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Another issue is that the chemical messenger produced by the implanted stem cells may be excessive or not appropriate compared with the normal levels that will be produced. Again, this anxiety could be offset by considering the likelihood that brain cells, once they are in place, will behave like their naturally occurring predecessors and release chemicals at normal levels, as and when they are stimulated and interacting in their normal micro-environment. In any event, the excessive amounts of chemical messenger released as a result of drugs will be far more likely to go beyond the normal range seen with stem cells, and be far more widespread.
Finally, some might say that the method of delivery could be problematic, involving major brain surgery. In fact, this is not the case: with so-called stereotaxic neurosurgery, the procedure can be performed under local anaesthetic. Only a small hole is made in the skull and a fine needle is introduced, using precise three-dimensional co-ordinatesit is a little like drilling for oil. The diseased area can then be specifically targeted and the injection of cells kept as strictly localised as required.
In summary, we have reason to be confident that, although not without risks and downsides, stem cell therapy could be not just a treatment of choice but a chance to turn the clock back to a situation where we are harnessing the nervous systems natural mechanisms. For an ever-growing number of individuals condemned to a severely compromised lifestyle and
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Lord Turnberg: I, too, congratulate the noble Lord, Lord Patel, on securing this debate, although having listened to him and subsequent speakers I am beginning to feel slightly redundant. I will press on.
My position both as a clinical scientist and as a physician on the value of research using embryonic stem cells is clearly in favour: as a physician because when I practised medicine I was faced every day with patients desperate for cures for diseases for which I could only hope to palliate; and as a scientist because I see research as the only way in which it will be possible to answer patients needs in the future.
As we have heard, research on stem cells shows promise for many patients. Clearly, they will not be the answer to all our ills, but they have the potential to help patients with some pretty nasty diseases. But today I want to concentrate my remarks on the views of the Association of Medical Research Charities of which I have had the pleasure of being the scientific advisor for some years.
Well over 100 charities belong to the AMRC, all of which fund medical research. Some are very large, such as Cancer Research UK, the British Heart Foundation, the Arthritis Research Campaign, some are medium sized, such as the Cystic Fibrosis Trust, Parkinson's Disease Society, Alzheimer's Disease Society and Diabetes UK and some are quite small, but vital for the patients whom they are concerned about, such as the Motor Neurone Disease Society, Epilepsy Research Foundation, Muscular Dystrophy Campaign and the Juvenile Diabetes Research Foundation.
They all have in common the need to support research into the causes and treatments of diseases for which they raise money, largely from the public. Collectively, they fund more than £700 million per annumwhich is larger than the Medical Research Councils contribution. If you add up all the diseases that they covercancer, stroke, heart attacks, diabetes, Parkinson's disease and so forthyou cover a very large proportion of the population either as sufferers or carers. Scarcely a family is not affected by one or more of those diseases.
All these charities are desperate to support good research. They do not all fund research into stem cells, although a considerable proportion does. They all believe that research using embryonic stem cells is sufficiently promising for them to be very concerned if that research was to be prevented.
These charities have their fingers very much on the pulse of public opinion. Most rely on public support to fund them and have lay trustees, and many have active public and patient involvement programmes. They know how much those who experience the reality of suffering disease support research of this type, which is inevitably going to be at the edge of existing knowledge. Of course, they want research on
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One example is the use of eggs derived from animals. These are the eggs from which the nucleus containing all the genes which make an animal an animal has been removed, leaving an empty cell to act as a nest which can provide the protective and supportive environment into which a human cell nucleus can be placed. No mixing of the relevant human and animal genes is involved. A human cell line is developed from these cells which can be used for research into the causes and treatments of serious diseases. The cells are not allowed in any case to develop into embryos beyond the 14-day stage. The sole reason for using empty animal cells is, as has been described, because of the great paucity of human eggs for research. The animal egg cell is an attractive and, to my mind, entirely ethical alternative.
A number of applications are currently before the HFEA for research using stem cells in this way. They are from Newcastle, King's College and Edinburgh for research into diseases such as motor neurone disease, Alzheimer's and Parkinsons disease. I hope and, much more importantly, the patients hopethat this research will be encouraged rather than discouraged.
Baroness Carnegy of Lour: My Lords, I shall say a brief word about human embryonic cell research. Undoubtedly, stem cell research is near the top of the list of the worlds most hopeful enterprises. We in the UK are at the forefront of that endeavour, so my heart sank when last weekend at a party I met a young Roman Catholic priest and I mentioned this debate. Tell them, he said, there are plenty of ways of doing that without killing babies.
I might almost have agreed with that young man when in 1990 I became involved in this House in the passage of the Human Fertilisation and Embryology Bill. That process and the visits, meetings and Committee reports that went with it, changed my mind. The big decision that had to be made then was whether to allow the minute cluster of cells that form the very beginning of the human embryo to be used during the first few days of its existence for research. As someone with a deeply Christian perception of life and a bit of a laymans interest in theology, I gradually came to the conclusion that it was right to allow that research but only for 14 days, only for medical research and under strict licence. Yes, the embryo had the potential to become a person, but at 14 days it was still a tiny cell cluster the size of a grain of sand and as yet without even the earliest development of what would become the spinal cord and nervous system. Importantly, because it would be an embryo surplus to a couples in vitro fertilisation need, it was in any case destined to be thrown away. The potential benefits of research as seen at that time, weighed against those facts, convinced me and the majority in Parliamentand so the Bill became law.
