reasonable answers

This is part 2 of the transcript of a debate on embryonic stem cell research that I am having on the Facebook group “Support Stem Cell Research.” I will be collating the comments in each part to focus on a specific argument, which means that some comments will be trimmed to only the pertinent sections, with other parts being addressed later in the series. The full discussion topic can be seen here, and there have also been some particularly nasty comments on the main wall of the board today that I may include in the future as well.

This part will focus on the argument that ESCR will primarily use frozen embryos left over from IVF procedures. Other people’s comments are indented and italicized to help distinguish who is speaking.

Tom wrote:
So you would have no problem with ESCr employing only leftover, unwanted, unused embryos from in-vitro fertilization clinics, wouldn't you? These embryos are created en masse because the process of scraping the ovary is invasive and therefore potentially dangerous, as well as uncomfortable and costly; the process to create the embryos is also expensive, so the fewer times these procedures are repeated, the more likely they will result in a successful embryo formation and implantation. But that leaves over 600,000 embryos in freezers right now in America, 350,000 of which will be thrown in the trash to be incinerated as medical waste EVERY YEAR. Donated to ESC medical research, these would be absolutely invaluable towards saving and improving REAL, FEELING, human LIVES.

ESCr destroys no "life." It takes cells which have absolutely no potential future other than as incinerator fuel, and applies them to research into treatments for some of our most debilitating diseases today. Did you know that 60-80% of all naturally-fertilized embryos are rejected from a woman's body, by her own natural processes? Where is the authoritarian demonization of menstruation after coital sex?

Tom, the fact that there are 400,000 (I'm not sure where you got your 600,000 figure) frozen embryos doesn't mean that they are all available for embryonic stem cell research. The most accurate data collected by the RAND Institute states that only 11,000 embryos have been designated for research, from which at most only 275 viable stem cell lines can be generated. That will simply not be sufficient for the research necessary to find treatments using ESCs. Thus it is inevitable that pursuing ESCr will require the creation of new embryos specifically for the purpose of research.

Here is the link to the RAND Institute study:
http://www.rand.org/pubs/research_briefs/RB9038/index1.html

Even if you consider one recent study that suggests (through survey results) that perhaps there will be up to 100,000 "leftover" embryos available for research, which may perhaps result in a "100-fold" increase in the potential number of stem cell lines (though the study doesn't describe why a 10x increase in embryos would result in a 100x increase in stem cell lines), this would result in at most 27,500 stem cell lines available. Considering that up to 100 million people can stand to benefit from treatments using stem cells, even this 27,500 number will be insufficient, and many more embryos will have to be created and destroyed if those treatments will come from ESCr.

On the other hand, scientists face no such limitation in the use of iPSC cells, since hundreds of iPSC lines can be generated from one skin biopsy, all of them exactly matched to the DNA of the patient.

Tom wrote:
"only 11,000 embryos have been designated for research, from which at most only 275 viable stem cell lines can be generated"

Not bad, since the ban on federal funding for embryonic research was just lifted three days ago.

"That will simply not be sufficient for the research necessary to find treatments using ESCs"

Based on what possible model?

"it is inevitable that pursuing ESCr will require the creation of new embryos specifically for the purpose of research"

I certainly don't have a problem with that, if it comes true. Those who do are welcome not to accept treatments derived from ESCr.

Apparently you didn't read the actual RAND report that determined these numbers. Otherwise you would have noticed that the report was published in 2003, and that the numbers of embryos available for research have no connection with Obama's order lifting the ban. You seem to imply that given more time more of these "leftover" embryos will be available for research, which is simply not true. The numbers that I cited are the maximum numbers of stem cell lines that can be generated from "leftover" embryos without the creation of new embryos specifically for research.

The reason that even 27,500 stem cell lines will not be enough if scientists want to actually use ESC for the treatment of diseases is because, like in organ transplantation, there must be tissue match between donor and recipient, otherwise the patient's own immune system will reject the transplanted tissue. Even 27,500 unique stem cell lines will not provide enough of a variety of tissue types to provide treatments for even a small percentage of the 100 million people that can stand to benefit from stem cells.

