Westchester Institute

religion and public life
DATE: December 11, 2007
TIME: 9:19 am EST

We must thank Governor Mitt Romney for getting us all thinking about religion and its place in our democratic way of life. Last Thursday in Texas he gave what was arguably the most important speech of his political career. Entitled “Faith in America,” the speech addressed both the issue of Romney’s Mormonism, and his understanding of the role that belief systems play in our democratic way of life. In my book, he scored well in both those endeavors. I happen to believe this speech will claim a lasting place alongside John F. Kennedy’s speech to the Greater Houston Ministerial Association on September 12, 1960. Kennedy’s speech has been remembered ever since for his dismissal of the role played by religious creed in American public life; Romney’s speech will be remembered for his wholehearted and unabashed endorsement of that role. And without hesitation, he declared: “I believe in my Mormon faith and I endeavor to live by it.” And then he added, to the amazement of not a few: "Some believe that such a confession of my faith will sink my candidacy. If they are right, so be it.”

Daring words those, for a would-be first-ever Mormon president of the United States.

To be honest, I find such forthrightness a very welcome breath of fresh air in this campaign. And his thoughtful speech raises many issues worthy of discussion.

But here I want to latch onto one profound and beautifully crafted thought in particular from Romney’s speech:

Freedom requires religion just as religion requires freedom. Freedom opens the windows of the soul so that man can discover his most profound beliefs and commune with God. Freedom and religion endure together, or perish alone.

There you have three lines which really capture the crucial role played by religion in public life—and expressed in a manner which would evoke the admiration of thinkers as diverse as Alexis de Tocqueville and Benedict XVI. But more on that in just a moment.

This whole issue of religion in public life also got me thinking about Fr. Richard John Neuhaus’ 1984 tome The Naked Public Square.

If you are unfamiliar with the book, I could attempt to explain its content, but better to get that from someone much more qualified than myself, someone like Mary Ann Glendon. In a 2004 First Things symposium marking the 20th anniversary of the book’s publication, Glendon wrote:

In The Naked Public Square, Richard John Neuhaus charged that the United States, while calling itself a democratic society, was systematically excluding the values of the majority of its citizens from policy decisions. He contended that to rule out of bounds in public life religiously grounded moral viewpoints not only does injustice to America’s “incorrigibly religious” citizenry but also saps the very foundations of our democratic experiment. Convinced that the moment had come for men and women of faith to make themselves heard in setting the conditions under which we order our lives together, Neuhaus was heartened by what he saw as the growing political effectiveness of groups that were beginning to do just that. If religious voices in the U.S. today are stronger, more confident, and more adept at translating their values into terms that are persuasive to their fellow citizens, more than a little credit must go to the encouragement and example of Richard John Neuhaus.

And as Fr. Neuhaus himself describes it, the book “was a plea not for religion as such but for reasoned public moral discourse, which discourse must also and of necessity draw on the resources of religion.”

Which brings us to the point of this column: what—we need to be reminded—is the role of religious belief in American public life? Or to paraphrase Governor Romney, why does (ordered, political) freedom “require” religion?

Fr. Neuhaus just offered us one answer: the moral tenets embedded in systems of religious creed are an important source of nourishment for a vigorous public moral discourse, without which a democratic system simply cannot thrive.

In addition to invigorating moral discourse, the expression of religious creed in the public square plays a further important role, a role certainly not lost on that young Frenchman Alexis de Tocqueville who came to the United States in 1831 to study the flourishing young democracy. Wrote Tocqueville:

If you give democratic peoples education and freedom and leave them alone, they will easily extract from this world all the good things it has to offer. They will improve all useful techniques and make life daily more comfortable, smooth, and bland…But while man takes delight in this proper and legitimate quest for prosperity, there is a danger that in the end he may lose the use of his sublimest faculties and that, bent on improving everything around him, he may at length degrade himself. That and nothing else is the peril.

In a democracy therefore it is ever the duty of lawgivers and of all upright educated men to raise up the souls of their fellow citizens and turn their attention toward heaven. There is a need for all who are interested in the future of democratic societies to get together and with one accord to make continual efforts to propagate throughout society a taste for the infinite, an appreciation of greatness, and a love of spiritual pleasures.

The expression of religious creed in the public square continually points us toward the transcendent—and experiments in ordered liberty like ours have thrived thanks in large part to those constant and manifold reminders of the “infinite,” the religious representations of “greatness,” and creedal appeals to the “love of spiritual pleasures.”

That individuals and the democracies they compose necessarily suffocate without these continual invitations to transcendence is a truth wholly present in the thought of Pope Benedict. As I noted in my series of reflections on Benedict’s Christianity and the Crisis of Cultures, the Pope understands that the question about God is unavoidable. There is something in our very human make-up that forces us to answer a “yes or no” question about God. "The thirst for the infinite," affirms Benedict, is a fundamental aspect of human nature, indeed, "the very essence of human nature." Speaking of the impossibility of putting agnosticism into practice in one’s personal life—and consequently in public life—Benedict wrote:

As a pure theory, it may seem exceedingly illuminating. But in its essence, agnosticism is much more than a theory: what is at stake here is the praxis of one's life. When one attempts to "put it into practice" in one's real field of action, agnosticism slips out of one's hands like a soap bubble; it dissolves into thin air, because it is not possible to escape the very option it seeks to avoid. When faced with the question of God, man cannot permit himself to remain neutral. All he can say is Yes or No-without ever avoiding all the consequences that derive from this choice even in the smallest details of life. Accordingly, we see that the question of God is ineluctable; one is not permitted to abstain from casting one's vote (pp. 88-89).

We are creatures who ask about the infinite, about our origin, about our ultimate destiny, and the Cause of it all. And that's why the presence of religious creed in the public square is so important. We need creed- based invitations to seek the Cause of it all, to aspire to that Ultimately Reality that is the ground and source of our own reality.

Lacking this, or in a liberal democracy which attempts to sanitize the public square of expressions of religious belief, as Governor Romney cogently reminds us, freedom will indeed “perish alone.”

