Guests:

• William B. Hurlbut, M.D.

  Professor, Program in Human Biology, Stanford University.

• Irving Weissman

  Director, Cancer/Stem Cell Biology Institute, Stanford University School of Medicine

Transcript:

Peter Robinson: Today on Uncommon Knowledge, stem cell research- getting to the heart of the matter.

Announcer: Funding for this program is provided by the John M. Olin Foundation and the Starr Foundation.

[Music]

Peter Robinson: Welcome to Uncommon Knowledge. I'm Peter Robinson, our show today; The Ethics of Stem Cell Research.

First a word of explanation: embryonic stem cells are undifferentiated cells in embryos that have the ability to become the specialized cells that make up the various components of the human body. Stem cells can become heart cells or brain cells or any other kind of cells. It's this ability of stem cells to become other kinds of cells that has researchers so excited. Work on stem cells, they argue, holds the promise of all kinds of medical breakthroughs. The difficulty? To use embryonic stem cells, the embryos from which they come- the human embryos- must be destroyed. In August 2001, President Bush announced his decision on the federal funding of stem cell research. The government would fund research using already established lines of stem cells, but it would not fund research requiring the destruction of any additional embryos. Did the President draw the line in the right place, and is it a line he can hold?

Joining us today, two guests; Dr. William Hurlbut is a professor in the Program and Human Biology at Stanford University, Dr. Irving Weissman, also at Stanford, is Chairman of the National Academy of Science's panel on the scientific and medical aspects of human cloning. He's also the founder of two adult stem cell research companies, SyStemix and Stem Cells Incorporated.

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Peter Robinson: President Bush said he would permit federal funding of embryonic stem cell research but only on the sixty some lines of stem cells that have already been established, forbidding federal funding on research that would require the destruction of additional human embryos. Do you disagree with the President's decision, agree with it wholeheartedly, agree with it with reservations? Irv?

Irving Weissman: I agree with it with reservations. I agree that we should've started but we need more lines.

Peter Robinson: You need more lines? New research…

Irving Weissman: That's right and I think that he opened the debate- now the debate goes on.

Peter Robinson: Bill?

William Hurlbut: I thought the President's decision was a balanced consideration of both of the very important dimensions of this subject and I welcome it as opening the dialogue that we need to have as a society.

Peter Robinson: But you both view the President's decision not as a final decision but as opening the debate- a starting point?

Irving Weissman: I think it's always dangerous to say, we're going to let the limits of knowledge end here and not go where science and medicine and concerns for human treatment take us.

Peter Robinson: Okay now, can you give me a nice summary statement of why embryonic stem cell research is important?

Irving Weissman: Embryonic stem cells are cells taken from an early stage in the embryo before the cells have made any decisions to make a heart or a brain or blood or muscle…

Peter Robinson: So this is one week, one day- what sort of time frame are we talking about?

Irving Weissman: …this is five to seven days only, at a hundred and fifty cells only. And at that point, you want to be able to grow the cells so that you can see how they make decisions- the cells- to become a heart cell or a muscle cell or a brain cell or for some of us, a hair follicle cell.

Peter Robinson: And why is this research considered so hopeful?

Irving Weissman: It's the part of human development that we know the least about. We've been able to work with mouse embryonic stem cells for about twenty years now. The amount of information we've gained is incredible about how mice develop, how cells develop and we're just learning now how the developmental decisions might lead to an understanding of either the genetic aspects of disease or the development of other kinds of adult stem cells or adult type stem cells which are the direct cells we'll use for therapies in humans.

Peter Robinson: Would you agree with that summary statement?

William Hurlbut: Oh yes, I strongly support the importance of this research and the powerful possibilities. This may turn out to be the most remarkable therapeutic tool in the history of medicine. It's of course equally important that we consider it from a moral perspective.

Peter Robinson: Okay, let's do that…

Peter Robinson: Let's do what Bill suggests and look at this from a moral perspective, tackling the big question: stem cell research and the emergence of human life.

