Promises, promises: is embryonic stem-cell research sound public policy?

The American love of science goes back to the very beginning of the nation, and so does the hyperbole. The day will come, Benjamin Franklin wrote, when "all diseases may be prevented or cured, not excepting even that of old age, and our lives lengthened at pleasure even beyond the antediluvian standard."

Many scientists would point to the promise of stem-cell research, particularly with embryonic cells, as Franklin's prediction about to come true. But hope and hype, in full display in the drive for government support of the research, are only part of its momentum.

A no less important ingredient of the drive is there in the background, a supposed ethical imperative to cure disease. Nobel laureate Joshua Lederberg put it in the bluntest terms to me some years ago: "The blood of those who will die if biomedical research is not pursued will be upon the hands of those who don't do it." That idea, in almost identical words, has been deployed by Irving Weissman, one of the leading stem-cell researchers. Though written well before the stem-cell era, Michael Walzer noticed still another deep current: "What has happened in the modern world is simply that disease itself, even when it is endemic rather than epidemic, has come to be seen as a plague. And since the plague can be dealt with, it must be dealt with. People will no longer endure what they no longer believe they have to endure."

The campaign for embryonic stem-cell research needs to be demythologized (to use a term from 1960s theology), and there is no better place to begin than with the passage in early November 2004 of Proposition 71 in California, authorizing $3 billion in bonds to support stem-cell research. The campaign for its passage brought most of the familiar hyperbolic ingredients together in a voter-friendly dish. Its proponents made skillful use of a well-tested advocacy formula first developed in the 1950s and 1960s by two wealthy philanthropists, Mary Lasker and Florence Mahoney, lobbying for an increased budget for the National Institutes of Health (NIH): recruit a mix of the rich, members of Congress, Nobel laureates, pitifully sick people, and well-known celebrities to make the case (in this instance Christopher Reeve and Michael J. Fox). Throw in for good measure more than a dash of the financial benefits to be gained by one and all, and don't forget to evoke fears of a competitive loss to other countries if the research does not go forward.

Robert Klein II, a real-estate figure who organized the stem-cell campaign in just that way, has since been nominated by Californian governor Arnold Schwarzenegger to head the state's Institute for Regenerative Medicine, which oversees stem-cell research. Klein has not been given to understatement. The discovery of the potential of stem cells, he said, was "one of the great watershed discoveries in history." The Alliance for Aging Research has claimed that well over a hundred million lives can be saved if the research is successful. That is inflated advertising language to be sure, but hard to resist.

As with many other recent scientific campaigns, it was easier, and politically more helpful, to inflate hopes for the future than to recall earlier failures. Over a decade ago there was a similar controversial campaign to implant fetal tissue in the brains of those suffering from Parkinson's disease. It failed to bring a cure. Then there was the effort, less heated, to push gene therapy as a cure for disease. That therapy has had meager results and, along the way, took the life of a research subject, Jessie Gelsinger. But no letdown has been quite so striking as that following the completion of the highly touted $3-billion federal project to map the human genome. Bill Clinton celebrated the end of that project by saying it would now be possible to "eradicate once-incurable diseases." Such talk is in short supply now. It turns out that there are many fewer human genes than projected, and that, in any case, proteins--the delivery system for genetic expression--may be more important for medical application than genes.

There is a scientific response to stories of that kind. Each of the cited failures may not in the long run turn out to be a failure after all. Good science takes time, with many false steps along the way. The contention that adult stem cells, which can be harvested without embryo destruction, may be as promising in the long run as embryonic stem cells draws a brisk response: the embryonic form looks theoretically more promising but, whichever view turns out to be right, good science wants to go down all available roads, never knowing in advance which will work best.

When I have pointed out to scientists that the NIH is already spending hundreds of millions of dollars pursuing "promising" research on other routes to finding cures for heart disease, Parkinson's, and Alzheimer's, they do not deny that. But now, they say, a new possibility has turned up--and maybe the best of all--and it would be poor science indeed to bypass it. They are not likely to mention that venture capitalists have not found this research a promising market--the benefits too distant, too uncertain, and too expensive to pursue, making for a bad cost-benefit ratio.

That's why government, with deeper pockets, is the place to look for money; taxpayers can more easily bear the economic cost of failure. Nor will scientists usually mention this, living as they do off grant money, but they will do well even if nothing comes of the research. That observation may sound more cynical than I mean it to be. Scientists need money, a good sum of it, to pursue their research. Since much of the medical outcome is almost always uncertain, they have to talk a good game, as would any of us in their situation. That is the only way money can be raised for research of any kind. Serious scientists would not want the money if they did not see some good coming of it, either advances in knowledge or useful clinical applications.

