January 12, 2019


What Happened to Bioethics? (Yuval Levin, Summer/Fall 2018, New Atlantis, ) 

[C]ritics of the research, and most prominently President George W. Bush himself, tried to offer a kind of case for moderation -- for finding a way to advance medicine while also respecting some boundaries on research, by insisting there was room and time for ethics.

By moderation I don't mean finding some mushy middle or avoiding controversy. Bush certainly didn't do that. I mean moderation in the deepest sense -- a moderation that consists of properly balancing genuinely competing practical goods by grounding our judgments about them in a commitment to the moral principles at the foundation of our society. That's what a durable moderation in politics would require, and I think it's also a kind of definition of statesmanship: prudence in defense of principle.

Bush tried to do this in two different ways in the course of his presidency. First, in setting his administration's funding policy, he said that the government would fund research using embryos that had already been destroyed before the policy was announced but would not permit federal dollars to be an enticement to further embryo destruction. Whether he found it or not, he was seeking a principled middle ground.

And second, particularly in his second term, Bush emphasized funding research on scientific alternatives to embryo research, and especially on ways of giving non-embryonic cells the characteristics of embryonic stem cells, to avoid the need to destroy embryos. [...]

Under the Bush administration's compromise policy, 21 viable stem cell lines were eligible for research. Today the number is 398, including 20 that have been added since the Trump administration began. But that number offers a misleading impression of the direction of policy.

In fact, funding for embryonic stem cell research has not grown that dramatically since the end of the Bush years. In 2008, the NIH spent $88 million on the research. This year it is set to spend $266 million. That's a lot of money, but it's nothing like the explosion of support researchers expected and Democrats promised once the Bush policy was undone. It's only half as much as the $516 million set to be spent this year on non-embryonic human stem cell research, and 15 percent of all NIH spending on stem cell research -- human and animal, embryonic and adult.

Even more telling, spending this year for research on so-called "induced pluripotent human stem cells" -- that is, adult cells induced to function like embryonic stem cells -- will be fifty percent higher than the amount spent on human embryonic stem cell research. Roughly the same was true over the last three years of the Obama administration. That's telling because the category of induced human pluripotent stem cells didn't even exist for most of the time that the debate over the Bush stem cell policy was going on, and it's fair to say that the category came into being, or at least got a very big boost, as a direct result of Bush's policy itself.

Bush's prohibition on funding for newly created lines of embryonic stem cells propelled the development of alternatives, and therefore encouraged work on developing cells that have the same properties as embryonic stem cells but can be generated without destroying human embryos. This new category of cells could well turn out to be more significant for the advancement of cell biology than embryonic stem cells themselves. The pattern of NIH funding certainly suggests researchers in the field think it is already. And it can, at least in part, be considered an achievement of the Bush policy, and of the prioritization of human life and human dignity in this area of policy.

But of course, neither these new cells nor embryonic stem cells have so far yielded anything like the miracle cures that some politicians were promising a decade ago. That's the most significant story on the stem cell front over this period of relative political calm around the issue: Stem cell science has proven valuable for better understanding developmental biology, but its direct application for therapies looks further off and more implausible now than it did ten and fifteen years ago.

This isn't necessarily a scientific setback: Better understanding the nature of cells and of human development is very important. But as with the more complicated promises of genomics and other flashy subfields of biology, investment in research, rather than opening up a direct path to therapy, often turns out to reveal a more complicated scientific reality. That is what scientific progress often involves.

This argues for humility in the political case for medical research, and it might also argue in particular for taking the time and making the effort to seek scientific paths around threats to human dignity and life in medical research, rather than setting the advance of medicine and the protection of vulnerable human life in opposition to each other. It argues for moderation, rightly understood, and for putting medical research in perspective in a way that makes room for ethics.

Government is exceptionally good at forcing innovation.

Posted by at January 12, 2019 9:19 AM