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Peter Robinson: Columnist Nat Hemtoff who's liberal on most issues, on this issue would be described as conservative. And he says the following, "The embryo is demonstrably alive, it's not canine, it's not simian, it's manifestly human. It is therefore human life, and therefore to be revered and treated as sacred, not to be submitted to medical experiments." Brief, clear line of thinking, what's wrong with it Irv?

Irving Weissman: Well first I think it's, uh, Nat Hemtoff's view, and many people's view that at that stage of development--five to seven days--before it even implants in the uterus that is, it's a free floating, um, developmental stage. So it's his view that it is a human with all of the properties that we ascribe to living, breathing, thinking, hoping, working human beings…

Peter Robinson: I don't know that he said all the properties, but it's "demonstrably human."

Irving Weissman: It is certainly demonstrably human…

Peter Robinson: Right.

Irving Weissman: …although you'd have to do a genetic test to know who's human. You wouldn't do it by--you would not know by looking at it. You could not tell it from a mouse blastocyst--that's the stage of development--or any of the vertebrate species blastocysts. So it's--it's--it's a decision that he's made, a very personal decision, a decision every individual who works in this field…

Peter Robinson: Yo--okay, so we know that he made…

Irving Weissman: …has to make.

Peter Robinson: …the decision, but where is the error in his thinking?

Irving Weissman: It's his--it's--there's no error in his thinking according to him. But we're a diverse society.

Peter Robinson: Is it an error in his thinking according to you?

Irving Weissman: Oh yeah.

Peter Robinson: Do you deny that it is alive and do you deny that it's human--one or the other?

Irving Weissman: Uh, I do not believe it has the properties that I would ascribe to humans.

Peter Robinson: Okay, what are those properties?

Irving Weissman: Capable of thought directly, not the future that thought might occur and it's not a--just a current issue. It's been an issue with us for a long time is; when does human life begin? And I would say, and we'll get to this, you've got to balance this against the human lives that can be treated, eventually, from the knowledge we gain.

Peter Robinson: Bill what do you with--with the Nat Hemtoff statement, an embryo is "demonstrably" alive and it's "demonstrably" human--it's human life--we live in a society that as an outgrowth of five thousand years of Judeo-Christian teaching and belief--holds human life sacred--Commandment Six, thou shalt not kill. What do you do with that?

William Hurlbut: I think it's a--a vexing problem--the status of the early embryo but the...

Peter Robinson: It is vexing?

William Hurlbut: It's a vexing question because there are questions about when individuation…

Peter Robinson: What--what strikes me about Hemtoff is that it's quite simple…

William Hurlbut: Uh huh.

Peter Robinson: …anyway, sorry, go ahead.

William Hurlbut: Well, having said it's vexing…

Peter Robinson: Um hm.

William Hurlbut: …let me--let me articulate the--the what's sometimes called the religious or the pro-life or whatever point of view. First of all, as a physician, and I think Irv would agree on this, we--we're intrinsically pro-life. I mean that, that--now then the question is how do you define--when do you define human life? If you look at that little clump of cells, it's hard to relate to it as--as human. It's hard to--it's an embryo--it just has very little form. When you understand it looking backwards, you see it somewhat differently. You--you see…

Peter Robinson: Looking backwards you mean, looking backwards…

William Hurlbut: …looking at the person that was formed from the embryo. You look backwards and you see the--even then the early outlines of potential, outlines of form. And you see it as the early dawn of the emergence of a person, or the first quiet notes of a majestic symphony. And I think we have to take very seriously those considerations. We need to have this dialogue and really open ourselves to the consideration of when life emerges because if we don't…

Peter Robinson: When does it emerge?

William Hurlbut: …it--you're asking me for an absolute answer?

Peter Robinson: I'm asking you for an answer we can act on.

William Hurlbut: Well…

Peter Robinson: It's a question of public policy.

Peter Robinson: Now Bill seems to want to have it both ways--where does he really stand?

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Peter Robinson: Irv's position strikes me as intellectually completely consistent. It may not be consistent if you follow the development of the blastocyst through its various phases. At some point I may say Irv, now wait a minute, tell me when it becomes a human. But Irv is at least saying look, five to seven days, I don't know perhaps when it becomes human, but it ain't then. And once Irv makes that decision, everything follows. I want to hear something--I mean, it seems to me you're saying there's some goodness in Nat Hemtoff's position but--but Nat Hemtoff's position by it's very nature is a--quite an absolutist position. It's saying keep your hands off the embryo--full stop.