This means that SCNT (ie "therapeutic cloning") will be required when it comes time for doctors to actually try to treatment people, which will require the creation of embryos on a massive scale.

As you said, Tom, you don't have a problem with creating new life for the purpose of research, so my point won't mean anything to you. However, it's important for people to be aware that IVF embryos will ~not~ be the only ones used for ESC research.

Tom wrote:
A pregnancy miscarries. Do the parents have the right to donate that fetus to medical research, or should they pop it into a freezer until all of its cells are dead, so they can incinerate it?

Leftover IVF embryos have no uterus in which to gestate. They are only different from any miscarriage in that they were NEVER in a uterus in the first place, and never even had the potential of that fetus -- not that 'potential' is a rational argument for anything, considering that you and I are 'potential' corpses, yet nobody will argue for the treatment of living people AS corpses until that comes to pass.

The arguments against allowing the donation of waste IVF embryos to medical research are pathetic, self-serving and/or self-righteous, and academic: not only do over 2/3 of Americans favor embryonic stem cell research, but both the President and the super-majority of Congress do, too. Funding will be established within the year, and after the first ESCr-derived treatments become available, the bulk of the opposition will finally realize what idiots they have been -- just like the opponents of organ transplant did, decades ago, when their loved ones first benefited from organ transplants.

Within my lifetime, people will laugh derisively at the idea that anyone ever opposed embryonic stem cell research the same way they do at opposition to organ transplant, opposition to interracial marriage, and opposition to women's suffrage. (Heck, lots of us already do)

Tom wrote:
"The arguments against allowing the donation of waste IVF embryos to medical research are pathetic, self-serving and/or self-righteous, and academic..."

And your assertion is entirely unsupported. If the arguments are really so pathetic, then why haven't you actually responded to the points I made earlier showing that the number of unique stem cell lines that can be generated from "leftover" IVF embryos will not be sufficient to provide the range of tissue matches required to provide actual treatment to all the people who could potentially benefit from stem cell treatments. Thus your argument implying that only IVF embryos will be used in ESCR is misleading and purposefully draws attention away from the fact that the majority of ESCR will require the creation of new embryos specifically for research.

Tom wrote: “Because you didn't bother to support your statements, so I see no need to rebut. It is also utterly tangential to the question of whether or not research itself should be conducted on these bits of human waste byproduct.”

Which of my statements did I not support? All the figures that I cited, the 400,000 leftover IVF embryos, the 11,000 embryos actually designated for research, and the 275 maximum potential stem cell lines that can be derived from these IVF embryos, were all taken directly from the RAND Institute study conducted in 2003, which is currently the most accurate data available. I even gave you the link to that report, but let me include it again: http://www.rand.org/pubs/research_briefs/RB9038/index1.html

I've never seen you cite where you got your figure of 600,000 for the number of frozen IVF embryos, even though you have tossed that number around in a number of discussion topics.

Marianne wrote:
HOW MANY TIMES? There are embryos which are not being used, they're going to be incinerated. Why not use them to cessate the suffering of the LIVING - the very proposal you're making is that suffering is bad and life should be preserved, well these embryos have ZERO chance of life but there are real, living, breathing PEOPLE with diseases which might be curable if these embryos are used. It's a completely untenable position you hold.

Three times in this discussion I have cited the hard, empirical numbers that show that the maximum number of stem cell lines that may be derived from current "leftover" IVF embryos is 275. No one has yet refuted these numbers, nor has anyone provided any evidence that the stem cells derived from these "leftover" embryos will actually be the ones used to treat the 100 million people that can stand to benefit from stem cell treatments.

So until someone can show actual evidence that only these leftover embryos will actually be used to treat people, I will continue to state that it is misleading and deceptive to imply that treatments from ESC research will only come from IVF embryos. Your arguments supporting SCNT imply that you know very well that treatments utilizing embryonic stem cells will undoubtedly require the creation of new embryos through SCNT, rather than relying only on IVF embryos.