The current anxiety about embryonic stem cell research, which is mainly about the use of human embryos, is the same anxiety as that in 1990. It is, indeed, the same as the anxiety that existed 40 years ago when the noble Lord, Lord Steel, put the Abortion Act on the statute book. That anxiety is linked to peoples understanding of what it is to be human and how and when that understanding grows in response to the revelations of science. It grows at different speeds in different parts of the community.
For us in this country, the seminal legal decision was made in 1990, and it still stands. Embryonic stem cells currently show by far the greatest promise and they can be used for research up to 14 days. The question today is a lesser one by farwhether the type of that research should be extended, how more embryos can become available and how regulation needs improving to enable the extension. Given the facts and with the assurance of careful regulation and the involvement of local ethics committees, which is very important, I believe that the majority of the public are ready for these new developments.
Four years ago, 70 per cent of our population showed support for the use of human embryos. Since then, the media have been full of the possibilities of embryonic stem cells. They have been discussing the unsuccessful attempt by President Bush to slow up research in the United States and progress all over the world.
On the whole, public reaction seems strongly positive on condition that proper regulation exists. After all, most people have family or friends whose medical problems might be alleviated and GPs, who are closest to the public, support progress. We simply must not dally. The Government should think very hard about increasing funding. We should legislate carefully to extend embryonic stem cell research now with matching supervision and licensing. At the moment the United Kingdom is in the vanguard; let us stay there.
Baroness Finlay of Llandaff: My Lords, the scientific community, all those with degenerative diseases and those concerned about the ethics of different aspects of research should be grateful to the noble Lord, Lord Patel, for instigating this important debate.
Stem cells is an umbrella term, often used far too broadly, inappropriately and with little understanding. Fantasy has fuelled scaremongering and the finger has been pointed inappropriately at researchers carrying out high-quality research. Meanwhile, vulnerable patients in desperate situations travel abroad for expensive treatments, where they are effectively robbed in undergoing non-evidence-based interventions, some of which may be harmful. That is a desperate situation for those patients and demonstrates the lack of understanding in the public domain about stem cells.
The science is developing and has huge potential, particularly to halt the progression of slowly degenerative diseases. Haematology pioneered this with haemopoetic stem cell research, which has now
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Recent randomized studies of cell therapy for heart disease represent a milestone in this rapidly developing field while serving as a cogent reminder that many important clinical and fundamental questions have yet to be addressed. We should guard against both premature declaration of victory and premature abandonment of a promising therapeutic strategy. The ultimate success ... is likely to depend on continued and effective coordination of rigorous basic and clinical investigations.
Stem cells, sometimes called progenitor cells, are pluripotent. Immaturity gives the ability to differentiate into different cell lines; hence the appeal of embryonic cells, but the ethical dilemmas abound. I shall confine my remarks to cord blood stem cells and even adult stem cells as they have also been shown to be able to differentiate into tissues such as cartilage, bone, adipose tissue and muscle. Normal adult tissue seems to have a few stem cells present which are responsible for ongoing tissue repair and protection from injury. Many of these are present in normal bone marrow and can be harvested for transplantation. Some are present in the liver and can regenerate, but a few also appear to be present in other tissues as well such as cardiac muscle. These nursemaid cells have an important role and warrant research as well.
It is difficult to know just what we are dealing with when people talk about stem cell research in scientific papers. The immature cell has poorly developed surface markers making it difficult to identify accurately. The only way really to know that a cell is pluripotent is to culture it on different media and see it differentiate. The lack of cell surface markers makes comparison of one research project with another difficult at present. CD34 cells are haemopoetic stem cells that are now relatively easily identified using cytofluorometric analysis, which basically gives the cell a coloured marker. Then you can extract the cell and know what you are dealing with. Those are the ones used in bone marrow transplant.
Intra-coronary and intra-muscular injection of stem cells is promising in cardiology but it is interesting to note that the benefits are marginal and short-lived because these cells die off quite quickly. An important development in the UK is the establishment of cord blood donation through the National Blood Service Banking Centre. Cord blood contains relatively immature cells that would otherwise be discarded. Interestingly, Virgin has entered this area with combined private/public banking whereby 20 per cent of the sample is cryopreserved for that family and 80 per cent donated for public use. It costs the parents about £1,500 but this does not cover the cost of collection in the delivery suite. The National Blood Services three collection centres in Barnet, Northwick Park and Luton and Dunstable now have a 40 per cent ethnic
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These are expensive developments. They are within the framework of the NHS and deserve to be supported. They will costit will be many years before we get financial returnbut we have an important start here in the UK. Even US Republican senators are seeing the value of such research. If research is encouraged, high-quality groups will develop. If not, poorly conducted research using non-vigorous methods will continue. It will only discredit this important area and result in patients continuing to seek quack cures abroad being robbed under false claims. We must support research. We must streamline the regulation of it. We must make sure that the monitoring is done by an expert central body of people who really understand the science, not people who are unduly cautious. That is the only way high-quality research will continue for the benefit of our country.