William Hurlbut: You know if--if it was my personal decision…

Peter Robinson: Right.

William Hurlbut: …that would be my decision too. I--I would not do an abortion or participate with abortion. But I don't pretend to make the decision for everybody else. And I think it's time we had a very profound discussion in this society and thought deeply through these questions, because if the--if the date is fourteen days as the--as the, uh, British Parliament has said, they allow, uh, even creation of embryo's and research up to fourteen days…

Peter Robinson: So the, uh, so British--British have taken up the question and they've decided that up to fourteen days you can do effectively anything with a--with the embryo?

William Hurlbut: They say that you can do certain types of research relating to contraception--to--to--to, uh, fertility treatments…

Peter Robinson: Okay.

William Hurlbut: …a few limited things. But they don't open themselves even at that stage for fourteen days to just blanket opportunity to go in and create embryos and investigate them in any way open. But look--fourteen days--what if it turns out that harvesting cells at sixteen days is fruitful for therapeutic medicine, are we going to extend it or not? What about if it's thirty-two days, what if it's six months, what if it's…

Peter Robinson: Why--why are you nodding knowingly, have you got answers to these questions?

Irving Weissman: I have an opinion.

Peter Robinson: What's your opinion?

Irving Weissman: I--I think first that you must realize that as scientists…

Peter Robinson: Right.

Irving Weissman: …we don't make a decision what we're going to do and then no matter what, act on it.

Peter Robinson: Right.

Irving Weissman: So when the era of recombinant DNA, which had exactly the same furor, that is putting two pieces of DNA from two different species together, was debated in the '70's, the scientists themselves said we need to have an advisory panel. The advisory panel has to have ethicists, scientists, doctors and so on to look at these issues. And all of us since then have proposed our research to these panels, had them judged by people who had societal interests in mind…

Peter Robinson: Right.

Irving Weissman: …not just our own research…

Peter Robinson: You're talking about DNA now right?

Irving Weissman: DNA…

Peter Robinson: Right.

Irving Weissman: …and it's the same for this. 'Cause if you're in Britain and you want to do development of an embryonic…

Peter Robinson: Right.

Irving Weissman: …stem cell line from a pre-designed, predetermined embryo that you found--you still have to go through those kinds of institutional and super institutional committees.

Peter Robinson: And there's a certain tidiness about it because once a scientist gets his work cleared by a semi-governmental authority, then he is in the clear.

Irving Weissman: It's more than just tidy.

Peter Robinson: More than tidy?

Irving Weissman: It's more than tidy. And--and--and what we have to understand is that we don't know enough to make a decision, as Bill says, for the rest of society. If we base our decisions on religion, as you know in our country, we have a complete separation of church and state. There's a good reason for that.

Peter Robinson: Yeah, well, on the other hand there are certain moral imperatives that we have recognized. Murder is against the law…

Irving Weissman: Sure.

Peter Robinson: …in all fifty states.

Irving Weissman: Absolutely.

Peter Robinson: Slavery, now, yo--I don't think anybody at this stage of the game would argue, well slavery--William Lloyd Garrison--the abolitionists were simply attempting to impose their view on others which, however, is exactly what they were attempting to do. But the nation made a decision on that and nobody today would argue slavery's a matter of personal choice.

Irving Weissman: They didn't say--they didn't say because my church told me to do it, did they?

Peter Robinson: Almost certainly.

Irving Weissman: No they didn't.

Peter Robinson: Absolutely! William Lloyd Garrison was a minister.

Irving Weissman: We--we made--but we made it a decision as a society…

Peter Robinson: It was a directly religious…

Irving Weissman: …because slavery was wrong.

Peter Robinson: But the agitation undoubtedly arose out of a religious point of view.

Irving Weissman: All kinds of reasons come into it…

Peter Robinson: Right.

