Stem-cell research divides doctors along with country

The physician community is split on whether federal funding should be used to fund embryonic stem-cell research.

By Tanya Albert, amednews staff. Aug. 6, 2001.

The debate surrounding federal funding for stem-cell research has reached fever pitch in the nation's capital as scientists, medical ethicists, relatives of the chronically and terminally ill and parents of children who were once frozen embryos all offer up their opinions on the controversial research method.

Mary Tyler Moore and Michael J. Fox have appeared before Congress making the case that embryonic stem-cell research could be the key to finding the cure for diabetes and Parkinson's disease. Parents who are parents by virtue of in-vitro fertilization say using frozen embryos for research that hold the potential to become children is reprehensible.

One hot topic; two diverse views

Pope John Paul II called the research morally bankrupt during President Bush's visit to the Vatican in July. But leading U.S. scientists say the research holds the most promise in finding cures for several chronic debilitating and terminal conditions.

Senators and representatives have weighed in on both sides of the debate, with abortion opponents Sens. Bill Frist, MD (R, Tenn.), Gordon Smith (R, Ore.) and Kay Bailey Hutchison (R, Texas) saying they support federal funding for the research.

But everyday physicians -- those most likely to see the benefits any such research could bring in improving patient care -- have been largely absent from the public debate. Most of the dozen physicians AMNews interviewed about the issue said they supported research using embryos that otherwise would be thrown away. The AMA was among 123 patient, research and academic institutions that expressed strong support for federal funding for research using human pluripotent stem cells in a letter to President Bush earlier this year.

But, like the population at large, physician opinions on this issue vary. And the debate is politically heated in the physician community as well.

123 groups asked for federal funding of stem cell research in a letter to President Bush.

"I feel bad for President Bush, who is going to have to make a decision in such a charged atmosphere," said Belleville, Ill., neurologist Ronald Welch, MD.

Bush has spent several months mulling over Clinton administration guidelines that spelled out the rules for federally funded embryonic stem-cell research projects. He recently said he wanted to take his time in making a decision about the guidelines so he can fully understand the opportunities and think through the dilemmas the research could present.

Arlington, Texas, obstetrician-gynecologist Tim Gorski, MD, said he hoped Bush would decide that no restrictions should be set. He supports creating embryonic stem cells to do research because he believes the existing cells are "pre-embryos."

"These embryos aren't the same as you see in pictures in the books of embryos implanted in the womb," Dr. Gorski said. "They are not that organized. People need to understand these balls of cells aren't the same."

But Burlington, Vt., family physician Robert Orr, MD, said embryonic stem-cell research shouldn't be allowed to go forward because it is destroying life. He said the end doesn't justify the means, even if there are no plans for the embryos to be implanted.

"If we have an adult dying, we don't hasten the death of the individual to help another individual," said Dr. Orr, a family medicine professor at the University of Vermont.

For many physicians, though, including Dr. Welch, the answer lies between those two ends of the spectrum.

Dr. Welch hopes Bush decides to allow public funding for research on the estimated 100,000 frozen embryos that were created for fertility treatments and are marked to be discarded. "Just to destroy those cells is counterproductive when something good can come out of it," he said. "There are a number of untreatable illnesses. For my patients' sake, we ought to be doing it."

Moral debate

Like those members of Congress who oppose abortion but support embryonic stem-cell research, some physicians believe that one has little or nothing to do with the other. But others have been surprised and troubled by the position taken by those very same members of Congress.

For Indianapolis family physician Scott Ries, MD, the question to be answered is this: Is it OK to use a live embryo, which he believes is a human being in development, to find cures for diseases?

"I'm not so sure that's the right thing to do," said Dr. Ries, an assistant professor at Indiana University School of Medicine's Family Medicine Dept. "To me there's an issue of what is the greater right."

To those who believe that life begins at conception, embryos in Petri dishes are as human as those in the womb and therefore destroying them for the purpose of research is akin to aborting them.

But Gainesville, Fla., ob-gyn Karen Harris, MD, called abortion a very different issue from embryonic stem-cell research, and she is encouraged by lawmakers who have stepped forward to support the research. "Rational thought has prevailed," she said.

Houston, Texas, neonatologist Michael Speer, MD, said he applauded lawmakers in favor of federal funding for embryonic stem-cell research.

"To me, the argument that you're sacrificing embryos doesn't make any sense," he said. "If you are going to discard something, that's no different than taking its life."

Peter A. Schwartz, MD, chair of the Obstetrics-Gynecology Dept. at Reading (Pa.) Hospital and Medical Center, said that while he has a problem with creating embryos for the sake of research, he supports research on embryos that already have been created.

"To me, it's akin to donating organs," he said.

Two paths

Physicians agree that federal funding of stem-cell research will lead to discoveries more quickly than if research is done only with private money. But they are divided on whether federal money should go to only adult stem-cell research or to both adult and embryonic stem-cell research.

Dr. Orr said research should continue only with adult stem cells.

"If we have two pathways to the same result, isn't it better to take the moral high ground?" he asked. "I would like to see vigorous funding for the adult research and continue the ban on embryonic research."

But Vanderbilt University's Frank Boehm, MD, an obstetrician-gynecologist, said research needed to go forward on both fronts because "research" means just that.

"There's no way to know which is best," said Dr. Boehm, director of the Maternal/Fetal Medical Division at Vanderbilt's medical school and chair of medical ethics there. "You have to do side-by-side studies. It is unscientific to assume that you have the answers when you are doing research."

Suburban Chicago ob-gyn James Milam, MD, agreed. "The right thing is to study both of them, because I see the potential in both areas. I'm hopeful that if there is benefit to be derived, that politics don't get in the way."

ADDITIONAL INFORMATION:

One hot topic; two diverse views

"The research is very, very important. With federal funding it would make it that more likely to go forward. ... Even staunch opponents of abortion can see it's a reasonable approach."
-- Timothy Gelety, MD, reproductive endocrinologist, Tucson, Ariz., on stem-cell research using embryos that would otherwise be discarded

"If we have two pathways to the same result, isn't it better to take the moral high ground? I would like to see vigorous funding for the adult research and continue the ban on embryonic research."
-- Robert Orr, MD, family physician, Burlington, Vt., on whether we should pursue adult or embryonic stem-cell research