Stem Cell Dialogues

Stem Cell Dialogues: A Philosophical and Scientific Inquiry Into Medical Frontiers

SHELDON KRIMSKY
Copyright Date: 2015
Pages: 280
https://www.jstor.org/stable/10.7312/krim16748
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  • Book Info
    Stem Cell Dialogues
    Book Description:

    Stem cells and the emerging field of regenerative medicine are at the frontiers of modern medicine. These areas of scientific inquiry suggest that in the future, damaged tissue and organs might be repaired through personalized cell therapy as easily as the body repairs itself, revolutionizing the treatment of numerous diseases. Yet the use of stem cells is fraught with ethical and public policy dilemmas that challenge scientists, clinicians, the public health community, and people of good will everywhere. How shall we deal with these amazing biomedical advances, and how can we talk about potential breakthroughs with both moral and scientific intelligence?

    This book provides an innovative look at these vexing issues through a series of innovative Socratic dialogues that elucidate key scientific and ethical points in an approachable manner. Addressing the cultural and value issues underlying stem cell research while also educating readers about stem cells' biological function and medical applications,Stem Cell Dialoguesfeatures fictional characters engaging in compelling inquiry and debate. Participants investigate the scientific, political, and socioethical dimensions of stem cell science using actual language, analysis, and arguments taken from scientific, philosophical, and popular literature. Each dialogue centers on a specific, recognizable topic, such as the policies implemented by the George W. Bush administration restricting the use of embryonic stem cells; the potential role of stem cells in personalized medicine; the ethics of cloning; and the sale of eggs and embryos. Additionally, speakers debate the use of stem cells to treat paralysis, diabetes, stroke effects, macular degeneration, and cancer. Educational, entertaining, and rigorously researched (with 300 references to scientific literature),Stem Cell Dialoguesshould be included in any effort to help the public understand the science, ethics, and policy concerns of this promising field.

    eISBN: 978-0-231-53940-1
    Subjects: General Science, Philosophy, Biological Sciences, Ecology & Evolutionary Biology

Table of Contents

  1. Front Matter
    (pp. I-VI)
  2. Table of Contents
    (pp. VII-X)
  3. ANNOTATED TABLE OF CONTENTS
    (pp. XI-XVIII)
  4. ACKNOWLEDGMENTS
    (pp. XIX-XX)
  5. INTRODUCTION
    (pp. XXI-XXX)

    The term “stem cell,” first introduced in the backwaters of cell and developmental biology nearly 150 years ago, has recently become a central organizing concept in a rapidly growing field of biomedical science. And because of their association with the human embryo, stem cells have also entered the lexicon of popular culture in a maelstrom of controversy. They have come to signify a new frontier called “regenerative medicine.” Stem cells are understood as the master building blocks and regenerating cells of an organism, starting in the fertilized egg and continuing in some form throughout development. Scientists have predicted that once...

  6. HARNESSING STEM CELLS FOR REGENERATIVE MEDICINE
    (pp. XXXI-XL)
  7. DIALOGUE 1 HOPE
    (pp. 1-4)

    Scene: Sitting in a park on an April afternoon, Samuel Franklin, a sixty-six-year-old retired contractor, and his daughter, Rebecca, a physician and Ph.D. medical geneticist, are enjoying a conversation. Samuel is in a wheelchair and tethered to a breathing machine. Classified as a quadriplegic, he has partial movement in the fingers of one hand, enough to move a computer mouse. Rebecca is sitting next to him, on a bench.

    Rebecca: What a glorious day. The sun feels like a radiant message on my back. [After pausing, and in a somber tone] I know today is the fifth anniversary. How do...