Irving Weissman: …but the fact is, we make our decisions as a state absent the religious direction.

Peter Robinson: Right.

William Hurlbut: Bear in mind that President Bush's decision was not a prohibition of this research.

Peter Robinson: Right.

William Hurlbut: It was the--it was a statement concerning the use of public funds. And a huge, huge number of people, by some polls the majority of people, opposed this kind of research. And I think we ought to take that seriously. Whether it's from a religious perspective or a scientific perspective.

Peter Robinson: So…

William Hurlbut: And by the way, there are a lot of scientists who--who are concerned about this. I think most scientists want to see this as I do--go forward in a moral way. Progress walks forward on two legs; scientific technology and morality. We are heading into a territory where the question will not just be stem cells at five to seven days, and I think Irv would agree with me on this, eventually we're going to face the question of what value could we learn from studying an embryo that's thirty days old if we could keep it alive--and people are trying to do that--keep it alive outside the womb. What--what research will we do, even in the womb--French Anderson is an advocate of, and researcher, thoughtful man in--in ways, I don't agree with everything he says--but he suggests that we actually do, uh, experiments on, uh, fetuses destined for abortion to see if we could effectively do genetic engineering and then abort them and see if it worked. Well, I think most people would have a problem with that. So we have to face these questions…

Peter Robinson: That's because there's the notion of personhood, at some stage--three months, six months--the fetus becomes a person.

Irving Weissman: Yeah, I think that--I don't want to go down the slippery slope argument. I want us to face the issue that's really the important issue now. And the important issue now is will we be able to proceed with the kind of research on human embryonic stem cells…

Peter Robinson: Right.

Irving Weissman: …that can lead us to both a greater knowledge and an understanding of how we can use that knowledge for therapy.

Peter Robinson: And--and the answer is Irv, you can't--the answer is no. You can't proceed, as you would like to proceed without first satisfying Americans that you're not taking us down a slippery slope.

Irving Weissman: Without a doubt.

Peter Robinson: So…

Peter Robinson: So how does a democratic country reach a decision on where to draw the line?

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Peter Robinson: There is some stage--we may not be able to say exactly when--when everybody would say experimentation on this object is wrong because this object is obviously a person, right? Everybody agrees on that. But you've got an American public, uh, Ronald Reagan said that he signed the Liberalization--Liberalization of Abortion law here in California--I can't remember which year that was, but late '60's or early '70's--he was told by the people who were backing the bill that it would only take place in very limited cases, and only in cases when there was a diff--difficult pregnancy, so on. Very limited, and in fact abortion's shot up the ye--the year after he signed that. So Americans are used to the notion of being told now wait a minute, we just do this and it doesn't necessarily lead to anything else, and in fact seeing that they're on the slippery slope. By what mechanism do we say we're going to draw lines? What--do you want another commission like the DNA commission--how do we do this?

William Hurlbut: President Bush has appointed Leon Kass, an ethicist from the University of Chicago…

Peter Robinson: Good move?

Irving Weissman: Oh yeah.

William Hurlbut: …a very serious and thoughtful scholar, could be described sometimes as a conservative but actually he's got--a man of great plasticity of mind. And I think--I really welcome this--this council being established because I think we need to figure out this issue thoughtfully and also the many issues that are implied by it, because a lot of very difficult and deep things are coming, I think we're at a--a hinge of history.

Irving Weissman: Can I just…

Peter Robinson: Sure, go--go ahead Irv.

Irving Weissman: …the panel that he heads--we don't know who's on the panel or how it's going to be constituted, what subjects it will take, but if it is a panel that will look at, uh, requests from the scientific and medical community, to look at an issue that might have an ethical side to it and come back with a reasoned judgment, transparent to everybody that it was examined from all sides--then I think this would be a great thing to have. Just like the Recombinant Advisory Committee opened up recombinant DNA and there's not a person in this room, or in this University who doesn't have a family member or a friend who's life was saved because of the recombinant DNA debate and the permission to go forward and make these important products from recombinant DNA. So we're talking about something that in our lifetimes--twenty some years ago--was a hot topic and it's in already.

