The Big Chill
Medical research seems to be on the verge of making miracles -- eliminating deadly disease and growing replacements for human organs. But trouble looms. The raw materials for all this potential magic come from a source that has the mighty anti-abortion movement up in arms.
CAROLYN ABRAHAM, MEDICAL REPORTER
Saturday, July 8, 2000
Vanugram Venkatesh wanted to save babies.
Every year, more than a hundred premature infants die in Canada when their thumb-sized lungs, pink and soft as custard, collapse as the babies take their first gulps of air.
Dr. Venkatesh, a B.C. neonatologist, wondered what specifically caused the malfunction.
To find out, he felt he needed to examine lungs at an early stage of development. So he secured ethics approval from the University of British Columbia and funding from the Medical Research Council, and ordered the lungs of an aborted fetus from a U.S. supplier.
The transaction would bring him days of grief and fear.
Anti-abortionists discovered his order form in files stolen from the company, which they had infiltrated. Dr. Venkatesh had neither terminated a pregnancy nor counselled a woman to do so, but they judged him complicit in crimes against the unborn. Then they punished him with a campaign of harassment.
The battle against abortion is expanding. As tissue taken from human embryos and aborted fetuses becomes important to some of the most promising areas of medical research, laboratories have joined abortion clinics as targets.
In the United States this week, the issue made headline news as anti-abortion groups condemned the American Heart Association's decision to invest heavily in research in human embryonic stem cells, which holds the promise of revolutionary treatments for countless conditions.
The controversy has created a chill among scientists. In fact, no Canadian is known to be working on experiments with human embryonic stem cells, one of the hottest research frontiers.
No matter how laudable the goal to treat disease, anti-abortionists argue, an aborted fetus should never be used for the pursuits of modern medicine.
They are writing this message in letters to Health Canada -- about 50 protesting against fetal-tissue research in the past six months -- and lobbying MPs.
As well, they have asked the Medical Research Council (recently absorbed by the Canadian Institutes of Health Research) for details about the fetal-tissue research it funds.
Mark Bisby, director of programs at the MRC, said that, as a public body, the council is obliged to explain the nature of the projects, but not who is conducting them or where.
"I hope you won't ask me who these researchers are," he said. "There is a campaign by certain right-to-life groups over this issue. . . . I'm sure that's casting a chill through scientists."
Dr. Venkatesh's use of fetal tissue was posted on the Internet last fall. Anti-abortionists published his name, home telephone number and address in leaflets and plastered them on windshields in the parking lot of the B.C. Women's and Children's Hospital, where he worked.
Mindful that abortion doctors have been shot in Canada, the Vancouver hospital cranked up security. "Our primary concern was the safety of our researcher," said Ellen Chesney, a hospital spokeswoman. "It was difficult for him and his family."
To this day, Dr. Venkatesh will not discuss the nastiness that befell him. "I want to leave it behind me," he said.
The debate over fetal tissue has blown wide open since U.S. biologists announced in 1998 that they had isolated human embryonic stem cells, a feat scientists had long imagined.
During the earliest stages of development, these primordial cells have the unique ability to multiply indefinitely before differentiating to form all the tissues and organs that make up the human body.
Scientists the world over are now excited by the prospect of chemically coaxing stem cells to provide a limitless source of fresh parts for ailing and aging bodies: new brain cells for Alzheimer's patients, mint-condition hearts for people with coronary disease, new optical nerves for the blind.
Editors of the medical journal Science chose stem-cell research as the most significant advance of 1999, predicting that it could dramatically change medicine.
But at the moment, the only viable methods of obtaining the cells are to culture them from an aborted fetus or, more simply, to isolate them from a human embryo, thousands of which are "left over" from in-vitro fertilization treatments that create test-tube babies.
This has raised fears among anti-abortionists and other observers that scientists would artificially create life only to destroy it for research purposes.
Abortion opponents generally do not object to in-vitro fertilization to enable couples to have children, but because they believe life begins at conception, they oppose the creation of surplus human embryos by fertility clinics. (Usually, the extra fetuses, like aborted fetuses, are destroyed.)