As for the Commander in Chief of a liberal democracy that welcomes expressions of religious belief and draws on their richness, we would expect him (or her, as the case may be) to govern, drawing on the guidance of a religiously informed conscience. As Michael Gerson put it quite cogently last Friday in The Washington Post:

It is one thing to assert, as Kennedy did, that politicians should not take orders from popes and prophets—that is the institutional separation of church and state. It is another thing to assert, as Kennedy seemed to, that politicians should not take guidance from their own religiously informed conscience—that is a multiple personality disorder.

Our American democratic way of life not only allows us, but encourages us to draw guidance from our systems of belief as we continue to order our lives together. It is permissible to talk religion in the public square, to talk theology, to dispute theology, to question our fellow citizens—and even our presidential candidates—about their creedal beliefs. Not only is it good, it’s essential to our survival. As Fr. Neuhaus surmised three years ago:

The liberal democratic tradition is a Western and Christian achievement and its future depends, for better and for worse, chiefly on the American experiment. If it dies here, I do not see anyone else picking up the fallen flag.

I can’t help but agree.

The beginning of the end of the Stem cell wars?
DATE: December 5, 2007
TIME: 9:10 pm EST

Syndicated columnist and one-time member of the President’s Council on Bioethics, Charles Krauthammer drew fire for a Washington Post op-ed published last Friday in which he asserted that a recent embryo-friendly breakthrough in stem cell research—somatic cell reprogramming—vindicates the Bush stem cell policy, and claimed that “the embryonic stem cell debate is over.” Since the breakthrough was announced two weeks ago, we have now come to understand that, while the former claim may be true, the latter one is clearly not. That notwithstanding, and if euphoria evidently led many of us to believe for a fleeting day or two that we had definitively reached “the end of the stem cell wars,” it is not unreasonable to believe that we find ourselves at least at the beginning of the end.

We need to consider very carefully the two principal reasons why the “wars” are not yet over and why we will need to work even harder to rein in the cultural scourge of embryo-destructive research.

First of all, the specter of human cloning looms near.

The recent breakthroughs in human reprogramming reported just before Thanksgiving in papers published by Shinya Yamanaka of Kyoto University, and by James Thomson of the University of Wisconsin, Madison have offered proof of principle that we now have a scientifically viable alternative to human “therapeutic” cloning (SCNT), and an alternative of such potential magnitude in terms of cost-effectiveness and simplicity—not to mention ethical integrity—that it could render moot the putative “need” for cloning. That theoretical success, however, will do little to stop the impetus of science to move ahead with human SCNT, especially now that recent research has apparently cleared any remaining obstacles to the cloning of primates and deriving viable lines of stem cells from the cloned embryos. Researchers now suspect that it will not be long—perhaps within the coming year—before these technological advances lead to successful human “therapeutic” cloning. Unless researchers now actively pursuing human cloning run into as yet unforeseen technical barriers, the successful cloning of human embryos appears inevitable.

Second of all, consider that the ‘holy grail’ of stem cell science has been a technique that would allow scientists to create stem cells genetically matched to a sick patient, and then grow and develop these cells into tissues for use in tissue replacement therapies (everything from regeneration of damaged heart tissue to Parkinson's to spinal-cord injury). A perfect genetic match, these tissues would not be rejected by the donor's immune system. The advent of somatic cell reprogramming would now appear to allow scientists to do just that, and to have stolen the prize from the human cloning enterprise—a technique that would conceivably afford the same benefit. We have to recognize, however, that while the ‘holy grail’ is certainly within reach of the reprogramming scientists, it is not yet in hand.

To be sure, the science of reprogramming still requires substantial refinement. Reprogrammed skin cells, the kind recently produced by Yamanaka and Thomson, are referred to as induced pluripotent stem cells (iPSCs). They are “pluripotent,” capable of producing all the tissue-types in the human body. However, multiple scientific studies show that all pluripotent cells, including human embryonic stem cells (hESCs), form tumors (teratomas) and can convert to cancer cells. Westchester Institute Senior Fellows Maureen Condic and Markus Grompe have pointed out to us that the risk of tumor formation may, at this time, be higher in iPSCs than in hESCs because the genes used for reprogramming remain inserted in the reprogrammed cells. However, leading stem cell biologists are optimistic that they can modify the iPSC technique to eliminate any added risk of tumor formation. Dr. Douglas Melton, co-director of the Harvard Stem Cell Institute, predicts this problem will be “solved quickly, maybe within a year or so” (AP, 22 November 2007), also noting: “Anyone who is going to suggest…that it won’t work is wrong” (New York Times, 21 November, 2007). Rudolf Jaenisch, a leading stem cell researcher at the Whitehead Institute for Biomedical Research in Cambridge, Massachusetts concurs, stating: “I don't think it is a big hurdle” (Washington Post, 21 November 2007). The ideal way to reprogram will ultimately be one which does not involve the insertion of genes (or the viruses that transport them) into the somatic cells at all. You have to believe that stem cell scientists are hard at it right now trying to make this work. The day we can reprogram stem cells this way, will be the day we have the holy grail in hand. While we don’t know how long it will take, the optimists say this too could happen within the coming year.

That said, however, let’s consider a number of key reasons why the advent somatic cell reprogramming could be the beginning of the end of the stem cell wars:

1- Advances in reprogramming undermine continued scientific claims regarding the putative superiority of hESC research.

In a response to the Krauthammer op-ed, Susan Solomon and Zach Hall purport to know that human ESC research is that which “remains the most promising and important.” Now, neither they nor any of us can look into a crystal ball and say which form of stem cell research known today holds most “promise.” And of course, their assertion begs the further question: what counts for “important” stem cell research these days, anyway? In the field, what counts today is not that stem cells be “embryonic” but that they be “pluripotent.” As I noted in my column last October, the Bush administration, in requiring the HHS to rename the "Human Embryonic Stem Cell Registry" as the "Human Pluripotent Stem Cell Registry" has simply adjusted itself to the fluctuating state of the science. The question today is which pluripotent stem cells—from embryos, from bone marrow, or from reprogrammed somatic cells—will be “most promising”. It is no longer a foregone conclusion that hESCs are the answer to that question.

