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Federal Funding of Stem Cell Research, and the War Against Disease
The medical community should be profoundly disappointed, but not surprised, that the recent cloning of a human cell for stem cell research was accomplished in South Korea. Disappointed, because the U.S. is intentionally taking a back seat in a therapeutically vital field of research. Not surprised, because that is the inevitable result of the lack of federal funding for this research. Britain, China, Singapore, and others are aggressively developing stem cell research centers, and some American scientists have already left for foreign shores. In response, the U.S. is vigorously advocating a U.N. resolution to impose a worldwide ban on therapeutic cloning. U.S. Deputy Ambassador James Cunningham says the administration is not "prepared to accept" a partial ban on reproductive cloning alone.
The basis of this policy is the President's (and the so-called Religious Right's) conviction that human life begins at conception. (Considering that those who hold this view generally favor capital punishment, one wag has quipped that "the Religious Right's concern for human life begins at conception and ends at birth!") In this view, cloned cells as well as excess frozen "pre-embryos" from fertility clinics are considered humans, and even those that will be discarded may not be used for life-saving research. This seems to be a consistent position, given its premise, but in one sense, it is incompatible with the duties of the President's office.
Any President, as Commander-in-Chief, must be willing to fight wars despite inevitable casualties, and the war in Iraq has proven this President's readiness to do so. But military conflicts are not the only wars. As physicians, we are acutely aware that the perpetual global war between man and disease has caused more casualties than all of history's shooting wars combined. In New York City, more people succumb to various illnesses in three weeks, than died on 9/11. In regard to the potential of stem cell research, there is thus a certain irony in using the term "pro-life" to describe a policy that would sacrifice countless people, suffering from myriad diseases, to save fertilized eggs. Even if we regard excess "pre-embryos" as humans, we should see them not only as what they are, doomed clumps of cells that will never be implanted in a uterus nor develop their potential as humans, but as the noblest they can be: foot soldiers in the global war against disease. The President's opposition to their use in that war can therefore be viewed as incompatible with his duties as Commander-in-Chief.
From the perspective of freedom of religion also, embryonic stem-cell research should be supported with federal funds. In America, we recognize that religious opinions vary. The world's great religions permit lives to be forfeited for a greater good. Even the most peaceful religion - Buddhism, often permits it; in certain cases, Judaism mandates it. As columnist Ellen Goodman has pointed out, "It's not a question of whether the pre-embryo has any moral worth, but whether it has more worth than a person." Countless Americans of every faith, including conservative Republicans such as Sen. Orrin Hatch of Utah, have no religious objections to therapeutic cloning. Rabbi Moshe Tendler, Professor of Jewish Medical Ethics at Yeshiva University, has called it "inhumane" to abandon it. Recently, even Nancy and Ron Reagan have forcefully advocated it. Any effort to impose one sectarian religious view on the general population actually threatens the separation of church and state. Those with religious objections to stem-cell research are free to refuse its therapies, but the rest of us must be free to benefit from them.
The advance of scientific knowledge cannot be forbidden. The full potential of stem-cell research is unknown, so it will be investigated, here or elsewhere. Despite federal restrictions, California and New Jersey are providing public funds for this vital research, but support from financially strapped states is necessarily limited. Several universities are using private funds to support stem cell research centers. The pivotal question is, without the support of the federal government, will the United States be able to lead research in this exciting field, as it does in most other areas of medical research, or will it cede leadership to others, who will reap the benefits of new therapies? Of the 60 existing stem cell lines that this administration initially claimed were fully adequate for research, at most only 10 to 15 are useable. Worse, none can be used to develop treatments for humans, since all were originally grown on mouse cells, and they could expose humans to an animal virus that our immune systems could not fight. We also know that adult stem cells, though readily available, are not as versatile as embryonic stem cells.
In April, 2002, Senate Majority Leader Bill Frist, M.D. (R-Tenn.), whose opinion on medical issues understandably carries extraordinary weight with his Senate colleagues, announced his support for a bill introduced by Sen. Sam Brownback (R-Kan.) that banned reproductive and therapeutic cloning. (Frist's initial announcement on stem-cell research in July 2001 was optimistically interpreted as representing enthusiasm for stem cell research, but it imposed so many conditions, all predicated on his clearcut statement: "I am pro-life," that his support for the Brownback bill should have come as no surprise. His announcement also insisted that any funding be within a "strictly controlled framework," and "this framework must ensure the highest level of respect for the moral significance of the human embryo.") Moreover, the President's Council on Bioethics is chaired by Leon Kass, M.D., who has called all forms of cloning "repugnant."
As physicians, we have not been bashful about expressing our desire for tort reform, and perhaps because of that priority, we have not spoken out against the federal government's science policies, even though 20 Nobel Laureates from various scientific disciplines have signed a letter doing so. As cardiothoracic surgeons we must always put our patients first. The limitless potential of embryonic stem cell research (new valves, new conduits for bypass, new blood vessels, new hearts?) obliges us to complain publicly about the lack of federal funding for this vital research.