Peter Robinson: So you're willing to submit yourself to the decisions of a panel of wise men--wise men and women?

Irving Weissman: Always, I think--wise men and women--I think the important issue that all of us are trying to say to you is that what we can do as scientists and doctors is say, here's where, from a scientific and medical point of view, we see the possibilities. Nobody knows the end of research because research is not research unless it is open-ended, but we're going to stop here…

Peter Robinson: Okay.

Irving Weissman: …and say to you, here's where it is.

Peter Robinson: Let me put…

Irving Weissman: …here's the possibility, as a member of society, you have to help us and others in judging how and whether it goes forward.

Peter Robinson: Okay, now let me put another…

Peter Robinson: Onto a hypothetical question on a possible next step in research using human embryos.

Title:

Peter Robinson: Irv aggressively--you with some reservations--is willing to say, we ought to be able to do research on embryos at ver--a very early stage. Let me ask the next question; what about creating embryos for that purpose, wo--would you permit that?

William Hurlbut: I--I don't think…

Peter Robinson: That is to say so far, the notion is, so far as I'm aware of reading--from reading on this stuff--that you're using in effect left over embryos--embryos that were created for in-vitro fertilization but not finally implanted. And the notion there is, they're destined for destruction anyway, so why not conduct them--you--you submit them to medical experiments, right? That would be the source of embry--embryos with which you'd feel the most comfortable?

Irving Weissman: No…

Peter Robinson: No?

Irving Weissman: …I think that there's all kinds of--what do you mean? The--the…

Peter Robinson: Ethically the most comfortable.

Irving Weissman: Well certainly…

Peter Robinson: Because the alt--the alternative is to create embryos that…

Irving Weissman: The ones that are--that are going to be tossed, right?

Peter Robinson: Right.

Irving Weissman: …from the IVF--in-vitro fertilization clinics…

Peter Robinson: Right.

Irving Weissman: …that--that was the first lowest hanging fruit. And that's obviously what you would like to do and if you can answer all of the important questions for the lives of the humans that we're going to treat, that's what you would do..

Peter Robinson: Okay. But it's not…

Irving Weissman: Um, and as I said, my personal belief is that the blastocyst, the pre-implantation embryo does not have personhood. So if I'm going to be consistent, I'm going to say it does not have--it does not have a problem of personhood any more than one created by sperm and egg fusion.

Peter Robinson: He's now willing to create embryos for the purpose of submitting them to medical experiments. Do you want to draw the line there?

William Hurlbut: Yeah, I'm uncomfortable with that. I--I'm uncomfortable with creating life…

Peter Robinson: But you've got to grant him--he's being intellectually consistent.

William Hurlbut: I'm uncomfortable with creating life in order to harvest it. But I--I hope--my--look; I really, really want this research to go forward. I want to make that clear. I think it's very, very important research…

Peter Robinson: Would you--would you both agree that this notion of getting the stem cells elsewhere, that is from adult cells--I'm not the expert here--but I've read that they're in bone marrow and certain organs, umbilical blood…

Irving Weissman: Let me clarify that for you. I am a…

Peter Robinson: That--that--you can't use…

Irving Weissman: …that's my field of research…

Peter Robinson: Okay.

Irving Weissman: Okay? In fact, arguably, we were the first to isolate any adult stem cell in mouse or man.

Peter Robinson: Okay.

Irving Weissman: We've studied it carefully. There are a lot of people out there who believe that somewhere in the adult--in the bone marrow or in umbilical cord blood--that there are cells that can turn into anything, the proof is not there.

Peter Robinson: Okay.

Irving Weissman: What we have are a couple of instances, in mice only, where some cells of one type can take on another kind of cell type. So for example…

Peter Robinson: Right.

Irving Weissman: …a blood forming stem cell in the mouse under unusual circumstances, could turn into a liver cell. It cannot turn into everything that a mouse embryonic stem cell can turn into. So quite clearly, if one is stating that we have already, in any species that's a vertebrate, an adult stem cell that can do the same thing as embryonic stem cell--they don't know what they're talking about.

Peter Robinson: Is it such a long shot that you'd oppose federal funding for the adult stem cell research?