Add to this that we now know three significant ways in which human iPSCs are better for research right now:

First, patient-specific iPSCs are available “here and now,” compared to the merely theoretical prospects of getting such cells through human embryo cloning. Reprogramming is currently the only way to derive patient-specific stem cells for research on genetic diseases at this time. Reprogramming allows researchers to study the diseases in human cells in a Petri-dish, a real first in the field and holding out potential for research breakthroughs on any number of genetic diseases.
Second, reprogramming makes multiple iPSC lines from an individual patient’s skin cells with relatively little cost or effort, especially when compared to the prospect of human cloning. This is an enormous scientific advantage. Obtaining iPSCs does not require the use of human eggs, nor access to fertility clinics, thus simplifying the requirements for research. And because these cells are easier to produce than hESCs, more scientists will work with them and research will advance much more quickly.
Third, because iPSCs do not involve human embryos or human eggs, they will be subject to significantly simpler regulatory requirements. iPSCs are fully eligible now for funding by the NIH, and in fact the Wisconsin iPSC study was partly funded by the NIH.

2. Advances in reprogramming undermine continued scientific insistence on the “need” for new lines of hESCs.

It can be granted that reprogrammers will want to compare human iPSCs with lines of existing hESCs. From all that we can tell, and from what stem cell scientists have been telling me, however, such comparisons need not require cloning or destroying human embryos to make more hESC lines. At least 21 viable lines of human embryonic stem cells are available for federally funded research to make these comparisons.

Furthermore, Dr. Grompe notes that the non-human primate system now represents the best in-depth platform for comparative studies between types of stem cells. From rhesus macaque monkeys, primate pluripotent stem cells are available from all conceivable sources: IVF embryos, naturally conceived embryos (removed from the Fallopian tube after fertilization), SCNT-cloned embryos, parthenoids and soon rhesus-iPSCs.

3. Human embryonic stem cells are not the gold-standard any more; what “works” will now be the standard.

Solomon and Hall also asserted, as a chorus of scientists did over the past week, that “no one yet knows the extent to which these new cells will behave like true human embryonic stem cells”.

To this we could respond that Dr. James Thomson, the first scientist ever to isolate, culture and characterize human embryonic stem cells in 1998, and author of one of the two iPSC studies, found that iPS cells “meet the defining criteria” for embryonic stem cells “with the significant exception that the iPS cells are not derived from embryos.”

Mouse iPSCs have passed the strictest possible scientific tests for being functional equivalents of mouse ESCs. Tests for human cells are more limited, but human iPSCs have met all the available criteria for being the functional equivalent of hESCs. And as mentioned just above, this can be established with somewhat greater certainty by comparing human iPSCs with the existing hESC lines eligible for federal funding.

But I would like to go a step further here. The contention that human iPSCs “must measure up” to hESCs suffers a severe internal incoherence. To be sure, this view presupposes that hESCs represent some kind of absolute gold-standard. It presupposes the misconstrued notion that hESCs are some kind of natural, pure–the real deal—point of reference.

But we must remember that hESCs are as much a product of a Petri dish as iPSCs are. Human embryonic stem cells are a laboratory product; they are not literally “harvested” from the embryo. In embryo-destructive stem cell research, scientists remove special cells from a 6-day-old embryo (at the blastocyst stage). These are the “inner cell mass” (ICM) cells. These cells are, indeed, pluripotent. But extracted, and left on their own, they will not proliferate indefinitely—a key characteristic of stem cells. It is only in the Petri dish that the ICM cells acquire the characteristic of indefinite proliferation, and likewise come to remain in an unnaturally undifferentiated state (ICM normally rapidly differentiates into more specific kinds of human tissue in a developing embryo). The acquisition of these particular characteristics—in the artificial environment of the Petri dish and culture matrix—reconstitutes these cells as essentially something new, a laboratory artifact confected in vitro.

While at present the existing lines of hESCs may be the only point of reference we have for understanding the pluripotency of iPSCs and drawing comparisons, in the end, the question is not going to be whether the latter “measures up” to the former, but rather, which ones get the job done best, which ones will be most useful for giving us patient-matched tissues for therapy. And in that sense, iPSCs do not have to “behave like” hESCs. In fact, they may prove even more useful and versatile.

All of which makes the age of developmental biology and stem cell research all the more fascinating, complex and morally precarious. And we must vigorously continue our efforts to protect the dignity of embryonic human life in this arena.

And returning to Charles Krauthammer’s other point, yes, I believe recent events have at least partially vindicated the Bush stem cell policy. As Yuval Levin pointed out earlier this week, “the message Bush has tried to deliver with his policies and speeches on stem cell research is that he does not think curtailing the destruction of embryos for research needs to mean preventing the development of stem cell science.” This is a view that millions of reasonable people ascribe to. In our interest to see stem cell science proceed, we have also pondered the significance of allowing science to use human embryos as raw material for that research, and we find this utterly unreasonable. And we cannot help but believe, to borrow the words of Dr. James Thomson himself, that “if human embryonic stem cell research does not make you at least a little bit uncomfortable, you have not thought about it enough.” Seems to me like a lot of researchers in the field are owning up now to the fact that they find the prospect of embryo-destructive research not only discomforting, but deeply disturbing—which may itself turn out to be the best single indicator that we are indeed nearing the end of the stem cell wars.

ipscs: what the scientists are saying
DATE: November 27, 2007
TIME: 11:40 am EST

News last week that separate teams of scientists had managed to reprogram human skin cells to be the virtual functional equivalent of human embryonic stem cells, sent a shock wave through the scientific world. The reprogrammed cells—called induced pluripotent state cells (iPSCs)—are produced without damaging, destroying or even involving human embryos.

After the Japanese team led by Dr. Shinya Yamanaka reported further successes in reprogramming mouse skin cells last June, no one expected that only five months later he would already be reporting on successes with human cells.

But what has been perhaps most surprising, not to say amazing, is what stem cells scientists themselves—many, ardent advocates of embryonic stem cell research—have been saying about this new alternative to embryo-destructive stem cell research.

