Monday, April 20, 2009
A perfect shade of blue
The sky is a perfect shade of blue, and it is 85 degrees out. I’m sitting here, dressed-down in my tank-top and boxers, wanting to bike westward to smell sunscreen. I have finals tomorrow, so I’ll stay seated for now. My bike is waiting, and I probably would go, but I already went to Coachella on Saturday. I should spend some time studying, I guess.
Friday, April 10, 2009
Good Friday, Stem Cells
I've been trying to come up with a coherent argument about stem cells for a long time. This is probably neither coherent or much of an argument for that matter, but I think it does address two fundamental issues surrounding the lay public's and the scientific community's approach to the issue of stem cells.
Writing this on Good Friday, as a lifelong Christian (raised in the Episcopal Church), my mind has been swirly all day with thoughts of faith, death and dying, responsibility and guilt, betrayal, sacrifice, and sorrow. And whether by accident or by desire, I began thinking about stem cells.
The issue of stem cell research has created a cycle of never-ending morality wars, pitted on one side are the fanatical religious, right-to-life, anti-abortion folks. On the other side are the folks yelling and screaming about how preventing stem cell research is like murdering their sick selves (or friends). Neither side has done much of a good job at convincing moderate people to tilt to the extreme. While it looks like the public is generally open to the idea of government-sponsored stem cell research using discarded embryos originally meant for IVF, they aren't picketing the streets (or using the issue as a deciding factor in elections, with some notable exceptions) in favor of one side or the other. But, as it is with so many other issues, the fringe groups are shaping the public discourse on the issue. They tell us that people either, "support lifesaving research" or "don't believe in murdering embryos that have a chance at life." People talk about stem cell research at parties, and they usually feel each other out (make sure they're on the same side of the issue), and then have a glorious time patting each other on the back for supporting the "most logical and just viewpoint." Even scientists find themselves reduced to conversations in which it is acknowledged that the "Bush administration's and christiantist movement's war against stem cell research has now ended," and that basically is the end of the discussion.
So, the implications of moral wars is that they prevent people from delving deeper into stem cells in a discussion. On a societal level, this makes stem cells an easy wedge issue when we consider health, human disease, health care of the future, and deep dilemmas in medicine. Obviously, people find it much easier to have an opinion on stem cells than they do with regards to the care of the elderly, palliative care, genetic discrimination, or the ethics governing clinical trials of life-saving medicines. How many people get into discussions about the moral and ethical issues of marketing and prescribing anti-cancer chemotherapeutics in only the interest of extending a person's life by several months? How many families are able to candidly talk about their decision to support an elderly relative in making the decision to initiate comfort care measures? Have you ever considered how and whether you would decide to undergo genetic testing? Not that these questions aren't brought up, but my point is that perhaps because they (thankfully) have not become easily-packaged wedge issues, they haven't been picked up by the fringe radicals. (Yes, I know, Terri Schaivo was an exception to this. But while her case was picked up and widely debated in the mainstream media, I don't think anyone really resolved how they felt about the issue, just that it shouldn't have become the circus it did. Maybe this is because I still have a challenging time about thinking about the Terri Schaivo case in the abstract, even if I know exactly what I would do...). In any case, we don't engage in the issue nearly enough. Worst of all, many of the people willing to talk about it boil it down to a one liner such as, "Well they just starved Terri Schaivo to death!" or "How dare those smug conservatives prevent a fair and appropriate withdrawal from care, interfering with the family's privacy like that!" The conflicted persons (and the families who are nevertheless forced to make difficult decisions) fall silent, they can't generate a soundbite in the allotted time on "Larry King Live."
A second phenomenon, which is very much linked to the morality wars, is one of inflated and conflated expectations of who, what, where, how, and why stems cells are. In general, the public and scientists (correctly) believe stem cells to be the starting point of organismal life -- they contain all of the genetic information, cellular machinery, and, in response to external and internal cues, they can give rise to fully developed and genetically identical tissue. It has thus been thought that stem cells have the potential for giving rise to the regrowth and re-engineering of tissue in an ex-situ fashion. Unfortunately, this is a sad over-simplification of what and where stem cells (and our knowledge of them) are in the scientific arena at present. Perhaps this is in part due to the fact that both of the fringes (pro and con) can easily justify their points of view using the simplification. For example, the right-to-life folks argue that adult stem cells can easily be used, and will "do the same trick" as those stem cells derived from the blastocyst of discarded IVF embryos. And the pro-stem cell community states that adult stem cells likely won't answer every question and may lack certain key elements that embryonic stem cells would otherwise contain.
Here's the problem I have: this prevents us from truly understanding what stem cell research is, what it should seek to do moving forward, and it denies us the chance to come up with reasonable expectations about what might happen with future stem cell-directed therapeutics. We're so focused on stem cells as a means to an end: a tool for replacing lost or damaged tissue, implanting new (genetically reprogrammed tissue), or as a way to circumvent the need to undergo transplants. I think to focus so broadly on those goals is a huge mistake. We think simply about what we can make, what we can surgically place or inject into a person, and what we may be able to engineer in the laboratory. How often have people spoken instead of stem cell research as a way to unlock secretes about how organs regenerate in situ? (Or, how organs have the intrinsic ability, given the correct internal and external cues, to respond to injury with regeneration instead of with chronic fibrotic and inflammatory processes?) In other words, aren't stem cells important because they offer an opportunity to unlock the internal and external cues that govern tissue genesis and regeneration? Making new organs can come later, or not. But better understanding how to manipulate what we have (rather than what we might transplant) is a more realistic, down-to-earth expectation I have from stem cell research. Maybe it doesn't sound as sexy. But maybe it's more practical.
