To Parkinsn List:

I agree with Bob Fink that Dr. Robert McMichael's posting in the Neurolist was very well thought
out, particularly because it seemed to stimulate further discussion.  Here is my point by point
reply, on the Neurolist, to Dr. McMichael's statements:

Message From: "Jorge A Romero" <[log in to unmask]>

Dear Bob:

I have not gotten into the discussion of this controversy, despite my usual
opinionated manner of proceeding, but I believe you have stated your
viewpoint in a very constructive way, and your points beg for a reply.
(items starting with > are from Dr. McMichael's presentation)

> 1. Stem cell research can be done on animals.

Reply:
Human stem cell research cannot be done in animal cells.  If human diseases
are the target of stem cell research, then the most direct scientific
approach is to study human stem cells.  There are fundamental differences
between human cells and animal cells.  Clearly, some technical aspects of
methodology can be developed using animal cells.  Intellectually, however,
the expected or desired outcome of the research is to allow what we learn
from these cells to be utilized in human applications.  Some techniques can
be developed using animal cells, but ultimately one is more than likely to
require human material, particularly genetic, and the same problems we are
having now about the source of those materials will come up again.  We can
postpone that issue, but we cannot avoid it.  Why is it wise to postpone it
now, if the potential gain is to promote the relief  of human suffering?

> 2. Human stem cells come from embryos, umbilical cord blood (so abundant
but
> ignored), and even adults.  Two of the 3 categories do not require
> destruction of human embryos.

Reply:
True.  However, one needs to keep in mind that even the scientists doing the
research are not secure on the equivalent pluripotential capacity of all
stem cells derived from all sources, as they may have already differentiated
past the necessary events.  In other words, for the research to be thorough,
stem cells from all sources need to be investigated.

> 3. I am skeptical about the claims advanced for stem cells.  Myoblast
> transfer has been a failure in treatment of muscular dystrophy.  This
seems
> to be due to rejection of cells containing foreign cell surface antigens,
a
> problem that would be likely to occur with transplanted stem cells.

Reply:
Skepticism is not scientific proof, but it is part of science.  Some major
scientific advances have been made despite skepticism, by courageous
scientists who had the energy and foresight to challenge preconceived
notions.  The inquisitors were skeptical about Copernicus' and Galileo's
claims.  In modern science, there have been enormous advances in the field
of immunology, which seems to be at the core of this aspect of your
argument.  The capacity to transplant organs, and have these organs survive
for years, was the object of severe skepticism at the beginning, for reasons
that are very similar to your own.  New drugs, new techniques, and new
harvesting and typing methods have been derived in practice, making
transplantation an established and successful therapeutic modality.  To
stall scientific advancement because of skepticism is short sighted.  Why,
many years ago the concept of regeneration of tissues was also discarded
because we all knew that neural tissues do not regenerate.  Now the prospect
exists for some ability to stimulate regeneration or implant regenerated
tissues.  Let's not stand in the way of progress, and give our scientists
the widest possible latitude within the structure of our society.

> 4. The most vociferous advocates of embryonic stem cell research seem to
be
> arguing against any restraints on medical research as much as anything
else.

Reply:
This is not a scientific argument but a political opinion, with which I
agree, except for the pejorative wording you chose.  In the section below
you talk about rights.  Isn't one of our most fundamental rights the freedom
to think and say what we want - to use our intellect to promote ourselves,
society, and mankind.  The choice of wording in your statement needlessly
vilifies the advocates of stem cell research.  Why, if you stated the same
fact in a different way, you could make them appear to be heroes:  "The most
eloquent advocates of embryonic stem cell research seem to be promoting
complete freedom in medical research for the benefit of mankind."

> These comments are political in nature:
>
> 1. Society has a right to regulate the permissible boundaries of medical
> research for safety and for moral reasons.  This includes placebo
controls,
> genetic therapies, and the use of human embryos.  We should expect
> disagreements.

Reply
That is a basic tenet of our societal organization.  The structure of
society also includes and promotes the evolution of human thought to accept
new and challenging ideas and concepts.  Society is capable of change.  Even
our Constitution, which so many use as a basic reference, provides for the
possibility of amendments.  Let's stimulate that change in promising and
productive new directions.

> 2. Human embryos have some legal rights.  If born alive, they are entitled
> to recover damages for personal injuries (including medical malpractice)
> sustained while still embryos.  If born alive, they are entitled to
inherit
> property from persons who died before they were born.  A person who
attacks
> a woman and kills her embryo can be prosecuted for homicide.  I am not
> making this up.  This is the law.