First there was Dr. Ian Wilmut, the creator of Dolly the sheep, who, foreseeing the successes that were coming in reprogramming (which renders the cloning of embryos for their stem cells obsolete) announced two weeks ago that he was abandoning cloning. “Reprogramming,” he was reported to have said in the London Telegraph, “is the future of stem cell research” possessing as it does “so much more potential” than standard ESC research.

Dr. Yamanaka affirmed that “Any scientist with basic technology in molecular and cell biology can do reprogramming." Dr. Doug Melton, a stalwart advocate of ESC research and of human “therapeutic” cloning affirmed in the New York Times that “anyone who is going to suggest that [reprogramming] is just a side show and that it won’t work is wrong.” And Alta Charo, a UW-Madison professor of law and bioethics, and popular secular voice on the ethics of stem cell research said the discovery “could be a game-changing event.”

Then, of course, to top these and many other declarations, there was an interview last Wednesday in the New York Times with Dr. James Thomson of the University of Wisconsin at Madison, who lead the other team that reported successful reprogramming and who is himself the first scientist to isolate human embryonic stem cells, the feat that initiated the great stem cell controversy in the U.S. “Now with the new technique, which involves adding just four genes to ordinary adult skin cells,” affirmed Thomson, “it will not be long…before the stem cell wars are a distant memory.” “A decade from now,” he said, “this will be just a funny historical footnote.”

Affirmations like these have led many of us to ponder whether or not we now indeed find ourselves—happily—at the end of the stem cell wars. Only time will tell. Voices to the contrary have certainly not been lacking. A chorus of voices have also been insisting that all avenues of research need to go forward, including embryo-destructive research. The reasonableness of such claims, however, has been dealt a serious blow. To the general public, the concept of ethically uncontroversial research which now holds out the same promise as human ESC research and can be used immediately in the laboratory, is not a difficult sell. As Institute senior fellows Maureen Condic and Markus Grompe affirmed in a TheWall Street Journal op-ed last Friday:

iPSCs are clearly superior to embryo-derived ESCs. Pluripotent stem cells can be used to study "developmental biology in a dish." They enable researchers to observe how human organs and tissues form. The insights garnered from such studies are likely to lead to the development of new drugs and strategies which can benefit human health.

Direct reprogramming techniques make it possible to generate pluripotent cells from specific individuals, including those with particular diseases. It will be possible to make iPSCs from children with Fanconi's anemia, a devastating genetic disease, and to study the effects of candidate drugs on the formation of human blood. These kinds of experiments are now immediately possible and likely will be the first practical application of iPSCs. (Emphasis added).

Not a hard sell to a nation that is by and large exhausted—or simply fed up—with the controversy surrounding the use of embryos for research. Add to all this the technical ease and cost-effectiveness of somatic cell reprogramming, and one cannot help but imagine a not-so-distant future in which the sad spectacle of embryo-destructive research has become for the most part—as Dr. Thomson says—a footnote in the history of science. Let’s hope so.

Eliminating down babies
DATE: November 13, 2007
TIME: 11:10 am EST

Someone recently brought to my attention that Arthur Miller, thePulitzer-winning playwright, had a son named Daniel, born with Down Syndrome. Apparently, Miller sent Daniel to an institution and visited him rarely, if ever. He neither spoke about Daniel, nor did he mention him in his autobiography. It was almost as if Daniel didn’t exist for him.

It is deeply troubling to note today that in many sectors the medical establishment appears bent on making sure that children with Down Syndrome actually don’t exist. The American College of Obstetricians and Gynecologists (ACOG) now recommends screening all pregnant women for Down Syndrome, and the latest prenatal tests allow doctors to determine whether a baby might have the abnormality as early as 11 weeks gestation. In fact, studies indicate that more than 90% of unborn children who test positive for Down Syndrome are aborted.

There is, of course, a name for what is happening here. It’s called eugenics—or, more precisely, the “new eugenics” (a topic on which I’ve written before). While we can wholeheartedly embrace genetic research that strives to prevent or eliminate Down Syndrome, we simply cannot tolerate a biomedical ethos that strives to eliminate Down syndrome children.

In the wake of the new ACOG recommendations, the Washington Post ran a touching first-person account of parenting a child with Down Syndrome. The mother who wrote the piece noted quite cogently:

Certainly, these recommendations will have the effect of accelerating a weeding out of fetuses with Down syndrome that is well underway. There's an estimated 85 to 90 percent termination rate among prenatally diagnosed cases of Down syndrome in this country. With universal screening, the number of terminations will rise. Early screening will allow people to terminate earlier in their pregnancies when it's safer and when their medical status may be unapparent to friends and colleagues.

I understand that some people very much want this, but I have to ask: Why? Among the reasons, I believe, is a fundamental societal misperception that the lives of people with intellectual disabilities have no value -- that less able somehow equates to less worthy… [W]e're assigning one trait more importance than all the others and making critical decisions based on that judgment.

In so doing, we're causing a broad social effect. We're embarking on the elimination of an entire class of people who have a history of oppression, discrimination and exclusion.

This also brings to mind a New York Times story from earlier this year which described how parents of children with Down Syndrome are trying to create a greater awareness about the positive aspects of parenting these children:

Sarah Itoh, a self-described “almost-eleven-and-a-half,” betrayed no trace of nervousness as she told a roomful of genetic counselors and obstetricians about herself one recent afternoon.

She likes to read, she said. Math used to be hard, but it is getting easier. She plays clarinet in her school band. She is a junior girl scout and an aunt, and she likes to organize, so her room is very clean. Last year, she won three medals in the Special Olympics.

“I am so lucky I get to do so many things,” she concluded. “I just want you to know, even though I have Down syndrome, it is O.K.”

Sarah’s life, and the lives of other individuals with Down syndrome, add a richness to society that cannot be measured. And this is so for one simple reason: Sarah, and all children with Down, are human persons. But we live in a culture that is rapidly losing its capacity to recognize human personhood where it is to be found. We well have reason to fear that, in our technical sophistications and narcissistic obsession with the unimpeded pursuit of every personal preference, there is very little separating us from a new barbarism.

