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I could not agree more with the point about public opinion. When I heard the noble Lord, Lord Patel, say that 70 per cent of the general public supported stem cell research, I thought to myself, “70 per cent? Do they really understand it? Am I a complete moron? I am a non-scientist, but I do not really understand it”. It was only the opportunity to speak in this debate that made me pore over so much of the information. I am convinced that 70 per cent of the public have not done that. I suspect it is like all things scientific; lay people feel that they have to cringe in a corner because scientists have so much more information and such bigger brains, and we probably feel inadequate and just agree with them. That is a serious issue. I have spoken to many non-scientific members of the public about this, and they think that embryonic cell research is a bridge too far. There have been undoubted successes with adult stem cell research. According to my research, something like 72 conditions have been helped by adult stem cell research. The other types of research deal with the sanctity of human life, which I know does not come high on everyone’s agenda, but it does so for quite a lot of people.

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I would guess that the public feel that adult stem cell research is fine, particularly bearing in mind that 72 conditions can be treated with it. People ask about embryonic research, but as far as I can see no treatments have come from embryonic stem cell research. There has been the huge scare story that has already been referred to today of the Korean experiment. People feel that this is an area of potential abuse, and that feeling will grow unless there is a greater understanding of the basic science. The possibility of human-animal hybrids, or chimera embryos, seems to really scare people. It smacks too much of eugenics and of what we are led to believe happened in the 1940s in central Europe. In any case, if such entities were permitted, it would raise huge questions over what is classed as human and what is classed as animal. Some scientists may think that it is an irrelevant question for the purposes of research, but it causes a problem and it raises profound questions about the nature of man and what it means to be human. It also raises significant legal questions. What legislation would cover any formed embryo; legislation affecting animals, or legislation affecting humans? That really concerns me. Maybe I am not aware of enough of the science to be able to make a judgment. We all know that the difference between an animal and a human in genetic terms is very small indeed, and it is not far-fetched to imagine a situation where a court could rule that an embryonic entity is actually an animal and allow it to develop past the 14 day cut-off period for human embryos.

I am almost at the end of my time. I have difficulties understanding much of the hype that surrounds embryo research and, given its lack of success to date and the availability of ethical alternatives that are proving successful, I share concerns about the proposals to amend the law and the possible development of animal-human hybrid embryos, as set out in the recent White Paper. If we insist on pursuing that route, I hope that we will have at least an assurance that there will be fantastic regulation, and monitoring of that regulation, to eliminate the potential for abuse. I am genuinely anxious and concerned. I do not want to knock the science; I am in awe of the science, but many other lay people like me feel exactly the same.

I shall end on this note: until the scientists communicate in the manner of the noble Lords, Lord Patel and Lord Winston, and bearing in mind everything said by the noble Baroness, Lady Kennedy of the Shaws, I will remain concerned.

12.50 pm

Lord Sutherland of Houndwood: My Lords, I, too, thank the noble Lord, Lord Patel, my friend, for introducing this debate. It is an exercise in education and I am delighted to follow the previous two speakers, both of whom have stressed the importance of public understanding of the issues. I appreciated the words of the noble Baroness, Lady Carnegy, who introduced that theme into the debate.

I shall speak from a particular perspective. I have the honour to be president of Alzheimer Scotland, which recently carried out a major survey of its

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members and staff about the issues that concern us today. They are not in the position of assuming that miracles will happen and that the problems of dementia can be solved quickly, but they see this as one avenue of research that could contribute to dealing with a significant human problem.

As a result of that survey, the organisation has formulated a clear policy in support of the development of stem cell research. It is clear in supporting the possibility of hybrids being developed. We need to ask ourselves: who are those people articulating that positive view? They do not assume that there will quickly be a solution to the problems, they are well aware that that is a long way down the road, but they are in the front line of caring for those who suffer from dementia and Alzheimer’s. Significantly, there were 1,000 returns from members and staff who know at first hand the dark shadow of forms of dementia in people’s homes among their nearest and dearest and their friends; they face that and move forward. They are people who give of their time and energy.

Of those 1,000, the vast majority—I would say 100 per cent, but well up in the 90s—are volunteers who provide help and support to those who care. Their viewpoint must be heard and taken into account. This is part of the ethical discussion; they are aware of huge suffering, although they are also aware of the lighter moments and even joys that come from their work—it is not totally dark. On the other hand, they face this issue and their voices should be heard. Of those who responded to the survey, 76 per cent felt that the use of human embryos in dementia research was acceptable; 83 per cent agreed with the use of embryos donated by couples having fertility treatment; and over 80 per cent agreed with the use of aborted foetuses that would otherwise be disposed of. These are significant figures.

The people who took part in the survey think about these issues very carefully, however. There was also support for the use of therapeutic cloning, but it was much less clear cut; 43 per cent agreed that it was acceptable, 34 per cent were against and 22 per cent responded “don’t know”. The “don’t knows” are critical, which is why the points made by the previous two speakers on the importance of educating the public are fundamental.

