a letdown in our self-image.

Another problem for any argument that rests on our special qualities of mind or emotion is that fetuses don’t have them. Even infants aren’t any too impressive. If they survive, they may eventually show subject-verb agreement, but that is only one possible future. Potential is not the same as actual. I may have the potential to win the Nobel prize, but that doesn’t mean anyone actually gives me one. As reproductive technology advances, every cell in my body may have the potential to become an entire new human being, but that doesn’t mean it will ever make sense to save each cell my body sheds in the course of a day. Being potential human beings makes embryos interesting, but it’s not enough, by itself, to give them special status.

So there are no objective criteria by which to define something as human. “Looks like a human” won’t work, certainly not at the embryonic stage. Chromosomes won’t work because every bit of DNA doesn’t equal a human being. A person with a transplanted organ, even transplanted ovaries or testicles, doesn’t suddenly become two people. And being a potential human won’t work because potential is far from the same as real.

Without any objective answers, the only possible answers are subjective. Like great art, we can recognize fellow human creatures when we see them, but we can’t define them. Unfortunately, what we recognize differs. Some people see a baby, others see an organized collection of cells, and–this is the point–there is no way to prove either point of view. They are both based on beliefs about what makes a being essentially human. These convictions can be very deeply held, but that does not make them facts.

It is frightening and troubling to understand that our definition of humanity is a matter of opinion. Some cultures didn’t even consider newborns human. If they lived to be some days, weeks, or months old, then they were named and accepted as members of society. The definition of who is human in a given culture is based on consensus. In these modern times, one can probably say that newborns are considered human the world over (although the consensus seems to slip when it comes to adults who belong to “them” instead of “us.”) There is no equivalent agreement about fetuses.

There is no way to resolve the debate about fetuses, because there is no way to prove one belief right or wrong. The more deeply held the beliefs, the closer the argument comes to a holy war, and there is no middle ground in a holy war. The fight over abortion is just that: a holy war between faiths with no end in sight.

The good news is that we know how to deal with conflicting beliefs. We separate beliefs and state. That is why it has to be a choice, not a child.


Technorati tags: abortion, pro-choice, pro-life, ethics, human beings, church and state, beliefs

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Tortured Sex

[The blogposts before March 2005 had been deleted, and were re-posted in October 2005.

This was my first post because I couldn’t, and I still can’t, stand what has happened in the US. I never thought this country would commit torture, and I never thought it would react with anything but outrage. I never, ever, thought Americans would calmly re-elect the people responsible. I’d forgotten you don’t have to be German to be a Good German. US crimes against humanity haven’t stopped, and now we’re due for another round of publicity. Let’s hope it slays the beast this time.]

Sex is not torture. Maybe that’s obvious, but then again, given some of the statements on prison torture, maybe it needs to be said. There’s Limbaugh, hopefully speaking only for himself rather than as a mouthpiece of the Too Right, saying it was a few soldiers having “fun.” The Muslim community, on the other hand, fully conscious of the subhuman brutality involved, sees it as symptomatic of debauched Western attitudes to sex. Whether or not Western sex is debauched, subhuman brutality is not its goal. So maybe the point bears repeating. Sex is not torture.

Sex–obviously–is pleasure. It’s the biggest, easiest high available without drugs, and it is bound up with the deepest desires for admiration and love. Poisoning that is to poison a person’s very heart . . . which is why sex is so effective in torture.

There has been no mistake in the methods used by the Americans. The humiliations were carried out not to gratify some inhuman appetite on the part of the torturers, although they may have done that too. Their stated purpose was to extract “information.”

Unattributed comments from an interrogator said the techniques had been practiced in Afghanistan, and that they had Afghani men talking within hours. Who knows what they talked abo

ut, because torture has a bad track record for extracting truth, but the techniques were then applied in Iraq to equal effect. Sexual humiliation, the military found, works wonders at causing compliance.

Why, one wonders on a horrible sort of practical level, did the soldiers at the bottom take those souvenir snapshots? Were they nuts? Apparently not. The pictures were taken to increase the humiliation, and they also had other purposes. They could be used for blackmail to extort more information once the prisoner was nominally free. And showing them to other prisoners could save the time and effort of having to commit more atrocities. Anyone with less than perfect courage was terrorized into compliance merely by knowing what could happen.

Make no mistake, it is the military and the administration at issue here, not just some soldiers. As Senator Collins pointed out, a few frustrated soldiers would try beatings. They wouldn’t apply techniques designed to cause maximum humiliation to Muslim men. The intent is also evident in Rumsfeld’s statement that what occurred is not torture. Lawyers, he says, have looked into it and it is not, to be exact, torture. This raises the macabre spectacle of well-spoken men in suits making sure that their kind of torture is legal. It does not square with the image of a few impulsive sadists. Never let it be said again that Americans lack cultural sensitivity. We can manage it when we want to.

