Thursday 28 December 2006

A hard cell

Eve Herold on why we should take sides in the Stem Cell Wars, and cheer those scientists pushing the boundaries.

Stem Cell Wars: Inside Stories from the Frontlines, Eve Herold, Palgrave Macmillan, 2007.

Eve Herold’s book puts a persuasive case for more biomedical research on human and animal stem cells, both to advance our knowledge of human biology and to provide the possibility of cures for debilitating diseases like diabetes, Parkinson’s, spinal cord injury, heart failure, cancer and more.

The book will be published in Britain early in 2007, and it’s a must-read for anyone who wants a better understanding of the current state of stem-cell science as well as an insight into the political and ethical controversies that are holding back developments in this new and exciting area of research. I talked to Herold about her book just before Christmas.

As director of public policy research at the Genetics Policy Institute in America, Herold argues passionately for taking medicine to a new level. She writes: ‘Disease and disability are already enormous drains on economies worldwide, but we are at the beginning of the biggest ageing boom in history.‘ She believes that medical science has made some spectacular strides in the twentieth century, stating: ‘In fact, more effective treatments and cures were discovered during the last century than in all prior human history.‘ Millions of people have benefited from new drugs, vaccines, diagnostic techniques such as x-rays, CT scans and MRIs, and our ability to carry out ever-more complex surgical procedures.

Although Herold recognises that the dramatic increase in life expectancy in the last century was mainly due to the development of modern sewage systems and water purification methods, she argues that medical progress has also played an important part. ‘If anyone doubts the march of medical progress’, she writes, ‘the most dramatic testament is the fact that, between 1900 and 1999, the average life span for Americans increased from 47 years to 77’.

What stem cell research may allow us to do, in the not too distant future, is provide cures for diseases that until now we have only been able to manage. But the research will not progress at an acceptable rate unless we have out some hard arguments about the need for experimentation. Stem Cells Wars provides ample ammunition against those who are trying to halt the research, both by putting the case for pursuing knowledge for knowledge’s sake and by confronting the ethical arguments – made both by religious and political figures – head-on.

My only concern is that Herold may have hyped the imminence of the medical benefits. When I asked her whether the medical promise of stem cell research may have been oversold, she responded: ‘Of course there is a very real danger of that. We are at such an early stage in the course of this research that there are a lot of unknowns.’ She pointed out that we have 30 years of animal research ‘that shows the proof of principle many times over’. But human research is at a very early stage – human embryonic stem cells were only isolated for the first time in 1998.

Herold argues that what we need is more laboratory research on adult stem cells, embryonic stem cells and therapeutic cloning. At the same time we need more animal research. Only then, she points out, will we be able to move on to clinical trials.

Just before Christmas, Professor Austin Smith, director of the Wellcome Trust Centre for Stem Cell Research told The Times (London) that ‘cloning research clearly upsets the general public’, and ‘there are real question marks about whether it has any utility at all’. Professor Smith would prefer scientists to focus on a basic understanding of adult stem cells and embryonic stem cells, rather than exploring their potential in helping to fight disease and injury (1).

Adult stem cells are more easily available than embryonic stem cells, but are more restricted in the types of cells they can form. Embryonic stem cells, also known as master cells, are extracted from early embryos and hold the blueprint for every cell, tissue and organ of the human body. Embryonic stem cells are currently only available from infertility clinics that provide surplus embryos donated by couples who have completed fertility treatment.

Many scientists believe that in the future embryonic stem cells could be generated from specific patients - through therapeutic cloning - by inserting a patient’s cells into an egg that has had its own nucleus removed. This method, called nuclear transfer, has worked in a mouse but has not yet been successful in humans. The benefit of patient-specific stem cells is that they will not be rejected by the patient.

Herold was surprised by Professor Smith’s statement about the utility of therapeutic cloning. Of course there is a possibility that scientists will never succeed in generating patient-specific embryonic stem cells, but unless we do the research we will never know, she argues, adding: ‘As Einstein said, “If we knew what we were doing, it wouldn’t be called research, would it?”’

Stem Cell Wars confronts the myriad arguments against this branch of science in a convincing and engaging way. Herold concludes the book by saying: ‘The idea of putting a freeze on progress because there are good and bad people in the world, because knowledge can be misused, or because we can’t always guarantee the outcome is an assault on the human spirit. It is living by our worst fears not our greatest hopes.‘

This is an admirable sentiment, as long as we have a realistic expectation of the medical benefits of the research. Stem Cell Wars is peppered with heart-rending human-interest stories – about individuals who suffer from currently incurable diseases and injuries. But unfortunately, these individuals stand little chance of benefiting from stem cell research, whether or not restrictions on the research are lifted. Like all science, this research is arduous and will progress slowly. But unless we let the research grow, and put the case for further exploration and experimentation, we will never take medical science to a new level.

Stem Cell Wars by Eve Herold will be published by Palgrave Macmillan in the UK in January 2007 (buy this book from Amazon (UK)).

(1) Cloning benefits oversold, says stem-cell scientist, The Times (London), 18 December 2006

First published by spiked