My way of demythologizing the case for public funding of stem-cell research will not, I fear, make much difference, even if plausible. A desperation for cures on the part of many, of biotechnology profits on the part of others, and for new knowledge on the part of scientists is a formidable obstacle. That an otherwise prolife conservative, Senator Orin Hatch (R-Utah), has signed on to the cause is a good sign of its strength, cutting across the usual ideological lines.

Can the fundamental ethical objection make a difference: that even an early embryo, already actualized along the road to full life, has a potential for life that should decisively stand in the way of its destruction? The power of that argument is already weakened by the fact that thousands of frozen embryos, otherwise to be discarded and thus finally destroyed, are available for research. They were created in the first place to help people have children, not a wholly nefarious purpose. Germany wisely limits surplus embryos from IVF procedures to one, but it is the only country I know of to do so.

For many years now I have had endlessly tiresome and unsatisfactory struggles with supporters of embryonic stem-cell research, most with ample ethical sensitivity. The debate usually stalls even before we can get to the kind of nuanced arguments in favor of the full humanity of early embryos that most research opponents press. At that point in the debate, the large and politically decisive argument in favor of the research comes to this: even if the early embryo has a full claim to life, nature itself is profligate in its destruction of them.

Whatever the claim of the early embryo, the argument goes, it is a claim to a future life set against the lives of those whose potential has already been realized but are now burdened by painful and lethal diseases. We don't weep when nature disposes of early embryos, and there are no rituals of mourning for them. The weight of the argument, in short, goes inexorably against the early embryo and in favor of the suffering ill, a weight strong enough to pull many people in the one direction rather than the other. If you take the view that a failure to carry out research is a form of killing--which I consider ridiculous--then the embryo hardly stands a chance.

To make matters worse, natural law or otherwise rational arguments supportive of the moral status of embryos are said in principle to require no religious support. In practice, I can't but note, they don't get very far with those outside of some religious tradition. Proof-text fundamentalism on the Protestant side, or papal authority on the Catholic side, has little weight. The demand in Catholicism that, whether one likes the arguments or not, they must be accepted hardly helps. Outsiders note what looks like coercive moral authoritarianism. If the arguments are so good, so self-evidently compelling, why do they need a church to back them up?

Any serious opposition to embryonic stem-cell research, moreover, has to take account of the possibility, so far exceedingly uncertain, that it may actually work. It is already going on around the world. If a cure for Parkinson's disease appears, not to mention Alzheimer's, will opponents still reject it, favoring the embryo rather than desperate patients?

The odds are against it. Opposition to in vitro fertilization was much stronger than the present opposition to embryonic stem-cell research. But when Louise Brown was born in 1978, that opposition melted faster than a snowflake in the Sahara. Perhaps resistance will continue in the face of success, but what is now only an uphill battle of resistance will turn into the rock climber's equivalent of mastering overhangs, those ledges above one's head, offering no place to find a solid grip while looking for it upside down.

There is a nonreligious way of making an argument against embryonic stem-cell research which just may have some force. It entails a two-part strategy. One part is to challenge directly the notion that there is an obligation to carry out a war against disease. There are plenty of good spending alternatives available to improve our common life. During the campaign drive for Proposition 71, for instance, another story was getting wide media coverage in California: 3.8 million adults in Southern California are illiterate. Three billion dollars applied to that problem would have an almost certain human and economic benefit. That can not be said of the still-speculative venture that is embryonic stem-cell research. Medical research does not, a priori, have a greater claim to support than many other ways of spending money for social benefits.

The second step would be to shift the emphasis from arguments upholding the full humanity of early embryos to a more moderate contention about embryos: that at the least they are owed "respect." Three government commissions in recent years have taken that position, trying to find a middle way between a denial of any value to embryos and one that gives them full value. Even among those who hold they have no value, it is not hard to detect an uneasiness about their position.

That uneasiness is perhaps one reason why there is great discomfort with the idea of creating embryos solely for research purposes, and certainly for commercializing them. The commissions, nonetheless, held that respect is morally trumped by the prospect of life-saving cures from research. If it is better understood that there is no moral obligation to carry out the research in the first place--it is a good, but not an absolute good--then the notion of respect may gain more bite. If the moral claims for the full humanity of the embryo are weak, the moral claims for an obligation to carry out embryonic stem-cell research are even weaker. Respect for embryos in any meaningful sense is, at the least, incompatible with destroying them solely for our medical benefit. They obviously gain nothing but death.

The research imperative already has excessive force. If embryos don't stand much of a chance against it, nothing else is likely to either. If the research imperative is not demythologized and neutralized, there will be no way of stopping many harmful medical developments.

Daniel Callahan is director, International Program, The Hastings Center, and author, most recently, of What Price Better Health? Hazards of the Research Imperative (University of California Press).