In a recent Vanity Fair article about Arthur Miller, the writer speculates about what the playwright lost by living his life as though his son, Daniel, didn’t exist:

“A writer, used to being in control of narratives, Miller excised a central character who didn’t fit the plot of his life as he wanted it to be. Whether he was motivated by shame, selfishness, or fear – or more likely all three – Miller’s failure to tackle the truth created a hole in the heart of his story. What that cost him as a writer is hard to say now, but he never wrote anything approaching greatness after Daniel’s birth. One wonders if, in his relationship with Daniel, Miler was sitting on his greatest unwritten play.”

A thought to ponder.

Of 'moral ecology' and the human embryo
DATE: November 6, 2007
TIME: 8:57 am EST

Our good friend Dr. Robert George delivered the annual Erasmus lecture for the Institute on Religion and Public Life at the Union League Club in New York City on October 29. I was delighted to attend. The lecture—presented to a standing room only crowd of over five hundred guests—was entitled "On the Purposes of Law and Government: First Principles and Contemporary Challenges." You can read more about it on the Mirror of Justice blog, at a posting by Rick Garnett. Eventually, it will be published in First Things.

Dr. George began by reminding us that “the obligations and justifying purposes of law and government are to protect public health, safety, and morals, and to advance the general welfare –including, preeminently, protecting people's fundamental rights and basic liberties.” Though public well-being requires that the role of government be limited, Dr. George emphasized that government has an inalienable responsibility to maintain “a reasonably healthy moral ecology.” Indeed, history has demonstrated over and over again that democracies can only flourishing in the fertile soil of a vibrant moral culture—or moral ecology. A properly functioning—limited—government achieves this, he affirmed, by supporting “the work of the families, religious communities, and other institutions of civil society that shoulder the primary burden of forming upright and decent citizens, caring for those in need, encouraging people to meet their responsibilities to one another, and discouraging them from harming themselves or others.”

He then went on to explore how our resolution of the two most fundamental moral questions of the day—our understanding of the nature of marriage, and our convictions regarding the moral status of the human embryo—will constitute a remarkable bellwether test of the vibrancy of American moral ecology.

Now, I think we can all agree that debate on these two great moral issues of the day is on-going, especially with regard to the latter. Debate over the status of the human embryo is, in fact, two-pronged. First there is the metaphysical question: what is the human embryo. Dr. George—who will soon be publishing a new book on the human embryo—articulating a view held by millions of Americans, responds that the embryo is an individual human being, a member of the species homo sapiens.

The second is a moral question: what is the moral status—or worth—of the human embryo, especially when considered prior to implantation in the womb, a circumstance artificially contrived when embryos are created in the laboratory.

In answer to this question, again, millions of Americans share the conviction that, even in an embryonic state, human beings bear a moral worth which precludes any possibility of their being deliberately submitted to harm or destruction.

I find today that secular bioethicists more often than not will concede to our insistence on the metaphysical question. On the moral question, however, they quite consistently hold to the party line: embryonic stem cell research is no more controversial than once was organ donation or the derivation of vaccines from aborted fetal tissue. Science has often been controversial in the past, but was generally allowed to move ahead; today’s controversial science—particularly embryonic stem cell research—should be treated no differently. And after all, this is about the pursuit of life-saving cures isn’t it?

And with breathtaking matter-of-factness many of the most vocal proponents of embryo-destructive research address the debate over the moral status of the human embryo as if it were not on-going, as if millions of Americans did not happen to disagree with them, or as if the debate—if ever there really was one—has been since resolved in their favor.

But we know things could not be further from the truth. Embryo destructive research is not merely “controversial,” and embryo-destructive research cannot be simply allowed to proceed on the grounds that “well, you can’t please all the folks all the time, therefore…”

I think a close collaborator and dear friend of ours, Dr. William Hurlbut, is quite right when he asserts, as I have heard him insist on a number of occasions, that a one-sided or “purely political solution [to this issue] will leave our country bitterly divided, eroding the social support and sense of noble purpose that is essential for the public funding of biomedical science." Dr. Hurlbut sees a long-term benefit for all of us as a nation in striving patiently to achieve some kind of consensus. As he cogently insists:

We're entering the age of developmental biology. The embryonic stem-cell conflict is just the beginning. It's the first symbolic argument between science and moral concerns (in a new era). We need to get this right.

We need to get his one right, indeed. We have every reason to believe, in fact, that our resolution to the question of the metaphysical and moral status of the human embryo will mark either the latent vibrancy or proximate extinction of our American experiment in ordered freedom.

Bush administration mandates definition
DATE: October 30, 2007
TIME: 3:25 pm EST

On June 20, President Bushed issued an executive order directing the secretary of the Department of Health and Human Services to expedite the funding of research into ethically acceptable alternatives to embryo-destructive stem cell research. I dedicated a column to this issue last August which you can read here. Executive order 13435 also directs the secretary to rename the "Human Embryonic Stem Cell Registry" as the "Human Pluripotent Stem Cell Registry."

For stem cell researchers, pluripotent cells are the gold hidden in the hills—and this biotech gold rush has been on in earnest since the late 1990’s. Harnessing the properties of these cells will conceivably lead to controlled growth of all the tissues in the human body and, therefore, to virtually unlimited therapeutic applications for diseases and conditions treatable by tissue replacement.

So, the change of nomenclature—from “embryonic” to “pluripotent”—is far more than mere wordsmithing. All indications are that it will have far-reaching implications for the future of the science and for our on-going national debate over ethical stem cell research. As Monya Baker has pointed out in a recent Nature Reports Stem Cell article, “Politics has, essentially, mandated that an answer be found to a fundamental scientific question.”

But, let’s back up a few steps to better understand what this all means.

First of all, the “registry.”

On August 9, 2001, President Bushed announced to the nation his decision to allow a limited amount of federal money for embryonic stem cell research—a policy he hoped would ultimately discourage the destruction of human embryos for research. Since then, the administration has made more than $130 million available for research on stem cell lines derived from human embryos—but embryos that had been destroyed prior to the President’s policy statement on August 9. Additionally, the administration has provided more than $3 billion for research on all forms of stem cells—including those from non-embryonic sources.