  8. DIALOGUE 2 WHY IS THIS CELL DIFFERENT FROM OTHER CELLS?
    (pp. 5-12)

    The idea behind stem cells goes back to the 1800s, when scientists hypothesized that some cells were precursors to other, more differentiated cells. By the early 1900s, the first blood stem cells were postulated by the Russian biologist Maximow and others. A major breakthrough came during the late 1950s and early 1970s, when James Till and Ernest McCulloch collaborated at the Ontario Cancer Institute in Toronto in studying the effects of radiation on the bone marrow of mice. In 2005 they were awarded the prestigious Albert Lasker Basic Medical Research Award, which honors scientists whose contributions to research are of...

  9. DIALOGUE 3 THE PRESIDENT’S STEM CELLS
    (pp. 13-18)

    In the wake ofRoe v. Wade(1973), public sentiment turned to concern that aborted fetuses would be used for research. In response, Congress established a moratorium on the use of federal dollars for fetal research until a national commission could be established to sort out the ethical issues. The commission issued its report in 1975, lifting the moratorium on federal funds but setting strict guidelines on fetal research that applied to tissues derived from aborted fetuses. Research on live embryos awaited the establishment of an Ethics Advisory Board (EAB), which in 1979 recommended that IVF research on embryos up...

  10. DIALOGUE 4 THE DICKEY-WICKER ENIGMA
    (pp. 19-24)

    U.S. Representative Jay Dickey of Arkansas, who served in the House from 1993 to 2000, and U.S. Senator Roger Wicker, who served from 1995 to 2007, contributed a rider to an appropriations bill introduced in 1995 and signed into law by President Bill Clinton in 1996. The so-called Dickey-Wicker Amendment prohibits federal funds to be spent on research that involves the destruction of a human embryo. It has been added to appropriations bills for the Departments of Education, Labor, and Health and Human Services every year since its inception.

    The history of U.S. policy on embryo research can be traced...

  11. DIALOGUE 5 THE MORAL STATUS OF EMBRYOS
    (pp. 25-32)

    By “the moral status of human embryos” we usually mean our obligations to the nascent forms of human life. Embryos themselves have no obligations. In humans, the implantation of the embryo in the uterus begins the approximately nine months of prenatal development. Different nations and cultures have adopted a range of obligations of both the individual and the state to the developing embryo. The issue has become more prominent in recent years with the debates over abortion and the development of new reproductive technologies, especially in vitro fertilization, cloning, and therapeutic uses of embryonic stem cells.

    The ancient philosophers argued...

  12. DIALOGUE 6 CREATING GOOD FROM IMMORAL ACTS
    (pp. 33-40)

    The history of Western ethics has been largely guided by two grand theories: deontology (represented by the ethics of Immanuel Kant) and utilitarianism (represented by the ethics of John Stuart Mill). Deontology is based on the fundamental rightness or wrongness of an action, whereas utilitarianism looks at the total balance of good versus evil when evaluating an act.

    In the wake of heinous crimes committed by the Nazis during World War II, German science was critically examined and deemed responsible as an enabler, contributor, and participant. Jews, Gypsies, the mentally challenged, and other minorities living in Germany or German-occupied territories...

  13. DIALOGUE 7 CIRCUMVENTING EMBRYOCIDE
    (pp. 41-48)

    After President George W. Bush prohibited the use of public funds for embryo research, there remained deep divisions in public opinion on the issue of destroying embryos for harvesting embryonic stem cells. Some scientists became uncomfortable in their complicity with embryocide. In seeking alternatives, they considered working on deactivated embryos, in which critical genes had been removed to render the embryo incapable of implanting in the uterine wall. They believed that research on embryos that had no potential to become a human life would address public concerns. Nevertheless, there remained opposition to embryo research leading to destruction, whether the embryo...

  14. DIALOGUE 8 MY PERSONALIZED BETA CELLS FOR DIABETES
    (pp. 49-54)

    Diabetes is a group of disorders characterized by persistent high blood sugar levels (hyperglycemia). The two most prevalent kinds of diabetes are type 1, or juvenile diabetes, and type 2, which affects adults, usually later in life. The common feature of these disorders is the body’s inability to produce a sufficient amount of the protein hormone insulin, essential for regulating the body’s glucose concentration in circulating blood. Insulin is produced by a group of cells called beta cells, located in the pancreas. In a normal individual, when the amount of glucose in the blood rises, the pancreas released more insulin...