I am the chair of the Human Genetics Commission, the Governments advisory body on developments in human genetics and their implications for healthcare, ethics, law and society. We see ourselves as a model for how public bodies should operate because all the commissions work is held in public. Our minutes are on our website and our agenda is there, too. We travel the country to have our meetings; we do not just have them in London. We hold evidence-gathering sessions. We have public information fora and we make sure that the public can be present when we hold our meetings. We have a consultative panel of more than 100 people, all of whom have, for whatever reason, an interest in this area of genetic developments, usually because they have a genetic trait within their own family.
While the Human Genetics Commission does not advise government on stem cell research specifically, many of its stakeholders, including members of the consultative panel I mentioned, have a very strong interest in genetic disease and, therefore, in the therapeutic possibilities offered by stem cell research. Recently, the commission discussed the specific issue of the creation of human/animal hybrid embryos. One of the strongest arguments for this research is that it would provide a much needed material resource for projects of stem cell research. One of the strongest reasons for carrying out this research is that it promises to provide therapeutic benefits for people suffering serious and life-limiting diseases. The case which those involved in the research make is strong, both intellectually and morally.
However, work that the Human Genetics Commission has carried out has revealed that there is a wide range of views about the ethics and prospects of stem cell research. For example, our consultative panel of people personally affected by genetic
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Our stakeholders, who are in regular contact with us and attend our open meetings and public information-gathering sessions, and the people who respond to our consultations give a mixture of very nuanced views. I emphasise that word nuance, because it is very often missing from press reports on stem cell research, which describe it either as monstrous or miraculous, but seldom as anything in between.
Some of our stakeholders are concerned about what the enthusiasm for possible cures means for those living with such diseases and our attitudes towards them. Understandably, they feel that the single-minded pursuit of treatments actively devalues those affected by genetic disease and encourages others to treat them as a problem, and sometimes diverts valuable resources from care for those facing such diseases towards possible cures. They would like to see a better balance in how resources are used. Some hold that the eradication of genetic disease amounts to the eradication of a distinct and important genetic group and that it means a form of modern eugenics, but I want to avoid that kind of hyperbole. What is really an issue of concern is that we could be creating a climate whereby the pursuit of perfection is paramount. That coarsens our values, and it dehumanises those who are less than perfect, which means most of us.
In my position as chair of the commission, I have always strongly advocated having such discussions in public so that scientists have to make their case in the public realm, explaining that the work that they do will not involve the devaluing of humanity or risk the creation of alarming new forms of life. It means that we should have those debates even if it means revisiting familiar moral arguments. I urge on this House today the importance of public debate and engagement of the public in science policy development. Good policy and progress in science are made in a context of public acceptance, and that public acceptance allows the establishment of good and successful regulatory regimes. Public engagement is essential to achieving that acceptance. From experience, what we have seen is that where science outpaces public acceptance, for example with genetically modified foods, it can lead to the inhibition of research and of the benefits of that research.
We remember the good side, on the other hand, of assisted reproduction, where early public engagement on the part of the scientific community and efforts to communicate the benefits in terms that could be grasped on a human scale led to widespread public acceptance and greater confidence for the future. Scientific discovery and biomedical innovation are necessarily the area of specialists, but we have to have good public debate. Our work has revealed that the publicnon-specialistsare perfectly capable of understanding complex scientific and moral problems if they are dealt with properly. They have an appetite
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I urge the Government to put more money into the work that the Human Genetics Commission does on public engagement. Public confidence is hard won and very easily squandered. To maintain it, it is important that the benefits of stem cell research are communicated honestly and without hyperbole. That is what I urge on the Government today.
Baroness O'Cathain: My Lords, we must all be very grateful to the noble Lord, Lord Patel, for initiating this debate on such an important area of research. The debate has been utterly fascinating and so informative; it has certainly increased my knowledge base. The absolute imperative that there should be much greater public understanding of stem cell research has just been so wonderfully explained by the noble Baroness, Lady Kennedy of The Shaws. I had a 10-page speech ready, and I could tear it up and just say, Amen to that. However, I have a couple of points to make, but I will stay within six minutes.
As a non-scientist, I have approached this subject from the point of view of caring for humanity, which is probably not unaffected by the fact that all the members of my immediate family, who are now dead and died far too young, would almost certainly have benefited from this type of research had it occurred 10 or 20 years earlier. There is a tremor in my voice even as I think about it. I absolutely agree with the noble Baroness when she asked whether we are in pursuit of perfection. Is it not better to have much happier, better lives, accepting all the flaws and frailties that we have, and try to make the best for all humanity, not just for those who will benefit from this research?
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