At the time, estimates suggested that upwards of 60 such lines of human embryonic stem cells were already in existence and available for research. Then, on November 7, 2001, the National Institutes of Health (NIH) launched the Human Embryonic Stem Cell Registry. The registry would, from then on, list all the stem cell lines eligible for federally funded research, along with information regarding the origins of the lines, the labs where they can be found and other information useful for researchers. Inclusion of a line of stem cells on the registry means automatic prestige for the lab that created them—a scientific imprimatur of sorts that the cells of genuine, and that research on them is eligible for coveted NIH funding.

Until June of 2007, the registry was limited to bona fide human embryonic stem cells already in existence prior to the August 9, 2001 Bush policy statement. The administration, genuinely desirous of increasing the number of available cells lines, wants to open the registry to candidate cell lines purported to hold the same key property of human embryonic stem cells—“pluripotency”—but which are derived from non-embryonic sources. In doing so, the administration is countenancing the genuine possibility that stem cell science has indeed discovered non-embryonic sources of such cells in the human body.

Consequently, inclusion of any such cells on the registry will constitute nothing short of a scientific endorsement that any new cells lines added meet a scientifically acceptable definition of “pluripotency.” And this is huge news for science, and for our nation which has been wrapped up in a bitter debate over the use of human embryos for stem cell research. Indeed, the pro life movement has correctly asserted for years that if science could discover adult (non-embryonic) sources of genuinely pluripotent stem cells in the human body, then the supposed urgency of creating new lines of embryonic stem cells would be largely quelled.

The crucial upshot, however, is the following: the change of nomenclature forces the NIH—specifically the NIH Stem Cell Task Force—to come up with a new workable definition of “pluripotency”. If this surprises you, it should. Here’s why.

The key question, of course, for most stem cell researchers is whether your newly derived cells (whether obtained from human embryos, or from certain non-embryonic sources such as the bone marrow or amniotic fluid) are truly pluripotent. It turns out, however, that the concept of pluripotency has always been somewhat fluid in the stem cell world. Consensus had generally settled on now standard definitions such as that proffered by the International Society for Stem Cell Research (ISSCR) in its December 2006 Guidelines for embryonic stem cell research: “The state of a single cell that is capable of differentiating into all tissues of an organism, but not alone capable of sustaining full organismal development.” The NIH currently defines a pluripotent cell this way: “Ability of a single stem cell to give rise to all of the various cell types that make up the body.” Such definitions were backed by a laboratory test for pluripotency. For many years, that standard test had been a procedure in which the candidate cells are placed subcutaneously in laboratory mice. Allowed to grow, if truly pluripotent, the cells would form a benign tumor known as a teratoma. If the excised tumor, upon examination, showed the presence of tissues whose sources were the three fundamental embryonic germ layers, then the cells were deemed to be pluripotent.

Very recently, however, researchers have settled on a new gold standard test called “tetraploid complementation.” Although it’s a mouthful, it is not that difficult to understand. It works like this. A tetraploid embryo is formed from the forced fusion of the two cells (blastomeres) of a normal (diploid) embryo when it is at the two-cell stage. The fusion of the two cells constitutes a single-cell embryo that contains twice the normal amount of DNA (literally, 92 chromosomes instead of the normal complement of 46; hence the term “tetraploid” embryo). The tetraploid cell, at this point, if allowed to continue development by itself, is not in a position to contribute to the formation of a fetal body, but only to the extra-embryonic membranes and tissues (such as the placenta). Researchers then take the cells they believe to be pluripotent and inject them into this tetraploid embryo as it reaches 5 or 6 days of development. The injected cells, if added in sufficient numbers, form an inner mass within the tetraploid host, and—if truly pluripotent—will go on to develop into a fetal body and eventually be born as a mouse pup.

This is proof in the pudding that the candidate cells were truly pluripotent, as they contributed to the entire new organism except for its placenta and related parts. The defectiveness of the older test was determined when it was found that at times, in mice, the same cells that would form teratomas were unable to generate full grown mouse pups.

The problem now facing the NIH is that the current best test hands down—tetraploid complementation—cannot be used with human cells. Everyone on all sides agrees (we should be grateful) that recourse to such a test would be unethical: we would literally have to grow a batch of the candidate cells into a human being within a host tetraploid embryo and see if the tiny human individual would survive to gestation and live birth—just as is typically done in mice.

Hence the current challenge: to settle on a definition and test for pluripotency that will apply to human candidate cells with the same rigor as tetraploid complementation. What new set of criteria for pluripotency the NIH will settle on remains to be seen. A better part of the stem cell world sees this new move by the Administration as a needless distraction, and a ploy to cover for its refusal to fund embryo-destructive research. Other scientists see it as an opportunity. We have no doubt that there are, indeed, scientists chomping at the bit to step forward and show the world their embryo-friendly, pluripotent stem cells. Over the past two years, I have seen a fairly steady flow of articles in scientific journals asserting the existence of just such cells. We now anxiously await to see if any of these cells rise to a new and scientifically rigorous standard of pluripotency. If that happens, a new day will have dawned in our efforts to curb embryo-destructive research.

Time to get real about Stem cell research
DATE: October 16, 2007
TIME: 2:55 pm EST

No one can look into the crystal ball and say exactly where stem cell research is headed. We can’t speak with certainty about the future of embryonic stem cell (ESC) research, nor can we speak with certainty about adult stem cell (ASC) research.