Summary

The “leftover” embryos argument is probably the most influential argument used by ESCR proponents, even having an effect on those who may in principle be opposed to the creation of new embryos specifically for research. The reason it is so influential is because it is a sad fact that the vast majority of the “leftover” embryos currently in storage will indeed simply be disposed of—a devastating tragedy in and of itself. So this argument preys on the desire to at least have this mass destruction of innocent life at least mean something positive by way of medical research for people currently living with crippling diseases.

But this is a misleading and deceptive argument, because the numbers show that these “leftover” embryos simply will not be sufficient when the time comes to try to develop actual treatments for patients using ESCR. My earlier entry on “The Slippery Slope of Embryonic Stem Cell Research” goes in depth into why this is the case.

In the debate, I repeatedly raised the hard numbers from the RAND Institute study indicating that only a maximum of 275 unique stem cell lines could be derived from the “leftover” IVF embryos. Neither of the people responding tried to refute those numbers, nor my claim that ESCR would inevitably require the creation of new embryos specifically for research, which has already been taking place in private labs around the world, and soon in federally funded labs in America. This is a conclusion that must be brought out whenever someone tries to use the “leftover embryos” argument.

So the tragic situation is that if ESCR is allowed to continue, not only will these IVF embryos be destroyed for no significant purpose, but it will actually prepare the way for an even greater acceptance of the use of humans in the earliest and most fragile state of development as simply a useful commodity.

The debate continues with Part 3: Dehumanizing the Embryo. Also see my earlier post on The Slippery Slope of Embryonic Stem Cell Research.

I inadvertently sparked a vigorous debate over embryonic stem cell research on one of the largest Facebook groups for stem cell research. It all started with an innocent comment I made to try to correct a misunderstanding that one wall poster had about stem cells. He commented that four years ago he was healed from a spinal injury by stem cells, but then he followed that with an epithet against the Republican party, a theme that is commonly repeated in this group by those who believe that Pres. George Bush’s policy restricting federal funds from being used to create new stem cell lines from embryos was the worst thing that could have happened to stem cell research. I simply made the comment that,

Since it was only this year that the FDA approved the first human trials using embryonic stem cells, the cure that you received was most likely the result of adult stem cells, which have never been restricted by any party in the government since there are no ethical qualms surrounding them. Your treatment thus serves as another example of the importance of focusing on ASCr [adult stem cell research] and the new iPSCs [induced Pluripotent Stem Cells] instead of on ESCr. You should be proclaiming the merits of adult stem cells rather than embryonic stem cells.

This comment drew a response from Tom, one of the most vocal members of this group, and when I responded to his comment, things kind of snowballed from there.

As a teacher, I believe that it is very important to help my students accurately see the various sides to an issue before drawing a conclusion, especially one as controversial as stem cell research. One of the best tools for helping my students gain this is by showing them a debate between two well versed representatives taking opposing sides on an issue. Now I’m not a biologist, nor a bioethicist, and I don’t know what the people that I’ve been debating with do, and I certainly wouldn’t count any of us as experts on the topic, but I believe that our discussion has hit many of the key arguments for and against embryonic stem cell research. So I thought that it might help others gain a deeper understanding of some of the issues involving stem cell research if I posted snippets from the ongoing debate, so that people could see the arguments and responses given by those who support and those who oppose embryonic stem cell research.

I would like to say that I’ve inspired others to join in the fight, but so far it’s primarily been just me against four of the most ardent supporters of embryonic stem cell research in the group. And even though the debate has only been going on for several days, it’s probably already too verbose for me to simply copy over verbatim, so I will be doing some selecting and trimming so as not to scare away my readers. But you can see the full, ongoing debate at this link, and you are certainly invited to join in!