  15. DIALOGUE 9 REPAIRING BRAIN CELLS IN STROKE VICTIMS
    (pp. 55-60)

    Annually, about 800,000 Americans and 120,000 people in the UK suffer a stroke. About a quarter of them will suffer a second stroke. Stroke is the largest cause of disability and the third most common cause of death (after heart disease and cancer); the annual cost to treat victims in the United States is estimated by the Centers for Disease Control at $37 billion, including the cost of health care services, medications, and missed days of work.¹ Stroke can produce paralysis, permanent brain damage, cognitive impairment, loss of speech, and long-term disability. The first stroke raises the risk of a...

  16. DIALOGUE 10 REVERSING MACULAR DEGENERATION
    (pp. 61-66)

    The human retina contains several types of cells, including photoreceptor cells, retinal ganglion cells, retinal pigment epithelium, and inner nuclear layer cells. Macular degeneration is a disease that affects the photoreceptor cells, causing vision loss in the center of the retina, called the macula; a certain amount of peripheral vision remains. The retina is part of the central nervous system. It is unable to regenerate neurons damaged by disease.¹

    There are two basic forms of macular degeneration, known as dry and wet. Dry macular degeneration is age related and affects 1 percent of people over age 50 and 10 percent...

  17. DIALOGUE 11 MY STEM CELLS, MY CANCER
    (pp. 67-74)

    Cancer remains largely an enigmatic disease, according to some scientists—more accurately, a group of diseases with a family resemblance. Some tumors stay put, some metastasize. Some are hormone responsive, some are not. Theories of cancer etiology have evolved and include viruses, somatic genetic mutation, dysfunctional immune systems, and abnormal tissue environments. Cancer cells have an uncanny ability to survive treatment and re-occur. Genomic studies of cancer cells have turned away from organ site classification to the commonality of mutations among cancer cells. The cancer cell taxonomy may be revised from point of origin to type of mutation.¹ In 2013...

  18. DIALOGUE 12 REPROGRAMMING CELLS
    (pp. 75-80)

    The reversal of organismic development has always been, like the movieBack to the Future, a science fiction fantasy. Can an adult be restored to youth? Can we reverse aging?

    Aging, like time, seems to follow an entropic principle. It moves in one direction and cannot be reversed. But this might not be the case at the level of a cell, rather than an entire organism. Each cell in an organism can ultimately be traced back to a pluripotent stem cell, usually a multipotent cell, from which it was eventually differentiated. Can the adult differentiated cell be reprogrammed to the...

  19. DIALOGUE 13 MY PERSONALIZED DISEASE CELLS
    (pp. 81-86)

    The discovery of induced pluripotent stem cells (iPSCs) has opened up a new path for the study of diseases and effective therapies to treat them. Certain diseases result from abnormal cells. By reprogramming abnormal cells from an adult afflicted with a disease using iPSC methods, scientists can re-create the precursor embryonic-like stem cells. These can then be grown, cultured, and differentiated to produce a continuous supply of diseased cells. Studying them will help scientists understand the development of the cell from its embryonic-like state to its mature form found in a particular tissue. For example, culturing neurons from adult animals...

  20. DIALOGUE 14 TO CLONE OR NOT TO CLONE: THAT IS THE QUESTION
    (pp. 87-94)

    The English word “clone” is derived from an ancient Greek homonym that refers to a process of creating a new plant from a “twig,” the literal meaning of the ancient term. In modern biology, cloning describes a process of replicating or producing multiple copies of DNA molecules (molecular cloning), many copies of genes (genetic cloning), unicellular organisms (cell cloning), or whole organisms (organism cloning). DNA or gene cloning is accomplished by transferring a gene from an organism (using recombinant DNA techniques) into a self-replicating bacterium, which uses the machinery of its cell to make copies of the gene. A cell...

