August 3, 2015--The Case for Fetal-Cell Research

I rarely, very rarely reprint articles from the New York Times or any other source. This op ed piece from last Thursday is an exception. 

It was written by Nathalia Holt, a microbiologist and author of Cured: The People Who Defeated HIV.

At a time when both sides in the agonizing debate about abortion, particularly the sale and use of fetal cells and organs for research and those who oppose it are heating their rhetoric to white hot, this sane piece provides a much-needed perspective. Among many things, what is at stake and how emotionally complicated the issues are. Even for those, like Holt, who support fetal-cell research.

The Case for Fetal-Cell Research

We first acquired the stem cells from the red receptacles of a local hospital's labor and delivery ward, delivered to our lab at the University of Southern California. I would reach into the large medical waste containers and pull out the tree-like branches of the placenta, discarded after a baby had been born. Squeezing the umbilical cord that had so recently been attached to a new life, the blood, ladened with stem cells, would come dripping out.

But sometimes a different package would arrive at our lab. Despite my distaste for wringing placentas, I felt more squeamish about what lay inside the unassuming white box. Packed in the ice was a crescent-shaped liver of dark red tissue: a human liver. Just like the placentas that were discarded after birth, this tissue was originally destined for medical waste following an abortion.

Although their fates were similar, their origins couldn't be more different. One source was the byproduct of celebrations, the other a procedure often marked with stigma and shame. While under the bright focus of the microscope the cells we isolated were indistinguishable, in our minds there was a significant difference.

Stem cell research is a big deal in California, thanks to the Institute for Regenerative Medicine, a state agency that has allocated almost $2 billion in research grants since 2004 (federal funding is still highly restricted). To meet the demand for cells, researchers turned to a procedure protected by federal law: abortions. The discarded tissues from terminated pregnancies, performed up to 24 weeks in California, is a rich source of stem cells.

But only certain fetal cells are useful. While embryonic stem cells, derived from fertilized eggs, can give rise to any cell that makes up the body, as fetal cells develop from the embryo they become committed to specific cell lineages. The liver and thymus, for instance, are packed with the precursor cells to the immune system, while the brain contains neural cells that form the nervous system.

To meet the need for these precursor cells, biotech companies form an essential middleman between tissues donated from abortion clinics and the research labs that need it. They insure that informed consent is obtained, harvest the organs, in some cases isolate and purify the cells, and then ship them out to laboratories. There are profits to be made by such middlemen in what critics call the abortion industry. I fetus runs upwards of $850, not including testing, cleaning, or shipping charges, while a vial packed with pure stem cells can fetch more than $20,000.

The use of fetal tissue in research is not new. Fetal cells extracted from the lungs of two aborted fetuses from Europe in the 1960s are still being propagated in cell culture. They're so successful that today we we still use them to produce vaccines for hepatitis A, rubella, chickenpox, and shingles. From two terminated pregnancies, countless lives have been spared.

It isn't just vaccines. Scientists at the University of California, San Diego, have injected neural stem cells into two patients to treat their spinal cord injuries. And progress is being made in the use of stem-dell therapies against cancer, blindness, Alzheimer's , heart disease, H.I.V., and diabetes.

As impressive as this is, for critics the lives saved cannot make up for those that have been lost. And as important as I believe the research was, I sympathize with the sense of loss, even after leaving the [USC] lab for Boston. 

Every week when the plain white FedEx box was delivered, uneasiness permitted the lab. We all knew that the tissues contained within were precious. We planned our experiments meticulously, trying not to waste a single drop. We rationalized using the cells by telling one another that the abortions would happen regardless of whether we used the tissue for research. And we knew that if we didn't use the tissue it was bound for the trash.

Still, even with our preparations, justification, and sheer excitement that accompanied our research, the fetal cells brought sadness. We wished we didn't have them, despite the breakthroughs.

This is why it was difficult to hear Dr. Deborah Nucatola, Planned Parenthood's senior director of medical service, discuss the organs of aborted fetuses so casually in surreptitiously recorded conversations with anti-abortion activists posing as fetal-tissue buyers. It's understandable that politicians, angered by her callous tone, are investigating how fetal tissue is handled and how research is conducted, despite the strict institutional review that governs the use of anatomical tissue donated to research.

Politicians aren't the only ones looking for answers. Scientists are searching for alternatives to fetal cells. One solution may lie in reprogramming adult cells, creating what researchers call induced pluriponent stem cells. These cells share the ancestral adaptability of embryonic stem cells, yet can also be manipulated to look and act like fetal stem cells.