Advocates of ESC research have made an art out of over-hyping their message, preying on the vulnerabilities and desires of desperate patients and their families, assuring them that cures are just around the corner for everything from Parkinson’s disease, to diabetes, to spinal cord injuries. But hype has not been lacking amongst advocates of ASC research. Note a cogent observation, for instance, from Westchester Institute Senior Fellow, Dr. Markus Grompe, in an editorial he recently published in the journal Nature:

The pro-ES cell side has accused their opponents of being anti-science, but at the same time has been guilty of public campaigns that have twisted scientific fact in sometimes grotesque ways. Examples include the advertisements for Proposition 71 in California or for the pro-cloning Amendment 2 in Missouri… On the other side, anti-ESC proponents continue to insist that adult stem cells can do everything ES cells can do and there is no valid scientific/medical reason to pursue ES research. Another frequently repeated mantra is something along the lines of "adult stem cells have cured over 70 diseases, whereas no one has been cured by embryonic stem cells". The anti-ES cell faction conveniently omits mention that the vast majority of those 70 diseases are blood-related, and that ongoing research with adult stem cells is in many cases as tenuous and speculative as research on ES cells.

I have to confess that, opposed as I am to embryo-destructive research, and as enthusiastic as I am about inroads in ASC research, I have never found hyping the case for ASC research to be at all helpful. Here’s why.

I concluded my most recent column with the comment that biotechnology and biomedical research are the engines behind an ever more pervasive exploitation of embryonic human life, and that the pro-life community would have to creatively engage a culture which by and large has already embraced embryo-based biomedical research and treatment (as discussed here, here, and here).

I firmly believe that simply promoting the tremendous achievements of adult stem cell research is an inadequate tactic for stemming the growth and popular acceptance of embryo destructive research. Certainly, this is not to minimize the importance of adult stem cell research, which, unlike ESC research, has demonstrated therapeutic benefits to human patients. But this simply cannot be our only answer to the constant push for embryo-destructive research.

Advocates of ASC have long touted the therapeutic potential of adult stem cells—as if this sole assertion, if repeated often enough, would suffice to get everyone off the topic of embryonic stem cell research. In my opinion, such a stance is wildly off the mark and out of touch with where this broad field currently finds itself. Getting real about the future of stem cell research means, first of all, to acknowledge that ESC research is not simply about cures. As Dr. Robert George and I stated in a Wall Street Journal op-ed last March:

Most scientists acknowledge that ESCs will not provide therapies for many years – if ever. Their therapeutic potential is, at best, speculative. They cannot be used now – even in clinical trials – because of their tendency to produce tumors. So it comes as no surprise that many scientists now admit that their primary interest in pursuing ESC research lies not in the hope for direct cell transplant therapies, but in the desire to enhance basic scientific knowledge of such things as cell signaling, tissue growth and early human development.

To respond to this reality by turning a blind eye, and continuing to insist that ASC-derived therapies will one day render moot any interest in ESC research is, quite frankly, to live in a dream world. Unless opponents of embryo-destructive stem cell research promote and pursue ethically acceptable alternatives to embryo-destructive research, alternatives that are both embryo-friendly and scientifically viable, then we will soon find ourselves utterly and ineffectually disengaged from the real debate.

The Age of "Savior Siblings"
DATE: October 9, 2007
TIME: 7:25 am EST

Newsday recently featured a series of articles about one family’s experience in trying to treat and cure their young daughter’s deadly disease. Their quest leads them to create another child who has a specific DNA sequence that is a perfect genetic match for their sick daughter, in order to perform a bone marrow transplant using the new child’s tissue. Such children are now commonly referred to as “savior siblings.” The first savior sibling was Adam Nash, born in 2000. Since then, approximately one to two hundred such children have been brought into the world.

I’ve made the point before (here and here) that the age of embryo-based biomedicine is here. Creating “savior siblings” is one of the most vivid expressions of that fact. In order to have a savior sibling, parents use in vitro fertilization (IVF) to create multiple embryos, each of which is genetically screened using Preimplantation Genetic Diagnosis (PGD) to determine if it has the correct gene sequence needed for the sick child. Once there is a genetic match, the matching embryo is transferred to the mother’s womb and brought to term.

In the case of the Trebing family featured in the Newsday series, the couple’s daughter had a rare disease called Diamond Blackfan Anemia, a condition where there are not enough red blood cells to carry oxygen to the body. It can be treated with steroids or—in the case of Trebing’s baby daughter—monthly blood transfusions. The human and economic toll of these treatments and their side effects is admittedly a tremendous burden. The anemia can be cured with a bone marrow or stem cell transplant from a donor who is a genetic match.

The Trebings—lacking another child or relative as such a genetic match—opted for an extreme: they chose to create multiple embryos (eventually 32 in total) in the process of trying to have a child that had the right genetic match for their daughter. All but one of these embryos – the one that was implanted and brought to term – was discarded or donated to research. The new child, a boy, eventually provided a bone marrow transplant to his older sister as treatment for her disease.

The creation of savior siblings is gravely disordered option. First of all, it would commonly entail recourse to IVF though couples are known to have conceived a savior child naturally prior to the advent of PGD for screening embryos. As I’ve noted before, IVF is immoral because through it, a child is manufactured as the result of a technician’s hand, rather than being generated through the unitive love of the child’s parents.

A second element of the moral disorder here is that this process requires the manufacture of multiple embryos. All the embryos are screened using PGD – a process which exposes the developing embryos to some risk – by removing one or two cells from each embryo in order to conduct the genetic testing necessary to determine whether the embryo is a match. When a genetic match is found, there remain multiple developing embryos – all of them genetic siblings to the first child – who are either frozen, destroyed in research, or simply “discarded.” In the Trebing situation, 31 such embryos were discarded or destroyed in research.

A third element of the moral disorder is the way it reduces newly conceived human life to the level of an object. The mere fact that a child’s very existence is solely due to his or her ability to cure an older sibling is stunningly utilitarian. Parents of savior children reassure critics that they love the specially-created child as much as any. Nonetheless, the child is brought to term on the calculated determination of his or her usefulness in curing an older sibling. But for that, the child would not exist.

Today, in no uncertain terms, biotechnology and biomedical research are the engines behind an ever more pervasive object-ification, commoditization, and exploitation of embryonic human life. I would only note in conclusion that it will take creative, out-of-the-box thinking from the pro-life community to engage a culture which by and large welcomes embryo-based biomedical research and treatment—of which the therapeutic perk of savior siblings is just one manifestation. In this new age, hoisting pictures of aborted fetuses and over-hyping the case for adult stem cell research are sorely inadequate tactics.