"Why do they have to create so many?" said Karen Murawski, director of the national public-affairs office of the Campaign for Life Coalition. "An embryo has everything it needs to become a child."
This week, the American Heart Association called stem-cell research an "opportunity to save millions of lives" claimed by cardiovascular disease and stroke, but Rev. Joseph Howard, director of a division of the American Life League, rejected that notion as "gravely unethical."
"Every time stem cells are obtained from a human embryo, the inner cell mass is destroyed, along with an innocent human person," he said. "There is no ethical way to obtain stem cells from a human embryo -- and there are no exceptions to this statement."
While many Canadian researchers are experimenting with animal embryonic stem cells, no academic institution is known to be working with the human version.
"There is a lot of concern about the ethical implications," said Robert Casper, head of reproductive sciences at the University of Toronto.
"I think researchers get a little gun shy about adverse publicity and research institutes are shy about getting involved in research that is very controversial," he said. "It could keep them from getting funding."
Mrs. Murawski said researchers are understandably "fearful about their funding." Her group would consider boycotts of companies or institutions that support research involving aborted fetuses or embryos.
"[Scientists] try to justify the research by saying there is a health benefit," she said. "But is it right to look for any health benefit when the source of your research is ethically wrong?"
Researchers at Toronto's Mount Sinai Hospital are now creating an ethics committee to determine how research using human embryonic stem cells should proceed.
Dr. Casper, who is a committee member, said he hopes that Canadian scientists might avoid controversy by ordering stem-cell lines from the United States because this means that they would not be destroying an embryo themselves.
Learning of the experience of the B.C. neonatologist who had ordered fetal tissue from the United States, Dr. Casper said: "This is the kind of thing scientists worry about. They don't want to be labelled pro-abortion."
Dr. Venkatesh had already left fetal-tissue research for clinical practice when the harassment against him began.
But the non-profit Maryland corporation that shipped him the tissue, the Anatomic Gift Foundation, was still in the business when it became a target.
Anti-abortionists picketed in front of the foundation's office and some of the researchers the company supplied received letters at their homes warning that "the Army of God is watching you."
The foundation felt compelled to stop supplying scientists with fetal tissue. "A campaign of harassment and falsehoods forced us out of that part of our business," said Joyce Pollack, the company's lawyer.
Using fetal tissue in medical research is hardly a new phenomenon. Jonas Salk relied on cells from an aborted fetus in the 1930s to develop the polio vaccine.
But only recently have scientists discovered that fetal cells, which by their nature grow quickly, might be transplanted to replace diseased tissue with a smaller risk of a patient's body rejecting it.
At the same time, scientific research practices have become wide open to public scrutiny.
A quick Internet search of medical literature reveals scientists in Israel transplanting human fetal kidney cells to repair patients' damaged organs. Swedish scientists are investigating whether embryonic cells can help restore hearing loss. Experiments with fetal-tissue transplants for leukemia and Huntington's disease have been tried in various countries.
And every so often, according to University of Toronto bioethicist Peter Singer, a new application for fetal tissue captures the scientific imagination and draws enough public attention to reinvigorate controversy.
"If there had been some kind of moratorium in place preventing fetal-tissue research, it raises the question as to whether it would have stopped some extremely important public-health advances.
"The focal point of the debate now is stem cells," Dr. Singer said. "It used to be Parkinson's disease."
Few people know this better than Lynda McKenzie.
The 46-year-old woman, who suffers from Parkinson's, had dopamine-producing neurons from four aborted fetuses implanted in her brain in December, 1998. She was among hundreds of patients worldwide to undergo the high-profile, experimental treatments that began in the past decade.
Ms. McKenzie happily shared the early results of her procedure at a Toronto news conference last spring: "I can roll over in bed at night without waking up my husband to do it," she said.
After her story was published, letters appeared in her local newspaper in Milton, Ont. One alleged that "full-term babies were being killed" to provide her with new brain cells. Another accused her of exploiting dead babies.