That set of views comes from an organisation that deals with the issue of caring in the most direct way. That organisation, however, is aware not simply of the cost of caring in individual human and family terms, but of the costs to the economy. I recently took part in a conference in Newcastle on the issues of changes in demography and ageing, and this was identified as one of the major issues facing our civilisation. Rightly, we hear of other issues such as global warming and so on, but if you look at the demography of developing countries as well as that of developed countries, there are changes in the structure of our communities that will be dramatic. The costs are already significant. We have heard some of the figures: in Scotland, between 60,000 and 65,000 people suffer from one form of dementia or another. You can roughly multiply by 11 to obtain the UK

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figure. The costs in Scotland are already between £1.5 billion and £2 billion and it is estimated that they will double by 2031. Again, one can multiply by 11 to obtain the comparable UK figures. We have already heard that the average cost of caring for a person with dementia is more than £25,000 per annum. The cost of someone in supported accommodation is some £31,000 per annum. There is a growing number of such people, because of the demography of our country and the costs will rise dramatically.

I ask three things of the Government. First, there needs to be more education; that was eloquently put by the noble Baroness, Lady Kennedy. Secondly, there should be adequate and sensible regulation. In the minds of many people, regulation quickly becomes over-regulation so a fundamental question is “What is the minimum regulation required?” “What new roles can we think up?”. Thirdly, funds must be targeted. The Science and Technology Committee of this House issued a paper more than a year ago on science and ageing. It asked for strategies in the spending of research money to be followed and encouraged by government. I put it to the Minister that this is one of the areas where such a strategy is required. If we ask these questions properly, the pay-off will be significant to the economy and even more so to the individuals who face this problem daily.

12.56 pm

Baroness D'Souza: My Lords, my thanks go to the noble Lord, Lord Patel, for introducing this debate, which is in large part about principles—whether existing medical and research techniques should conform to current ethical and moral norms in our society, or whether society should recognise the advances in medical science that are made every day and develop new standards to accommodate those advances. There is, as lawyers point out, a fundamental rule in international law, especially that which governs human rights: customary law obliges states to adhere to standards that have been developed throughout the world—for example certain human rights abuses are subject to customary law and can never in any circumstances be condoned. Stem cell research in one of its aspects at least falls into this category of a widely accepted or customary practice. As we have heard, the UK is a global leader in stem cell research and there are centres throughout the world. Nowhere is this research better regulated than in this country, it would appear. The HFE Act 1990 is clear about what is allowed and what is not, and how research should be monitored.

The point here is that stem cell research is an ongoing and major programme in the UK with many successes. Ethical and moral concerns will not cause it suddenly to cease but can guide its procedures as inevitably scientific progress comes up with new techniques to address human suffering. Where should the line be drawn? To assert categorically that it is impermissible to destroy embryos and/or to use animal cells to further this research is to ignore the long path, dating from the early 1970s when the first bone marrow transplant took place, of careful and

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diligent scientific inquiry and public debate that has accompanied each stage. Earlier legislation has allowed us to reach this stage, where radical techniques are now possible. The regulatory safeguards have been amended accordingly.

Given that in vitro fertilisation has become almost standard practice, it has to be acknowledged that there will always be excess embryos which will be destroyed whether or not they are objects of research. I understand that, in the normal course of events, up to 30 per cent of fertilised embryos are lost before implantation by women who may not even be aware that they have conceived. It is neither logical nor necessarily ethical to be concerned with preserving excess embryos, especially if there is a strict time limit on their use.

I ask your Lordships to consider whether it is moral to deny people access to medical techniques that already exist under stringent conditions. Would we be happy to do so if those we most loved faced degenerative conditions such as motor neurone disease, diabetes and/or dementia? Do we want to ignore the animal rights constituency and continue indefinitely with animal models when cellular ones may become more easily available?

My final point concerns the use of embryos as well as of hybrids and chimeras in order to find alternative sources of cells. Much research is going on in these areas and a Stem Cell Bank with international links has already been set up, but needs far more investment to become a genuine alternative resource for medical science. For example, the challenges of safe, long-term storage, if met, could obviate the need for the future collection of embryonic stem cells. In the US, it is claimed that a case of sickle cell anaemia has been cured with transplanted cells harvested from umbilical cords. As I understand it, there is interest in amniotic fluid cells and autologous stem cells, which occur naturally in the body. The reprogramming of adult stem cells from brain, eyes, muscles and bone marrow is a fruitful area of research. All these procedures are waiting in the wings but need far more investment and far more research using embryonic and animal cells to become standard practice.

The history of medical research is replete with accompanying ethical concerns—rightly so. However, these concerns have to be resolved through public debate, public engagement, transparency, regulation and monitoring, and this process is now taking place. The principle that I adhere to is the harvesting with humanity of stem cells, whatever their origin, thereby continuing what scientists are already doing in the interests of public good and an end to some kinds of human suffering.

