Embryonic Stem Cell Research —
the Hope andthe Debate
By Lisette Hilton
October 4, 2004
Say the words “embryonic stem cell research” and expect responses that are all over the map — from hope and strong support to strident opposition based on religious beliefs to polarizing political debate.
With the presidential election just weeks away, nurses may find themselves on the front lines educating patients and families about stem cell research, a contentious issue between the two major candidates.
“It used to be that the only place you heard about stem cells was in the cancer arena with someone getting a bone marrow transplant. ... Now, stem cells are making news in all these other disease areas, and people are reading [and hearing about it],” says Laurie Badzek, RN, MS, JD, LLM, director of the American Nurses Association Center for Ethics and Human Rights. “Imagine someone who is at the beginning stages of Alzheimer’s who still can comprehend things. That patient will want to know: ‘Is this going to be ready in time for me?’”
Hot campaign topic
In 2001, President Bush, concerned about the destruction of human embryos in the stem cell harvesting process, limited governmental research funding in this area to only those lines of embryonic stem cells created before Aug. 9, 2001. The American Association for the Advancement of Science (AAAS) reports that some 19 viable embryonic stem cell lines are available for that purpose.
What this all boils down to is that the president and his supporters maintain that no embryo should be destroyed no matter what the potential benefits might be, says Mark Frankel, PhD, director of the Scientific Freedom, Responsibility and Law program at the AAAS.
The Democrats have taken a different stand, and many moderate Republicans concur. Former President Ronald Reagan’s son, Ron, made a strong plea in favor of stem cell research at the Democratic National Convention in July. Sen. John Kerry, the Democratic presidential hopeful, says he’ll restore funding for embryonic stem cells if he is elected.
Bush’s limitations on federal funding do not restrict private funding for research on embryonic stem cells. And no restrictions are imposed on adult stem cell research. However, federal funding represents a large portion of research monies. Moreover, many believe embryonic stem cell studies offer more promise. Maria Amador, BSN, CRRN, director of education for the Miami Project to Cure Paralysis at the University of Miami School of Medicine, explains that embryonic stem cells are attractive because they have not yet been assigned their families [specific cell types].
“So, if you take the cells at that stage and put them in their culture dish, perhaps we can find a way to push them toward the lineage that we wish to have,” she says.
According to an Aug. 16 Associated Press report, Nobel laureate H. Robert Horvitz, a Massachusetts Institute of Technology biologist, said that “the Bush administration’s limits on funding for embryonic stem cell research effectively have stopped the clock on American scientists’ efforts to develop treatments for a host of chronic, debilitating diseases.”
Frankel says that a few clinical trials are just beginning or are in the planning stages for the use of adult stem cells, but that scientists are nowhere near human clinical trials with embryonic stem cells.
“We don’t have a lot of access to stem cells because of the administration’s policy on stem cell research,” Frankel says. “Stem cells from embryos are the ones that are the most controversial, least available, and even more nascent with regard to our knowledge and research capabilities as compared to adult stem cells.”
The result is that America is falling behind, according to George Daley, MD, PhD. In an editorial in the Aug. 12 New England Journal of Medicine, Daley notes that the president’s policy has severely curtailed opportunities for U.S. scientists to study the cell lines that have since been established. Some 128 new human embryonic stem cell lines have been produced worldwide since the president’s announcement about three years ago.
On the other side of the debate, many groups are strongly opposed to embryonic stem cell research. The National Right to Life Committee says that the blastocyst [early embryo] is a human life to be respected like any other. And some researchers question the motives of those seeking increased funding.
Jean Peduzzi-Nelson, PhD, research associate professor at the University of Alabama at Birmingham, opposes embryonic stem cell research, but says it’s because adult stem cells are better for patients. They’re less apt to be rejected by the body and cause unwanted effects, such as tumors, she believes. The problem, in her view, is money and the quest for profits. She says the opportunity for patentable intellectual property in adult stem cell research isn’t available the way it is in embryonic stem cell research. For this reason, it’s unlikely that the “best treatment will reach the patient” because there’s no financial incentive needed for the major organizations to pursue it.
The public weighs in
A Harris Poll, released in mid-August, reports that the public supports stem cell research 6 to 1. According to the poll, large numbers of Republicans and Independents, not just Democrats, support the research.
Results from the nationwide survey of 2,242 adults interviewed online by Harris Interactive July 12-18 reveals:
- Those who believe that “using stem cells from human embryos for research comes too close to allowing scientists to play God” have fallen sharply from 40% in 2001 to only 19% now.
- The number of those who believe that “allowing any medical research using stem cells from human embryos should be forbidden because it is unethical and immoral” also has fallen sharply from 32% to 15% in the last three years.
- The level of opposition to stem cell research varies according to people’s religious beliefs. Those who describe themselves as “very religious” are much more likely to oppose stem cell research than those who are “not at all” or “not very” religious (23% vs. 4%). Born-again Christians are more likely to oppose it than are other Christians (21% vs. 9%); and Catholics are somewhat more likely to oppose it than Protestants (15% vs. 10%).
A highly charged issue
In the meantime, only research will uncover the true value of embryonic stem cells to cure or alter the course of disease, but the concept of their use holds promise. That hope has sent associations and several celebrities calling on the Bush’s administration to lift limits on embryonic stem cell research.
The groups represent patients with all sorts of chronic illnesses, such as diabetes, multiple sclerosis, and Parkinson’s disease and those with spinal cord trauma and other types of injuries.