  21. DIALOGUE 15 PATENTING HUMAN EMBRYONIC STEM CELLS IS IMMORAL AND ILLEGAL (IN EUROPE)
    (pp. 95-102)

    A German scientist, Professor Oliver Brüstle at the University of Bonn, filed for a patent on December 19, 1997, on neural precursor cells, the processes of their production from human embryonic stem cells, and their use for therapeutic purposes. The patent application claimed that the transplantation of neural cells into the nervous system is a promising method for the treatment of numerous neurological diseases, such as Parkinson’s disease. The patent was granted in 1999. Greenpeace filed a lawsuit with the German Federal Patent Court (Bundespatentgericht) on the grounds that the precursor cells were obtained from human embryos, which were destroyed...

  22. DIALOGUE 16 MY EMBRYO IS AUCTIONED ON THE INTERNET
    (pp. 103-110)

    The company eBay Inc. has revolutionized consumer trading, purchasing, and auctions online. Founded in 1995 by Tufts University graduate Pierre Omidyar, eBay is one of the successes of the dot.com explosion of the 1990s. The company describes its business model: “Buyers and sellers are brought together in a manner where sellers are permitted to list items for sale, buyers to bid on items of interest and all eBay users to browse through listed items in a fully automated way. The items are arranged by topics, where each type of auction has its own category.”¹ Some have described eBay as the...

  23. DIALOGUE 17 HERE COMES THE EGG MAN: OOCYTES & EMBRYOS.ORG
    (pp. 111-118)

    In his essay titled “Regulating Markets for Human Eggs,” David Resnik describes an unusual sale that became a model for the next dialogue. Resnik wrote: “In the fall of 1999, Ron Harris held a human egg auction on his website (www.ronsangels.com). The site featured three female models with accompanying photos and descriptions. Bids started at $15,000, with $1,000 increments.”¹ Human eggs are sold or auctioned off in the United States without regulatory oversight. According to Rudhika Rao, “No federal law limits compensation for egg donors, and only a handful of state statutes address the issue directly.”² Louisiana explicitly prohibits the...

  24. DIALOGUE 18 HUMAN-ANIMAL CHIMERAS AND HYBRIDS
    (pp. 119-130)

    The word “chimera” is derived from Greek mythology. The “Chimaira” was depicted as a fire-breathing female creature of ancient Lycia composed of parts of three animals: a lion, a goat, and a snake. The term has come to mean any mythological creature that is a composite of two or more animals. The earliest literary reference to a chimera is found in Homer’sIliad, where it is described as “a thing of immortal make, not human, lion fronted and snake behind, a goat in the middle, and snorting out the breath of the terrible flame of bright fire.”¹

    In modern biology,...

  25. DIALOGUE 19 STEM CELL TOURISM
    (pp. 131-138)

    The term “medical tourism” refers to patient travel from industrialized nations to foreign clinics for medical treatment. Patients seek foreign treatments for a number of reasons that include lower costs;¹ access to procedures, medical devices, or drugs that are unavailable in their home country; shorter waiting lists for treatments such as surgery; luxurious and private accommodations in foreign treatment centers; and assured privacy and confidentiality.² Under the U.S. regulatory system a drug must be proven safe and effective before it can be licensed for consumer use. The threshold for approval differs across national boundaries. Some nations allow physicians more discretion...

  26. DIALOGUE 20 SOCIAL MEDIA MEET SCIENCE HYPE
    (pp. 139-146)

    Science and the media have become irrevocably intertwined. The mass media report scientific results in leading journals in a form accessible to the popular reader. Increasingly, this summary reporting exaggerates the significance of the results. For example, imagine a study reporting that mice, after being administered a drug, learn to run a maze more rapidly than controls. Once the scientific publication passes through the media food chain, it will most assuredly be announced by a headline, “Drug Enhances Intelligence.” All the caveats and limitations scientists offered in the journal article will be ignored in the popular version.