And yet, every time I worked with a fetal liver, I imagined that somewhere in California a woman had made an agonizing, heartbreaking decision to end her pregnancy. Yet she had also donated her aborted fetus to medical research. I thought of this as I isolated the golden-tinged cells inside the vent hood. A promise had been made; these cells were not simply trash.

The choice I made is repeated every day, in labs all over the world, Researchers have no say in whether a fetus is aborted or developed into a human body; those decisions are made by women and shaped by politicians. Yet their science, performed on discarded tissue, has the ability to save lives. It already has.

November 5, 2014--The New Mediocre

As if we didn't have enough to complain about. We need to make it worse?

That's just what Vanessa Friedman did in a column in last Sunday's New York Times Review, "Mired in Mediocrity."

The title of her piece says it all--things globally, but especially in the United States, are stalled out because we are accepting, even embracing what she calls "the new mediocre."

Her bonafides? She is the Times' chief fashion critic and fashion director. More about that in a moment.

Let me summarize her indictment--

The idea that mediocrity is "the new normal" originates, Friedman claims, with Christine Lagarde, director of the International Monetary Fund, who applied that term to the global economy. It could use a jolt, Lagarde correctly suggests, to get it going, mired as it is, "muddling along with subpar growth."

Fine. But to generalize this to just about everything else is questionable. I do not want to come a across as Pangloss, seeing everything to be the best in "this best of all possible worlds," but to see everything to be the worst in this worst of all possible worlds goes way beyond the defensible and slips more into whining than legitimate analysis.

When she sees the newly emboldened Republicans putting forth an economic agenda that is made up of "a compendium of modest expectations," Friedman sees this this to be a manifestation of "the new mediocre."

Ranging far afield, she sees Twitter losing participants and thus income not because as a fad it is fading but because it has become an example of "the new mediocre."

"Old-guy action films" and "comic-book-hero" flicks that are predominating at the box office, squeezing out higher-quality art-house Indies, is yet more evidence that the the movies that are thriving--what else is new--are yet more evidence that "the new mediocre" is all-pervasive.

And then there is clothing, fashion, Friedman's expertise. Here she sees the same thing--mediocrity.

Enduring the recent spate of fashion shows in New York and Europe, she sees little evidence of new ideas among designers. Rather, she unhappily reports, everything seems deja vu--1960s-style "rock chick dresses," 1970s "flared trousers," 1980s "power jackets," and even 1920s "flapper frocks."

It doesn't get any worse than this, in this worst of all possible worlds.

I've been hearing from disillusioned and generally despondent friends that the Friedman piece sums up what they have been thinking and feeling about the contemporary world. That we are in fact mired in mediocrity. That this not only explains what they are seeing but also helps reconcile themselves to their own unhappy and frustrating circumstances. "It's not my fault," they are in effect saying, "but the larger world's."

I have been pushing back, claiming that though there is much to not feel good or optimistic about, to balance things, one could contemplate making a case in opposition to "the new mediocre" in support of "the new excellent."

A list of things to feel optimistic about would include--

All the advances in medicine and healthcare. Yes, the system for its delivery is deeply flawed, but if one has various types of cancer or needs life-saving, minimally-invasive surgery, with any good fortune, methods and tests and medications are now available that a scant few year ago were only dreams. "The new excellent."

If one is fortunate enough to be in the top 25 percent academically, public education capped by still the best higher-education system in the world could be considered an example of the new or continuing excellent.

Then there is Google, wirelessness, iGadgets, the Internet itself and all the possibilities that these enable--more "new excellent."

Evidence-based philanthropy, best exemplified by the Gates Foundation, which just last week announced it is stepping up its promising efforts to eradicate malaria, is, as part of "the new excellent," making progress on many fronts from environmental conservation to potable water to sustainable economic development. Yes, I know the counter list, but the picture is more balanced than the "new mediocre" people are claiming.

Even in regard to military hardware, while waiting for peace and sanity to break out in the world, drones, as one example of excellence of its own sort, enable battles to rage that inflict fewer civilian casualties than conventional methods. I know many of my anti-war friends (include me among them) will blanch at this, but in realpolitik terms this represents "progress."

At a different level of things to feel good about is the New Brooklyn, ATM machines, E-ZPasses, and the ubiquitousness of really wonderful coffee--my counter case to worrying too much about power jackets and flapper frocks.

One reason to consider the excellent to be at least as pervasive as the mediocre is that it can motivate one to shake the funk, get up off the couch, turn off the TV and iPhone (at least for a few hours a day), and look for ways to become engaged with making things a little better for yourself and the larger world. To take the opposite tack is to me to waste one's life.