One excuse is that whatever you call it, American torture isn’t as bad as even more horrible tortures practiced by others, or it’s not on the same scale, or it’s in a good cause, or something. Yet the inescapable fact is that no matter how little we do, more of the same is all it takes for us to become like any monster in history. To say we’ll somehow only dabble in it is like saying we’ll only be a little bit pregnant. There is no reliable social equivalent of abortion if a monster is in the making, not least because abortion does require some foresight. Prevention is really the only approach.

To avoid taking that road altogether, we have to recognize that the first step is dehumanization. It makes torture excusable. Whether the torture then uses sex to strike at a person’s innermost heart is a matter of methodology. It doesn’t change the nature of torture, except to make it worse, and it has nothing to do with sex itself.

The use of sexual humiliation to force compliance is not a rare event, whether in its worst form as state-sponsored torture, or in more individual crimes. It is practiced against women daily, hourly, and everywhere. It is so common, it seems like a normal, if regrettable, state of affairs. It is not. Its effect on women is no different from its effect on men. It is so completely dehumanizing and terrifying, it can force compliance of any kind. We belong to the same species, after all.

Consider the situation in some of the housing projects near Paris. Gangs of toughs rape women who don’t conform to their idea of proper behavior for Muslim females, such as not wearing a head scarf. Now, clearly, women can choose to express their religion as they see fit, but if someone chooses not to wear a head scarf, sexual humiliagtion is not a legitimate means of forcing compliance. The situation was reported by the BBC because of a woman who refused to knuckle under–and who had suffered gang rape twice as a consequence. I can’t even begin to imagine how much courage she has. The BBC reporter wondered who, in such a system, would dare to speak or even know her own mind. Anyone with less than infinite courage is terrorized into compliance merely by knowing what could happen.

That is not fundamentally different from the common brutalities that happen every day, everywhere. Their message to women is clear: stay in “your” place or you’ll get put there. They work. They affect where every woman goes, what she does, and how she makes a living. Women either live within narrow limits, or they need the courage and caution of a war reporter to make it through the day and, even more so, the night.

Crimes by states are, of course, a different order of evil than crimes by individuals, even gangs of them. States have practiced sexual humiliation on a recurring basis, although generally against women rather than men. And even though it is the women who are tortured, they are so much less than nothing, they aren’t even the real targets. Mostly, the intended targets are the men to whom the women “belong.” Such mind-numbing levels of dehumanization need their own category among crimes against humanity.

The victims are not the only ones dehumanized. Everyone has understood by now that the perpetrators have to lose their humanity first to commit horrors like the annihilation of the Jews or the lynchings of blacks. It is no less true of torture.

It is also no less true of crimes against women. People might ask why we should extend the parallel to women when there is a much closer one in the treatment of prisoners right here in the USA. However, with prisoners it’s possible to pretend that the problems are happening somewhere else to someone else. By extending the parallels as far as they go, we may learn to recognize the quiet beginnings of atrocity.

The sexual humiliation of women touches every one of us. It shows how easy it is to deny that brutality is happening, to deny that it has any far-reaching effects, to deny even that anything is being denied, and to thereby enable the whole system to continue. My point in drawing the parallel between the sexual torture of women and that of prisoners is to show how easy the first steps are, and how quickly we take them as the path of least resistance.

I am not trying to say the torture of prisoners and the humiliation of women is always exactly the same. Nor is either of those the same as ethnic cleansing, or slavery, or genital mutilation. Nothing is ever exactly the same. If we wait for exactly the same crime, new horrors can never be prevented.

The Limbaughs of the world notwithstanding, atrocities aren’t generally committed for entertainment. They’re done for a higher purpose, to preserve a way of life against all enemies, to survive. But some fates truly are worse than death. Living with a poisoned heart is one of them. Losing one’s heart altogether is another.

(For details and sources of the facts discussed, see Sy Hersh’s series of articles on US prisoner abuse in the New Yorker, 10-05-2004, 17-05-2004. Many of the facts were also indicated earlier on blogs. The ones I have drawn on include Juan Cole – Informed Comment, www.juancole.com, Billmon – Whiskey Bar, www.billmon.org, and Riverbend, riverbendblog.blogspot.com/.)

Technorati tags: torture, prisoner abuse, crimes against humanity, hate crimes, sexual torture

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