Key to acronyms: ESCr = “embryonic stem cell research”; ASC = adult stem cells; iPSC = induced pluripotent stem cells (stem cells derived by reprogramming human somatic cells)

So let me start off with just the first exchange between Tom and myself:

Tom wrote:

Ken, there is no rational reason to focus on ASC "instead of" ESC. It is a false dichotomy. They are separate studies, and DO NOT SHARE FUNDING.

The "ethical qualms" can be easily resolved with a little logical thought:

You are in a burning building. Equidistant from you are a crippled child and two frozen embryos. You only have time to save one, but not both. Which do you save?

If you save the embryos, then what? Like ESCr embryos or leftover IVF embryos, they have a 0% chance of being implanted in a uterus to conceive a pregnancy. Even if they were, 75% of IVF embryos fail to implant. Even if they did, there is a 23% chance that the pregnancy will miscarry. So the embryos really only have the potential to die, anyway.

If you save the child, then you acknowledge that the life of a child is worth more than twice as many embryos; why would you consider it okay to sacrifice these embryos to save a child's life from a fire, but not from a deadly disease?

My response:

Where your analogy is wrong is that it falsely phrases the choice as either save the child ~or~ the embryos, when in fact the child could be saved without the destruction of embryos at all. Let's rewrite your analogy to make it more consistent with the reality of ESCr:

You are in a burning building. Inside the building is a crippled child. You have time to save that one child, but not anyone else. And then someone goes and drops two frozen embryos into the building.

I do believe that the life of a child is worth more than the two frozen embryos, so I would still save the child. But then I would ask, why pursue a line of research that involves the creation and destruction of embryos to find treatments, when iPSCs offer the same potential without requiring the destruction of embryos?

Also, the gov't only has so much funding for research, so whatever goes to ESC is that much less going to ASC and iPSC research.

The debate continues with Part 2: The Leftover Embryos Argument, and Part 3: Dehumanizing the Embryo. Also see my earlier post on The Slippery Slope of Embryonic Stem Cell Research.

President Obama has reversed a restriction on federal funds for embryonic stem cell research (ESCR), placing America that much farther down the slippery slope that could eventually lead to the creation of new human life solely for the purpose of research and medical treatments. Though he did not directly order a change to the NIH guidelines set during Clinton’s administration banning the use of federal funds for embryo creation and the making of animal-human chimera embryos, it is telling that the only restriction he imposed was a ban on reproductive cloning; stated Pres. Obama, “we will ensure that our government never opens the door to the use of cloning for human reproduction.”

However, even if the NIH initially upholds the guidelines set during Clinton’s administration, if the purpose of ESCR is to eventually provide medical treatments, then a future reversal of the ban against embryo creation is inevitable. Why? For the same reason that people in need of organ transplants die even though organ donation is perfectly legal and there are plenty of available donors: the shortage of matching donor tissue. If a person needs a new organ, doctors cannot just transplant the organs from any dead body; the donor and the recipient must have a number of matching tissue characteristics – very rare between unrelated people – in order for the transplant to have any probability of success, and even then the patient must be pumped full of immunosuppresant drugs to keep the person’s own body from attacking or rejecting the transplanted organ or tissue.

This same problem will hinder treatments using ESCs. To develop a viable treatment, a doctor must use a stem cell line that has a significant degree of tissue correspondence to the person requiring treatment, otherwise the recipient’s immune system will simply destroy all the injected stem cells or tissue, because it considers it to be an outside invader. The critical question is, how many stem cell lines would be available without the creation of more embryos specifically for research?

Addressing the use of “leftover” embryos

One of the primary arguments of proponents of ESCR is that there are hundreds of thousands of frozen embryos, “leftovers” from IVF procedures, that would simply “go to waste” if they weren’t used for research. Why would anyone, the argument goes, be unwilling to allow these “leftover” embryos to be used to develop treatments that could possibly save millions of lives? This argument seems convincing even to those who in principle oppose ESCR on the grounds that human life is lost. If they will be discarded anyway, why not at least use them for some good? This is sometimes even viewed as a positive means to offset the tragedy of the loss of innocent life.

