- Stem Cells:The Next Steps
Often enough, moral debates are settled more by acclamation than by rational argumentation, and often acclamation means a preponderance of opinion rather than universal support, and frequently that preponderance is reached only by degrees, and reflected only in a change in the questions people are thinking about, rather than in any decisive exchange. One wakes up one morning and suddenly realizes that the debate has moved on, even though the initial question was perhaps never fully resolved.
We may be at this point in the debate about whether to destroy embryos in order to do research on the embryonic stem cells they contain. In fact, perhaps the related debate about whether to engage in cloning in order to create new stem cell lines is also over.
At any rate, some of the material in this issue of the Report asks us to look at the next set of questions—those that follow the threshold question of whether to do the research at all. A special set of essays (made possible by a gift from Frank Trainer, one of The Hastings Center's board members) offers an update on how stem cell research is proceeding and what new issues are arising as it does. The central theme of the lead piece, by science writer Steve Hall, is that there are many ideas and initiatives but, because of the political snarl around stem cells, few projects under way. We have settled on doing the research; the immediate next question, says Hall, is how much delay to allow (or require) for work that most people support and from which many might benefit, but that a significant minority finds deeply unacceptable.
Very little, think the scientists Hall interviews. A more cautious view is offered by Jonathan Kimmelman and coauthors in an accompanying commentary. Recalling pitfalls that slowed and maybe ruined gene therapy research—the last great wave of high-tech biomedical science—they draw out some lessons for clinical trials on stem cells. The key lesson: don't go too fast. It only leads to trouble. Allegations that Woo Suk Hwang and his researchers may have falsified some of their results when they claimed last year to have produced eleven new stem cell lines (a story unfolding just as this issue went to press) perhaps bear this lesson out.
In other commentaries, David Magnus provides an update and defense of the California stem cell initiative, which is arguably at the forefront of national science policy in this domain, and Josephine Johnston explores the questions surrounding the donation of eggs for cloning—questions also dogging the South Korean team that is at the forefront of international work on cloning.
A feature article by Mark Greene takes up questions of fairness that arise in developing stem cell therapies. If and when we get them, those therapies should be broadly available; they should not be a whites-only treatment. But if we end up working with a limited number of cell lines (rather than using cloning technology to create a new line crafted from, and for, each patient), then we will probably end up with therapies that work better for the country's most populous ethnic groups. Blacks will be largely excluded. Greene proposes that other groups—states and private groups like the American Medical Association—be asked to publicly address their own historical role in discriminating against Blacks by providing funds that will make stem cell therapies possible for them. [End Page 2]