"I was angry that people didn't understand," Ms. McKenzie said in an interview. "I was hurt that people would think I would do something that wasn't nice or against babies or against the concept of life. That's what I did it for. I wanted to do it for the sake of life."
She has since learned that the long-term benefits of the transplant have "not been the miracle doctors hoped for."
Paul Ranalli, a neurologist at the University of Toronto who opposes abortion, said the Parkinson's experiments have been "a miserable failure," showing only slight improvement for patients under the age of 60.
"The unfettered use of fetal tissue should not continue blindly while scientists wait for a breakthrough," Dr. Ranalli said. "Researchers are closing their eyes and holding their noses and we all know in our heart of hearts it's wrong [to use this tissue]. . . . These are babies."
But Ivar Mendez, who runs the only fetal-transplant experiment for Parkinson's patients in Canada, said the work has not been in vain.
"Transplanted fetal cells proved the principle that we could repair the brain," said Dr. Mendez, the head of neurosurgery at Dalhousie University and the QE2 Health Sciences Centre in Halifax.
Mrs. Murawski of the Campaign Life Coalition, who during the 1960s worked in a Sudbury pathology lab handling fetuses who died in miscarriages, said abortion opponents do not "lack compassion" for disease-stricken patients.
But the aborted fetuses used in their treatment "are not a clump of cells," she said.
"My mother had Parkinson's disease and it's not like I wouldn't want her cured," Mrs. Murawski said. "But not that way."
In the United States, the controversy over fetal-tissue research has galvanized not only anti-abortionists, but also patient advocacy groups, which argue that the cures of the future could be at stake.
A newly formed organization called the Patients Coalition for Urgent Research, which represents wide-ranging groups of patients, is lobbying Congress to allow fetal-tissue and stem-cell research to proceed at full speed.
The Bush administration had prohibited government-funded scientists from conducting fetal-tissue research. But President Bill Clinton reversed that ban in the early 1990s, opening the door to fetal grafts for Parkinson's patients.
Since then, excitement over the potential of stem cells in the past year has prompted the government to intervene again.
The U.S. National Institutes of Health recently decided that publicly funded scientists could work on cells cultured from stem cells, but only if the actual stem cells were isolated from an embryo and provided by someone who does not receive government funds. The distinction apparently made it more ethically comfortable to distance research from the destruction of an embryo.
"This has been forcing the creation of middle-man companies [to supply tissue] and pushing the work into the private sector," said Ron Whorton, scientific director of the Ottawa Hospital Research Institute.
Dr. Whorton has paid close attention to the U.S. situation partly because he asked the federal government recently for up to $5-million to create a network of stem-cell researchers in Canada.
To avoid the moral quandary, Dr. Whorton said, the research network plans to concentrate on work that suggests that people of all ages retain a limited number of stem cells in specific regions of the body that regenerate, such as muscle, blood and the brain.
If this is so, researchers may be able to manipulate these cells to behave like embryonic stem cells to form different types of tissue and override any concerns of transplant rejection. Indeed, Dr. Mendez hopes to produce new transplantable neurons from Parkinson's patients' own stem cells.
But early experiments in which researchers have turned stem cells from muscles into blood have not yet been widely replicated.
Samuel Weiss, who discovered stem cells in the adult human brain, suspects that only embryonic stem cells are powerful enough to generate new organs.
"It's inevitable that we will be researching them, and when that happens, we should be discussing where we should go to get these cells," said Dr. Weiss, chairman of the Genes and Development Research Group at the University of Calgary.
"What if a couple suggests, 'How about my husband and I create an embryo in vitro so you can grow up a kidney out of it for my dying child?' "
Dr. Whorton said his major concern is that embryos could become a valuable commodity and "that would be totally out of line."
And not out of the realm of possibility. This spring, a U.S. government committee investigated allegations that an Illinois company was selling fetal body parts to researchers for hefty profits after an anti-abortion group obtained a price list advertising fetal brains for $999 (U.S.), pituitary glands for $300 and eyes for $75 each.