Perhaps we should start really thinking about the implications of these issues, and stop bickering about abortions and embryo-killing.
Writing this on Good Friday, as a lifelong Christian (raised in the Episcopal Church), my mind has been swirly all day with thoughts of faith, death and dying, responsibility and guilt, betrayal, sacrifice, and sorrow. And whether by accident or by desire, I began thinking about stem cells.
The issue of stem cell research has created a cycle of never-ending morality wars, pitted on one side are the fanatical religious, right-to-life, anti-abortion folks. On the other side are the folks yelling and screaming about how preventing stem cell research is like murdering their sick selves (or friends). Neither side has done much of a good job at convincing moderate people to tilt to the extreme. While it looks like the public is generally open to the idea of government-sponsored stem cell research using discarded embryos originally meant for IVF, they aren't picketing the streets (or using the issue as a deciding factor in elections, with some notable exceptions) in favor of one side or the other. But, as it is with so many other issues, the fringe groups are shaping the public discourse on the issue. They tell us that people either, "support lifesaving research" or "don't believe in murdering embryos that have a chance at life." People talk about stem cell research at parties, and they usually feel each other out (make sure they're on the same side of the issue), and then have a glorious time patting each other on the back for supporting the "most logical and just viewpoint." Even scientists find themselves reduced to conversations in which it is acknowledged that the "Bush administration's and christiantist movement's war against stem cell research has now ended," and that basically is the end of the discussion.
So, the implications of moral wars is that they prevent people from delving deeper into stem cells in a discussion. On a societal level, this makes stem cells an easy wedge issue when we consider health, human disease, health care of the future, and deep dilemmas in medicine. Obviously, people find it much easier to have an opinion on stem cells than they do with regards to the care of the elderly, palliative care, genetic discrimination, or the ethics governing clinical trials of life-saving medicines. How many people get into discussions about the moral and ethical issues of marketing and prescribing anti-cancer chemotherapeutics in only the interest of extending a person's life by several months? How many families are able to candidly talk about their decision to support an elderly relative in making the decision to initiate comfort care measures? Have you ever considered how and whether you would decide to undergo genetic testing? Not that these questions aren't brought up, but my point is that perhaps because they (thankfully) have not become easily-packaged wedge issues, they haven't been picked up by the fringe radicals. (Yes, I know, Terri Schaivo was an exception to this. But while her case was picked up and widely debated in the mainstream media, I don't think anyone really resolved how they felt about the issue, just that it shouldn't have become the circus it did. Maybe this is because I still have a challenging time about thinking about the Terri Schaivo case in the abstract, even if I know exactly what I would do...). In any case, we don't engage in the issue nearly enough. Worst of all, many of the people willing to talk about it boil it down to a one liner such as, "Well they just starved Terri Schaivo to death!" or "How dare those smug conservatives prevent a fair and appropriate withdrawal from care, interfering with the family's privacy like that!" The conflicted persons (and the families who are nevertheless forced to make difficult decisions) fall silent, they can't generate a soundbite in the allotted time on "Larry King Live."
A second phenomenon, which is very much linked to the morality wars, is one of inflated and conflated expectations of who, what, where, how, and why stems cells are. In general, the public and scientists (correctly) believe stem cells to be the starting point of organismal life -- they contain all of the genetic information, cellular machinery, and, in response to external and internal cues, they can give rise to fully developed and genetically identical tissue. It has thus been thought that stem cells have the potential for giving rise to the regrowth and re-engineering of tissue in an ex-situ fashion. Unfortunately, this is a sad over-simplification of what and where stem cells (and our knowledge of them) are in the scientific arena at present. Perhaps this is in part due to the fact that both of the fringes (pro and con) can easily justify their points of view using the simplification. For example, the right-to-life folks argue that adult stem cells can easily be used, and will "do the same trick" as those stem cells derived from the blastocyst of discarded IVF embryos. And the pro-stem cell community states that adult stem cells likely won't answer every question and may lack certain key elements that embryonic stem cells would otherwise contain.
Here's the problem I have: this prevents us from truly understanding what stem cell research is, what it should seek to do moving forward, and it denies us the chance to come up with reasonable expectations about what might happen with future stem cell-directed therapeutics. We're so focused on stem cells as a means to an end: a tool for replacing lost or damaged tissue, implanting new (genetically reprogrammed tissue), or as a way to circumvent the need to undergo transplants. I think to focus so broadly on those goals is a huge mistake. We think simply about what we can make, what we can surgically place or inject into a person, and what we may be able to engineer in the laboratory. How often have people spoken instead of stem cell research as a way to unlock secretes about how organs regenerate in situ? (Or, how organs have the intrinsic ability, given the correct internal and external cues, to respond to injury with regeneration instead of with chronic fibrotic and inflammatory processes?) In other words, aren't stem cells important because they offer an opportunity to unlock the internal and external cues that govern tissue genesis and regeneration? Making new organs can come later, or not. But better understanding how to manipulate what we have (rather than what we might transplant) is a more realistic, down-to-earth expectation I have from stem cell research. Maybe it doesn't sound as sexy. But maybe it's more practical.
Perhaps we should start really thinking about the implications of these issues, and stop bickering about abortions and embryo-killing.
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