The American Diabetes Association supports the opportunity for scientists in the U.S. to be able to conduct biomedical stem cell research as long as it’s consistent with the recommendations and guidelines of the National Bioethics Advisory Commission. That would include research involving the use of stem cells derived from adults, fetal tissue, or embryo stem cells, according to Cathy Tibbetts, RN, MPH, CDE, president of health care and education for the American Diabetes Association and a diabetes nurse educator at Innova Fair Oaks Hospital in Fairfax, Va.
Speaking from a personal perspective, Suzanne Murray, LVN, an ambulatory care nurse in gastroenterology in Murrieta, Calif., tells her own story of embryo adoption. She gave birth to Mary Elizabeth 15 months ago. The child has no genetic ties to Murray. “She was left over from her genetic family that had had in vitro fertilization. Those are the [stem cells] that you’re talking about regarding stem cell research — those are left over from IVF,” Murray says.
The embryonic adoption, through Nightlight Christian Adoptions in California, was like any other adoption, Murray says. She and her husband went through a full home study, and the genetic family chose them.
Murray is against additional federal funding for stem cell research and believes research should not go beyond what current policy allows. “In all the research I have done, there is a lot more promise in adult stem cells or cord blood stem cells. ... They thawed [the embryo that would grow to be my daughter] two days before she was implanted into me. So she was alive. All I added to her was a warm place to grow, nutrients, and oxygen.” She argues that the available embryos are humans and should be saved for couples suffering from infertility.
Others feel quite differently. Cheri Gunvalson, RN, MSN, staff development coordinator for the Good Samaritan Nursing Home in Clearbrook, Minn., is pushing for anything that might help her son, who has a form of Duchenne muscular dystrophy, and others like him. She believes that stem cell research, including studies with embryonic stem cells, holds promise.
“I’d personally never have an abortion, but I would give my entire body to save my son. What is really most difficult for me is people like President Bush who are for fertility clinics and the production of 5-day-old blastocysts, which a large percentage are not needed and are going in the garbage,” Gunvalson says.
“For me, it’s hypocritical for a president to be for fertility clinics and against stem cell research.”
The 2004 presidential election won’t stop the debate on embryonic stem cell research, no matter who wins. But right now, patients and heath care providers on both sides of the issue are paying close attention to each candidate’s position. As trusted resources for health care information, nurses need to be prepared for questions from patients and families and, at the same time, formulate their own position on this issue.
Type 1 diabetes — the case for stem cell research
To counter the destruction of pancreatic beta cells in Type 1 diabetes, one possible solution is the transplantation of new beta cells, says Alan Cherrington, PhD, chair of the department of molecular physiology and biophysics at Vanderbilt University School of Medicine in Nashville, Tenn. But limits on the amount of available tissue and control of the human immune system are barriers to successful beta cell transplantation.
“There are not enough cadaveric islets available. It takes one of two cadavers to provide enough islets to transplant into an individual to effectively control their disease,” Cherrington says. “And we can’t control the immune system properly, so once we put this tissue in, there is a chance that the body will again attack and reject it.”
Stem cells might allow scientists to develop other sources of beta cells. The challenge, Cherrington says, is to convince these pluripotent cells to become beta cells.
“We need to learn more about the signals involved in creating that outcome,” he says. “By learning more about stem cells and how to make them go in a certain direction, the hope is that we can make enough tissue available to at least begin to approach solving the problem of supply. To the extent that we can have enough tissue available and to the extent that we then learn how to control the immune system in one way or another, then we can actually identify these people, give them islets, and prevent the rejection.”
According to Cherrington, new classes of drugs are being developed that seem to encourage new beta cells to form and old beta cells to divide. These drugs, which could slow the destruction or death of beta cells, probably will be on the market in about two years. A second-generation drug that would encourage cells to move from the precursor state into beta cells might be available in a decade, he says.
“How long it will take for us to be able to take embryonic cells and grow them in culture and tell them ‘I want you to become X’ — that’s probably a long time away, a minimum of 10 years,” Cherrington says. “In 10 years, we will have a better idea of how practical this is, but that’s a long-term solution, and I don’t think you can actually give that a date other than to say it’s a long-term solution.”
For more information
The National Coalition for Health Professional Education in Genetics <www.nchpeg.org> was established in 1996 by the American Medical Association, the American Nurses Association, and the National Human Genome Research Institute. The site is committed to a national effort to promote health professional education and access to information about advances in human genetics.
- The Genetics Resources On the Web (www.geneticsresources.org) site and search engine optimize the use of the Internet to provide health professionals and the public with high- quality information related to human genetics. Nurses with questions can contact Laurie Badzek, RN, MS, JD, LLM, with the ANA Center for Ethics and Human Rights, by phone at (202) 651- 7054, or e-mail lbadzek@ana.org.
- For AAAS materials on stem cell research, go to www.aaas.org for links to several useful resources, including the main AAAS report.
- The Coalition for the Advancement of Medical Research (www.camradvocacy.org) is made
up of nationally recognized patient organizations, universities, scientific societies,
foundations, and people with life-threatening illnesses and disorders. - The International Society of Nurses in Genetics (ISONG) is at www.isong.org.
- Information about stem cells and spinal cord repair is at www.themiamiproject.org/x637.xml.1999.
Editor’s note: For information on the different types of stem cells, bioethical concerns, and current stem cell research, read the continuing education article online at www.nurseweek.com.
Lisette Hilton is a freelance health care reporter.