    The term “hype”...

  27. DIALOGUE 21 FEMINISM AND THE COMMERCIALIZATION OF HUMAN EGGS/EMBRYOS
    (pp. 147-154)

    The next dialogue, which takes place between two feminists separated in age by a generation, explores how women relate to the moral status of embryos. Feminism can be described as a series of social and political movements committed to furthering the rights, opportunities, self-identity, and power relations of women. The feminist movements are viewed by historians and gender studies scholars as having evolved through three stages, sometimes referred to as waves. The first wave of feminism developed in the United Kingdom and the United States during the nineteenth and early twentieth centuries. Women organized around property rights, voting rights, and...

  28. DIALOGUE 22 WAS MY BIRTH EMBRYO ME?
    (pp. 155-164)

    How do we acquire a self-identity? When does it appear in children? And how do we connect our self-identity with the many states and stages of our physical and psychological development? This issue has occupied some of the greatest philosophical minds. A number of philosophers have linked self-identity to our brain or mental states. The distinguished British empiricist John Locke included a chapter on personal identity in his groundbreaking workAn Essay Concerning Human Understanding. Locke, like many intellectuals of his time, believed in mind-body dualism—that two fundamentally distinct substances make up a person. Our identity, according to Locke,...

  29. DIALOGUE 23 EMBRYOS WITHOUT OVARIES
    (pp. 165-172)

    Human eggs and excess embryos have become valuable sources for the development of embryonic stem cells. If restrictions are removed from paying women for their eggs or their discarded embryos contributed to research, and if somatic cell nuclear transfer becomes more prevalent, the demand for oocytes and embryos will be driven up.¹ Imagine for a moment that human embryos or embryolike cells could be produced for use in research as a source of stem cells without using natural human eggs or destroying human embryos. And further imagine that sperm could be produced from the skin cells of a woman. It...

  30. DIALOGUE 24 HOW MY CELLS BECAME DRUGS
    (pp. 173-180)

    A company named Regenerative Sciences established a clinic in Broomfield, Colorado, to treat patients with a range of orthopedic conditions, including fractures that failed to heal and chronic bursitis, with a stem cell therapy it called RegenexxTM. The therapy consisted of mesenchymal stem cells taken from the patient’s bone marrow and grown in tissue culture for about two weeks. In the human body the stem cells produced bone and cartilage. Company scientists conducted some preliminary treatments, which they claimed helped to treat joint problems in some patients.

    According to the Food and Drug Administration (FDA), treatments involving stem cells are...

  31. DIALOGUE 25 A CLINICAL TRIAL FOR PARALYSIS TREATMENT
    (pp. 181-192)

    Spinal cord injury (SCI) has been one of the major medical targets of those seeking to advance stem cell research. The late Christopher Reeve and his wife, Dana Reeve, established a foundation with the mission of using stem cells to cure diseases like SCI. According to the Christopher and Dana Reeve Foundation website: “There are at least three basic opportunities presented by embryonic stem cell research. First, it could lead to the development of innovative replacement or transplantation therapies for diseases and disorders such as spinal cord injuries, diabetes, heart disease, and Parkinson’s disease.”¹ In an interview with June Fox,...

  32. EPILOGUE
    (pp. 193-198)

    When Rebecca Franklin began her journey to gain an understanding of the science and ethics behind stem cells, she was driven by the personal desire to find a cure for her father’s paralysis. What she discovered were many intersecting voices expressing the hopes and dreams of the afflicted, as well as the cautions of those following their moral compass on the use and commercialization of embryos in research and medicine. Stem cells brought regenerative medicine from a backwater research project to the forefront of cell biology. Within a decade and a half, a new field of scientific inquiry premised on...

  33. NOTES
    (pp. 199-220)
  34. GLOSSARY
    (pp. 221-228)
  35. INDEX
    (pp. 229-238)
  36. Back Matter
    (pp. 239-239)