Reply:
The law is written also for the benefit of society.  It can be changed, and
has been changed when necessary and appropriate.  One can work within the
law to promote change.  Let the law serve society and mankind, and not the
opposite.

> 3. The fact that a woman has legal rights superior to those of her unborn
> embryo or fetus, including the right to have an abortion, does not mean
that
> the embryo has no rights.  An embryo outside the womb is generally treated
> as property, but a human embryo may be able to acquire certain legal
rights.
> After all, even the lower animals have some rights against mistreatment by
> humans.

Reply:
Remember that those legal rights are a matter of law.  Those definitions
serve the needs of society.  We are now encountering situations which the
writers of those laws did not anticipate.  We should not apply those laws
without re-examination of how they meet the needs of society, keeping in
mind that what we call "rights" are our expression and interpretation of
fundamental freedoms.  When one freedom conflicts with another, when one
right conflicts with another, then the law written to protect those rights
must reflect an attempt to deal with or resolve that conflict.

> 4. Arrogance by scientists, if they are so foolish as to hold society in
> contempt, can lead to a backlash against researchers, especially if there
is
> some incident that shocks the general public.

Reply:
Once again, you have resorted to ad hominem attacks on the character,
motivation, and wisdom of scientists by your choice of pejorative language,
and pretend to be protecting them against their own foolishness.  Are the
scientists arrogant, or are those who oppose scientific development
shortsighted?  Was Galileo foolish?

We may be living through a second renaissance which will revolutionize old
ideas, and challenge many religious and ecclesiastical concepts, not to
mention legal, moral, and ethical ones.  The first Renaissance challenged
our concepts of the universe, and we learned a lot.  Religion and faith did
not die as a result, but evolved.  In the first renaissance, religious
thought evolved to accommodate progress in scientific thought.  In this
renaissance, we may end up challenging our definitions of human life, and
the concepts of how human life regenerates.  Perhaps we should welcome that
challenge once more, rather than opposing it.

Religion is an intellectual product of man to account for the unknown.  As
we know more about the unknown, religious concepts have evolved over the
centuries and millennia of the existence of man.  Religion will survive.

> President Bush has at least recognized that embryonic stem cell research
has
> multiple aspects and that there are strong and incompatible beliefs among
> different persons.  He has attempted to make a political decision that is
> consistent with the values of society.  Whether his choice was wise will
> become apparent in the next few years.

Reply:
I think President Bush has made an expedient and brilliant political
decision, but has sacrificed an opportunity for leadership which could turn
out to be more revolutionary than when Kennedy launched the space program,
or when Roosevelt launched the New Society.

Human embryos are being produced by in-vitro fertilization.  Suddenly we
find that there is an excess of such embryos, since more are produced than
are actually utilized by the original biologic parents.  Supposing that we
do not use those embryos for anything but human procreation, are we under a
moral or ethical or legal obligation to cultivate those embryos without fail
to the point that they produce a human being with legal rights?  The unused
embryos may be donated to other childless couples.  That is wonderful.  Is
the destruction of the surplus embryos wrong, and the equivalent of
abortion?  If the answer is yes, then some would argue that we should stop
all efforts at in vitro fertilization that would risk the creation of
surplus embryos which might ultimately be destroyed.

If we allow for the creation of the embryos for the purpose of human
procreation, and we allow for the destruction of the surplus embryos, does
it really matter whether you remove a cell or two before such destruction
occurs, or even in the process of such destruction?  The opponents of human
embryonic stem cell research should, if they are to be consistent, also
oppose in vitro fertilization which leads to the formation of excess embryos
some of which would be destined for destruction.  Yet, somehow, that doesn't
make complete sense, since our society has already in large measure accepted
the methods of in vitro fertilization for human procreation, and laws are
being written to serve that change.  Where do we go from here?  Backwards?

The old question, "What happens when an irresistible force meets an
immovable object? then takes very special meaning.  Logically, the existence
of one negates the existence of the other, and therefore the problem can
never arise.  The human intellect seems to have difficulty conceiving
either.  I don't think that legal, ethical, moral, and religious principles
are immoveable objects, since they are the product of the human intellect.
But I do have a very healthy respect for the human intellect as the closest
candidate we have for an irresistible force.

Jorge A. Romero, MD
Baylor University Medical Center
Dallas

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