The fate of frozen embryos
DATE: October 2, 2007
TIME: 12:30 pm EST

A couple of weeks ago, I wrote a column about StemLifeLine, a California company that has recently begun offering a unique service to couples who have created human embryos by means of in vitro fertilization (IVF). The company offers to take their remaining frozen (cryopreserved) embryos and “transform” them into “useful” stem cells. The company’s entire premise—to take these embryos, destroy them, and derive from them stem cells that would be “customized” for use by either the father or mother—is, as I pointed out, a complete sham: tissues developed from stem cells derived from these embryos, if implanted in either parent, would require life-long immunosuppression, lest the tissues be rejected by their bodies. So much for “customized” stem cells. As I stated at the time, however, the very existence of this company—notwithstanding its phony advertising—is a powerful reminder that the age of embryo-based biomedicine is now upon us.

For the past two years, we have also seen significant efforts in the U.S. Congress to press for legislation that would “free up” the existing population of frozen IVF embryos for research purposes. In spite of these efforts, it is clear that under the present administration the current federal prohibition on using federal funding to destroy IVF embryos for research will stand. (It may not in future administrations.)

But such realities have brought to the forefront a difficult and disturbing moral question: what can be done ethically with those IVF embryos judged unsuitable or no longer intended for transfer into the womb?

In the survival-of-the-fittest world of IVF, multiple embryos are manufactured from the eggs and sperm of couples pursuing pregnancy by this means. Surplus embryos—those not implanted immediately—are placed in suspended animation, their initial cellular development arrested at the very outset of their existence, sometimes even at the one-cell stage. Immersed in a soup of cryoprotectant chemicals, then sucked into straws, these embryos are then entombed in tanks of liquid nitrogen and instantaneously frozen. Just under four hundred thousand such embryos are preserved in IVF clinics in the United States alone according to the most recent, reliable study produced in 2003 by the Rand corporation.

The Catholic Church continues to teach that recourse to IVF as a remedy for infertility is morally illicit. The Church rejects this as a morally viable option on the grounds that children have a right to be brought into the world, not through the dexterity of lab technician’s hand, but through the unitive and procreative act of conjugal intercourse of a man and woman united in marriage. Children brought into the world through IVF are not generated, but literally manufactured. . While the Church endorses any number of licit means of assisting the marital act, we maintain that it is morally illicit to substitute that act with technical interventions—which is precisely what happens in the case of IVF.

There should not be 400,000+ human embryos currently stored in tanks of liquid nitrogen. The entire IVF enterprise is to be credited for bringing about the stunning and absurd moral predicament. The probing question that now faces so many IVF parents is: what to do with the remaining embryos that they do not intend to gestate?

Couples in this situation are forced to choose from the following options: allow their offspring to be kept in frozen storage indefinitely; have the embryos removed from frozen storage and allowed to expire naturally or be “disposed of” as laboratory waste; give up the embryos to scientific research; or give up the embryos for adoption by another couple.

I would suggest that choosing to keep the embryos in frozen storage indefinitely only delays the inevitable—eventual death through organismic decay while in the frozen state. Noting that the thawing process itself often kills IVF embryos being prepared for transfer, some moralists object to the prospect of a couple choosing to thaw their embryos, allowing them to expire naturally. I believe that a sound argument can be made for the removal of frozen embryos from their storage containers on the grounds that continued cryopreservation constitutes an extraordinary and ultimately futile means of continued existence—an absurd and tragic existence to be sure. Allowing the embryos to die is not the same as directly killing them. Directing lab technicians to “dispose” of the embryos is ethically unacceptable as this entails taking actions directly on the embryos with the intention of destroying them. A recent study conducted by the University of Pennsylvania discovered that protocols for the disposal of excess embryos at American IVF clinics varies in surprising ways, including quasi-religious ceremonies. The study also suggests that such disposal creates serious problems of conscience for clinicians, many of whom opt out of involvement in the disposal procedure.

Parents who decide to remove their embryos from frozen storage to allow them to die naturally should be encouraged to ask their pastor whether some blessing or other appropriate ceremony might be possible. The remaining embryos (though microscopic) should be treated with the degree of respect due to all human remains.

Obviously, embryos should never be sacrificed upon the altar of biomedical research. Such a decision would constitute a grave affront to human dignity and a direct assault on innocent human life. No putative medical benefit can justify the direct killing of a human being.

I would not exclude the possibility of donating cells from an embryo after its death. If a criterion for embryonic death can be established, it may be moral to donate cells from a deceased embryo just as one might from any child who dies.

Catholic theologians continue to be of diverse opinions, however, on the question of embryo adoption: the licitness, that is, of implanting unwanted IVF embryos into the wombs of women willing to gestate them to term with the intention of “rescuing” them from almost certain death, or even to adopt them outright. The Holy See has not expressed a definitive moral judgment on the matter. Some theologians hold that such a proposition is not only morally licit, but even heroic. Others hold—at least in the case of married women—that such a prospect (which entails the woman’s becoming pregnant apart from the intervention of her husband), though noble in its intention, would constitute a grave violation of the marriage covenant.

At a Westchester Institute Scholars Forum, held in October 2004 we engaged in a thorough examination of Catholic arguments for and against embryo adoption. These arguments were later gathered and published in detail in a volume of essays entitled Human Embryo Adoption: Biotechnology, Marriage and the Right to Life. Later this week, I will be speaking on this topic at a gathering of the Catholic Medical Association.

My on-going exposure to the field of embryonic stem cell (ESC) research compels me to believe that the interest in embryo-based scientific research is growing—research we should remember that might have little or nothing to do with eventual cures to which such research might directly or indirectly contribute. I am convinced that today we stand on the verge of an era in which such embryo-destructive research could become common-place. There are any number of grim indications that a majority of Americans are slowly being cajoled into endorsing such a barbarous plan. To avoid such a future, we must demand that lawmakers pursue a complete federal ban on the creation in vitro of human embryos for any purpose other than implantation in a human womb. Surely Americans have not yet reached such a state of moral confusion as to fail to see the reasonableness of such a moral boundary line. But I have reasons to wonder…