Let me address this argument in two ways: first by moral analogy and then mathematically.

Let’s say a family member is dying of heart failure, and requires a heart transplant to continue living. The hospital runs a search and comes up with a tissue match. The heart that could save your family member belongs to a convict who is now sitting on Death Row awaiting execution. Unfortunately, he isn’t scheduled to be executed for another couple years, by which time it would be too late for your family member.

The question is: would it be morally, legally, or ethically right for you to request that the prison reschedule the convict’s execution for the very next day so that you could obtain the man’s heart for your family member? Since the convict is going to die anyway, why not kill him now so that his death can actually serve some good? The answer of course, is because this would be WRONG! Even a convicted criminal, awaiting execution for committing a horrendous crime, and whose continued existence arguably serves no further benefit to society, even this person has the right for his life to not be ended before his time for the purpose of medical research. Who then can claim the right to end the life of an innocent unborn human? It will indeed be a great tragedy when these hundreds of thousands of frozen embryos eventually die or are discarded; what would be a greater tragedy is if we try to diminish the depth of this tragedy by trying to justify it with some demeaning purpose.

But if moral arguments don’t do it for you, then let’s do some math.

The most accurate data on the number of frozen embryos available has been collected by RAND researchers Gail L. Zellman and C. Christine Fair, together with the Society of Assisted Reproductive Technology (SART) Working Group led by David Hoffman. Their findings include (emphasis added):

• Nearly 400,000 embryos (fertilized eggs that have developed for six or fewer days) have been frozen and stored since the late 1970s.
• Patients have designated only 2.8 percent (about 11,000 embryos) for research. The vast majority of frozen embryos are designated for future attempts at pregnancy.
• From those embryos designated for research, perhaps as many as 275 stem cell lines (cell cultures suitable for further development) could be created. The actual number is likely to be much lower.

The researchers explain why only 275 stem cell lines might be obtained even though 11,000 embryos are available for research:

Although the 11,000 embryos designated for research might seem like a large number, the actual number of embryos that might be converted into stem cell lines is likely to be substantially lower. Because assisted reproductive technology clinics generally transfer the best-quality embryos to the patient during treatment cycles, the remaining embryos available to be frozen are not always of the highest quality. (High-quality embryos are those that grow at normal rates.) In addition, some of the frozen embryos have been in storage for many years, and at the time that some of those embryos were created, laboratory cultures were not as conducive to preserving embryos as they are today. Some embryos would also be lost in the freeze-and-thaw process itself.

To illustrate how such laboratory conditions might limit the number of embryos available for research, the RAND-SART team performed a series of calculations. Drawing upon the few published studies in this area, they estimated that only about 65 percent of the approximately 11,000 embryos would survive the freeze-and-thaw process, resulting in 7,334 embryos. Of those, about 25 percent (1,834 embryos) would likely be able to survive the initial stages of development to the blastocyst stage (a blastocyst is an embryo that has developed for at least five days). Even fewer could be successfully converted into embryonic stem cell lines. For example, researchers at the University of Wisconsin needed 18 blastocysts to create five embryonic stem cell lines, while researchers at The Jones Institute used 40 blastocysts to create three lines.

Using a conservative estimate between the two conversion rates from blastocyst to stem cells noted above (27 percent and 7.5 percent), the research team calculated that about 275 embryonic stem cell lines could be created from the total number of embryos available for research. Even this number is probably an overestimate because it assumes that all the embryos designated for research in the United States would be used to create stem cell lines, which is highly unlikely.

Here is the key point: the figures of hundreds of thousands of frozen embryos that is tossed around by proponents of ESCR is meaningless, because only a tiny fraction of that number (11,000) would actually be available to research, and then only a small percentage of that number (275) might possibly yield a usable stem cell line. So instead of having hundreds of thousands of embryos to work with, researchers might in fact only obtain 275 stem cell lines.