Irving Weissman: Not at all.

Peter Robinson: That's not such a long shot? Is that one way out of your dilemma? Just say to the President look--go ahead with this limited funding for embryonic stem cell research, but dump a lot of money on the search for alternatives.

William Hurlbut: I--let me answer that.

Peter Robinson: Sure.

William Hurlbut: I--I--I think that we probably, scientifically, need to do embryonic cell, uh, stem cell research. And I don't have an objection to using a properly, morally procured embryonic stem cell. That's very--a very important distinction. I think it's a part apart from a whole and it does not have the full potential and dignity of a developing human life. The question is how to procure the cells. As for adult stem cells, I--I think we'd be foolish to cut ourselves off from both avenues of approach scientifically. It--it would be a mistake, and it would end up being a moral error.

Peter Robinson: But you're not especially…

Peter Robinson: Last question: what does the future hold?

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Peter Robinson: I want to quote Richard Doerflinger who's a spokesman for the National Council of Catholic Bishops. He says, if embryonic stem cell research were allowed to go forward unchecked then, quote, "the creation and destruction of human life"--Nat Hemtoff--"human life in the laboratory would become an ongoing aspect not only of medical research but of everyday medical practice." Will the creation and destruction of embryos become a routine aspect of medical research in everyday practice? What's your prediction? Irv?

Irving Weissman: Well let me just make an important point about…

Peter Robinson: Okay.

Irving Weissman: …why it's being done. And nobody should get away from this. There's no middle ground in this debate. If one decides to stop embryonic stem cell research, where it is or where it was at the beginning, then you are in effect saying, I believe the pre-implantation blastocyst is a human and therefore it shouldn't be worked on. But on the other hand, there are just hundreds of those that have been used for that purpose. On the other hand, I believe, without even a religious belief, but from scientific and medical grounds, that we're talking about tens and hundreds of thousands of lives. So let's just take it…

Peter Robinson: Tens of hundreds of thousands of lives that could be helped?

Irving Weissman: Of human lives who could be helped…

Peter Robinson: Right.

Irving Weissman: …and may be saved.

Peter Robinson: Okay.

Irving Weissman: And we're saying, let's stop and think about it for five years--ten years…

Peter Robinson: What I'm asking you is…

Irving Weissman: Well let me finish this…

Peter Robinson: You've got to finish fast because it's television. What I'm asking is, as a society will we decide to go ahead and do it?

Irving Weissman: As a society, I think we need to because…

Peter Robinson: Bill?

Irving Weissman: …we have that window of time to save those lives.

Peter Robinson: Will we?

William Hurlbut: I hope not--not unchecked production of embryos. In that sense, I think that--the idea that we become calloused to that is a appalling thought. I think what we should do is above all realize that whatever we do, we should, as the English, uh, professor C.S. Lewis said, answer all our problems with more love not less love.

Peter Robinson: And what's the loving approach to an embryo? Destroy it if it hasn't been implanted--I'm not quite sure where the…

William Hurlbut: Irv, you answer that one.

Irving Weissman: Well I'll an…

Peter Robinson: No, no, no, you raised it. Go ahead.

Irving Weissman: Well, I'm just trying to say that--that we must move ahead with this kind of research because we take the burden of those lives…

Peter Robinson: Right.

Irving Weissman: …if we decide the other way. I'm trying to say you cannot have it both ways. You have to make the decision.

Peter Robinson: That I grant, that I grant…

Irving Weissman: And live with it. And I think that…

Peter Robinson: …I've given you…

[Talking at same time]

Irving Weissman: Anyone, anyone of us--anyone of us who wants to do the next step that could be morally offensive, has to go through your own institutional committee and a national committee probably on Leon Kass' to say are we ready for this next step so that there'll never be a time, as far as I'm concerned, that we should have free reign to create at will even blastocysts for any experiment we want to do.

Peter Robinson: Irv and Bill thank you very much.

Peter Robinson: On stem cell research William Hurlbut wants us to be guided by love, but as the discussion made clear, it's going to take a great deal of thinking as well.

I'm Peter Robinson, thanks for joining us.