The debate on stem-cell research: How to decide

President Bush should reject the argument that adult stem cells can take the place of embryonic ones in critical medical research.

Editorial. Aug. 20, 2001.

The intense controversy over federal funding of embryonic stem-cell research has already equaled, at times eclipsed, attention paid to a patient's rights bill or Medicare restructuring, the two putative contenders for top medical issue before the Bush administration.

President Bush is being heavily lobbied by media commentators, religious leaders and political figures to reject federal funding of the most promising, direct and rapid path of stem-cell research -- that is, using embryonic, pluripotent cells -- in favor of limiting funding to adult stem-cell research. To follow that course would be a serious mistake and an enormous disservice to millions of Americans now or in the future faced with devastating illnesses such as Alzheimer's disease, Parkinson's disease, ALS, diabetes, paralyzing injury or heart disease.

Back in January, when federal funding of stem-cell research was still little talked about outside the scientific community, the AMA joined with 122 other scientific and medical organizations in writing a letter to then President-elect Bush. The letter urged him to allow the federal funding for embryonic stem-cell research, previously approved by President Clinton, to move forward.

The letter underscored the important distinctions between what is known about adult and pluripotent, embryonic stem cells: "A vocal minority has argued that adult stem cells will be sufficient to pursue treatments or cures for disease. But, the prevailing expert scientific opinion is that it is far too early to know if adult stem cells have the same potential as embryonic stem cells. For diseases that prove not to be treatable with adult stem cells, impeding human pluripotent stem-cell research risks unnecessary delay for patients who may die or endure needless suffering while the effectiveness of adult stem cells is evaluated."

The letter pointedly added, "We are particularly concerned that those who cite the promise of adult stem-cell research do so without full understanding of the limitations and preliminary nature of much of this research."

Since the time of that letter, the National Institutes of Health has released an extensive review of the literature that, while finding potential for both adult and embryonic stem cells, also concluded that embryonic stem-cell research should continue. Others, including 80 American Nobel laureates have also written to Bush to defend this essential research.

The promise of stem cells is that they can become any type of tissue. But what makes embryonic stem cells special is that they can be obtained easier, cultured faster and are more adaptable than adult cells. Already a small number of embryonic cell lines, derived from embryos or aborted fetuses, have been created using nonfederal money. The issue of federal funding largely turns around the use of these existing cell lines, as well as the potential presented by the use of donated embryos. An estimated 100,000 of such embryos are now frozen after being created during in vitro fertilization treatments.

Those who reject federal funding and often offer adult stem-cell research as an alternative most often do so from an anti-abortion perspective. They cannot reconcile their heartfelt beliefs with research using embryonic stem cells -- nor should they be expected to.

However, most Americans, including many who oppose abortion -- most notably among the latter, lawmakers such as Sens. Frist, Hatch and others -- say they support embryonic stem-cell research. They can reconcile their beliefs with the use of a potential life, but one that will never be implanted in a uterus and is destined to be destroyed, to find cures that will enormously aid society.

Critics of embryonic stem-cell research raise the prospect of the slippery slope to deflate such arguments. Yet the complications that are bound to arise are matters of steps rather than a slope. They will be obvious -- such as the recent (and many would say, unwise) decision by one fertility clinic to create embryos explicitly for research -- and can be explored and addressed. If anything, federal funding offers better hope for oversight and control. And it helps keep the research within our own shores and national values.

The president's decision is expected soon. Both sides want Bush to choose in favor of life. To do so in the fullest sense would also be to choose in favor of science.