A recent study has suggested that more couples may be willing to donate their embryos to research, resulting in perhaps 100,000 available embryos and “a potential 100-fold increase in the number of stem cell lines,” although the article didn’t explain how having 10 times the number of available embryos would result in a 100-fold increase in stem cell lines. This would then result in a maximum of 27,500 stem cell lines derived from “leftover” embryos. Many researchers would say that this is an overly optimistic number. According to Dr. Barry Behr of Stanford University, “By far, by far, the vast majority of embryos that are frozen are not good. If we thawed 10,000 embryos, we would get 100 or so that are viable blastocysts” (from Do No Harm).

But let’s grant this unreasonably high number for the sake of argument. Remember our earlier discussion on the critical importance of finding an exact tissue match before a stem cell treatment will be accepted by the recipient’s body? The Americans for Cures website states that: “Over 100 million Americans may benefit from stem cell therapies and cures.” Now what percentage of these 100,000,000 Americans may potentially find a match among the 27,500 potential stem cell lines derived from “leftover” embryos? Do the math!

Even if actual treatments using embryonic stem cells are developed in the near future, how long will it take before researchers run out of “leftover” embryos that are tissue matched to the waiting patients? And when they do reach this point—most likely sooner rather than later—will these researchers say, “Well, we’ve used up all the leftover embryos… I guess we can’t do any more treatments with embryonic stem cells anymore! Tough luck for those who didn’t get a match…” and then close up shop? Once the dike has been punctured, the flow of water will only increase, and the demand for more embryos for the purpose of medical research will only increase. And the only way to obtain more embryos is to actually create them specifically for the purpose of research.

This is currently already being done in privately funded labs around the world. The method of choice is Somatic Cell Nuclear Transfer (SCNT), sometimes given the benevolent sounding name “therapeutic cloning.” But the only difference between “therapeutic” cloning and reproductive cloning is that in the latter, the clone is allowed to live and be born, while in the former, the clone is destroyed in the process of acquiring the “therapy.” Even the clones on The Island were given the chance to live a little before they were taken off to be harvested for their body parts.

SCNT has its own ethical issues that will affect its potential success, including the very real potential that women would be exploited to harvest their eggs (see Hands Off Our Ovaries), which is required for SCNT. However, the key point that I want to make in this post is that “leftover” embryos from fertility treatments will not be enough for the purpose of developing actual treatments, and instead in the very near future we can expect to see tax-payer funding for the creation of embryos specifically for the purpose of research and medical treatments.

There has been a raging debate on the ethics of using tissue from aborted fetuses for transplant, because of the high likelihood that woman may be coerced into conceiving and aborting babies just so the body parts can be used (see this egregious story for example). This same thing—in essence—may soon occur on a massive scale if people continue to pursue treatments using embryonic stem cells.

Let me finish this entry with the response given by House Republican Leader John Boehner following  President Obama’s decision to allow taxpayer funding of human embryonic stem cell research:

“This decision runs counter to President Obama’s promise to be a president for all Americans.  For a third time in his young presidency, the President has rolled back important protections for innocent life, further dividing our nation at a time when we need greater unity to tackle the challenges before us.  I fully support stem cell research, but I draw the line at taxpayer-funded research that requires the destruction of human embryos, and millions of Americans feel similarly.  As we move forward, I am hopeful that the President will re-evaluate this and other controversial decisions that put government at odds with the sanctity of human life.

“Non-embryonic stem cell research is not only showing great promise in the laboratory, but its applications are already being used to treat scores of diseases and medical conditions.  Indeed, science and respect for human life can coexist.  Politicians in Washington would be well-served to recognize this fact before they ask taxpayers to subsidize the destruction of innocent human life simply to advance a particular agenda.  Instead of asking taxpayers to pay for efforts that destroy life, Congress and the Administration should support bipartisan solutions like Rep. Randy Forbes’ Patients First Act, which would promote stem cell research that is actually getting results.”

In the near future I hope to describe more on this promising non-embryonic stem cell research that Boehner describes.