No laws govern the use or procurement of fetal-tissue or embryonic-tissue research in Canada. A federal government embargo on fetal-tissue research imposed in 1988 fizzled and legislation that might address the issue has long been pending.
"Now, with all the press and charge to use stem cells for medical research, this is a real clarion call to get our act together," said Patricia Baird, a professor of ethics and medical genetics at the University of British Columbia.
"It's exciting to scientists and to people who suffer quite serious diseases. But the other people it's exciting to are the people who would like to make a profit from it."
The 1993 Royal Commission on Reproductive Technologies, which Dr. Baird headed, suggested women should be asked to donate fetal tissue for research only after they have decided to have an abortion.
It also said a fetal-tissue donation should not be made for profit or affect the way an abortion is performed.
The commission further recommended that human embryos be procured for research only with informed consent, never sold for profit and not be used for research beyond 14 days old, after which time scientists believe the embryonic nervous system appears along with the earliest possible stirrings of consciousness.
Ottawa has not acted on these recommendations. But even if it did, none of these provisions would alleviate the concerns of anti-abortionists.
As Dr. Ranalli put it: "If [donating their fetal tissue for research] can put an altruistic halo around abortion, then more women will be tempted to have one."
For the past 10 years, Steven Bamforth, a geneticist at the University of Alberta in Edmonton, has run the country's only fetal-tissue repository, a non-profit entity that sends parts of aborted fetuses to a small number of scientists across the country.
(Other researchers generally rely on procuring tissue from abortions performed in their own hospitals, with the approval of academic ethics boards.)
Dr. Bamforth considers fetal tissue to be like any other kind of organ donation. "Using an organ from someone killed by a drunk driver does not condone drinking and driving," he said. "The fact that researchers use fetal tissue does not mean they condone abortion."
About a dozen times a year, Dr. Bamforth and another colleague make regular collections at hospitals and abortion clinics in the Edmonton and Winnipeg areas.
He said he follows the royal commission guidelines and discusses the possibility of fetal donation only with women who have already booked their procedures. "We definitely don't want to be part of their decision to terminate their pregnancy."
Dr. Bamforth maintains the repository because he believes that it will become especially important now that scientists have mapped the human genome. With a blueprint of all the genes that encode human life, researchers will need human tissue to learn how genes interact with one another, he said.
"But governments govern and they have some responsibility in this matter to find out what this country wants," he said, "and if this is not acceptable to a majority of Canadians, then fine, end it."
For six years, he has received harassing phone calls from anti-abortionists accusing him of being in cahoots with baby killers, and "to be honest," he said, "I have feared for my safety."
Dr. Bamforth knows that the researchers who receive tissue from the repository are also apprehensive.
"There's a tremble of fear that runs through each of us," he said. "But our job is to use this tissue to ask scientific questions that will perhaps alleviate the suffering of other human beings.
"So I suppose you're damned if you do and you are damned if you don't."
110,000: Approximate number of elective abortions performed in Canada every year.
2%: Estimated percentage of abortions from which fetal tissue is procured for research.
7,000: Approximate number of embryos left over in the creation of test-tube babies in fertility clinics each year. It is unknown how many embryos are used for research purposes in Canada.
50%: Percentage of surplus embryos that would be available for research.
MAKING BODY PARTS FROM CELLS
Scientists are eager to better understand how human embryonic stem cells develop into the body's 200 different tissue types. The hope is that one day scientists will be able to grow the cells into replacement tissue for damaged or diseased organs or body parts.
A fertilized egg divides and multiplies, becoming a blastocyst, a core of embryonic stem cells surrounded by a protective cell wall.
The stem cells are removed and placed in cultures, where the cells will multiply and begin to differentiate.
Conversing among themselves through a system of chemical signals and receptors, the cells begin developing into the body's specialized tissue types.
The tissue types occur in three groups:
MESODERM: Forms the core tissues of the body, including bone, muscle, cartilage, heart and blood cells.
ECTODERM: Develops into many of the most specialized tissues, including the central nervous system, eyes and ears.
ENDODERM: Ultimately forms the lining of the digestive and respiratory tracts along with the lining of several glands.