1.01 pm

Lord Crisp: My Lords, I, too, congratulate the noble Lord, Lord Patel, on initiating this debate and on attracting an eminent group of speakers, such that I arise with great diffidence to make a few comments based on my background of having been involved in health service management for 20 years and in policy-making as a civil servant for the past nine of those. I had better declare the interestsof having been

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chief executive of the NHS and Permanent Secretary at the Department of Health. I think that those perspectives will allow me to make three points: one about services, one about research and one about public trust.

There has already been a great deal of talk about the potential benefits of stem cell research to individuals, patients and all of us—perhaps to whole services—and there has been some discussion about the cost to health services. As a health service manager, I want to hear more about how the development of stem cell research will make far more generic products available to a wide group of patients than is the case now. The noble Lord, Lord Patel, said clearly at the beginning that early research on adult stem cells has been very patient-specific and that the great goal in embryo research—I am looking at my notes to check that I have the science roughly right—is the ability to produce more generic products, which may then have an effect on a much wider group of patients. That must be the goal for which those of us who have been involved in managing health services will be looking from this research.

However, the issue goes slightly wider than that. This is part of a much broader and longer-term trend in health services. To put it very simply, it is about the importance of early intervention. Health costs are growing rapidly in every country, whether they are developing or developed countries, and, before we reach the sort of situation in America in which perhaps 20 per cent of costs go on healthcare, we need to reorient health services much more towards early intervention; the slogan needs to concentrate far more on early health than on late disease. This research has the potential to contribute greatly to that sort of development and to reduce costs both in health services and in the wider community, as the noble Lord said.

My second point, which goes hand in hand with the first, is the importance of research going hand in hand with clinical application. Having run a teaching hospital, I know how crucial it is that our services are constantly informed by the latest knowledge and that our knowledge is constantly informed by service reality. There needs to be as rapid a transition as possible from the laboratory to the bedside and learning from the bedside to the laboratory.

However, the issue here—a point raised by my noble friend Lady Greenfield—is that we are talking about a substantial change in the way that medicine is conceived and therefore the way in which services will be delivered in the future. Therefore, alongside the science go important areas of research, which are about service delivery, sociology and economics. It is not enough for stem cell research to be purely at the scientific level. Science alone will not have the impact on services that we need; it needs to be accompanied by a wider range of research.

Those first two points are variations on the theme of why stem cell research is important, and they come from the perspective of the manager or the person involved in healthcare delivery. But all that is

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valueless if stem cell research is unethical, immoral or, for that matter, hugely opposed by the public.

That leads me to the issue of public trust, on which I want to make two short points. One is that, as a former policy-maker, I saw things very much from the decision-maker’s point of view. It is interesting that individuals may find it very easy to make a decision on this issue, as is the case with many other things that face people in government. They may, for a priori reasons, either see very clearly that it is inappropriate to do anything with human embryos, or equally see that, as a way of helping people who are crying out for help, it would be unethical not to do so. Many individuals will make those decisions easily but, for policy-makers, the issue is finely balanced. I urge the Government to be very clear about the messages that they give out in their forthcoming legislation, documentation and policy. The Government have been good in setting the right environment for stem cell research but it is important that a clear lead is given here. The Government must show that they have listened, understood and decided, and that they have a clear position on the ethical issues and on what will be allowed. They must not sit on the fence on this matter and give misleading signals to researchers or funders in this country.

My final point on public trust has already been made much better by the noble Baroness, Lady Kennedy, and others. On most topics, I am not convinced by surveys that show that 70 per cent of people have answered a question in a particular way. There is a deep need here for appropriate members of the public to be involved in the decision-making process. Prior to this debate, I carried out a short straw poll of people whom I know to find out what they knew about stem cell research. I was happy to learn that they knew even less than I do. I, too, have gone through a process of learning over the past few days. We cannot hope to get people up to the level where they can debate this issue in the way that many people in this Chamber can; nevertheless, having what I think the noble Baroness, Lady Kennedy, called the nuanced involvement of the public in this debate is absolutely essential.

1.07 pm

Baroness O'Neill of Bengarve: My Lords, I, too, thank the noble Lord, Lord Patel, for initiating this debate on a very important topic. Much of the debate so far has concentrated on the question of using animal ova to reprogramme human cell nuclei for research purposes. I make no apologies for returning to that subject. It is a very difficult topic for us to think about, because the revolutionary discoveries in biology over the past 50 years which underlie the possibility of stem cell therapies constitute some of the rare occasions when scientific advance must lead us to being more cautious about some traditional ethical arguments.

The particular argument that I have in mind advances the claim that the unique moral status of the human embryo, from the earliest stage of its

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development as a fertilised ovum, derives from its unique potential—if many things occur in the right order—to become, in turn, an implanted embryo, a foetus, an infant and a person. However, once we appreciate the reality that cell nuclei can be reprogrammed—that is, that they can become less specialised and then be specialised in different directions—we can no longer be sure that this wide-open potential for developing into cells of all types will uniquely be found in the fertilised human ovum. So we have to rethink the traditional view that located the unique moral status of the human being in a view about a unique biological route to human life.

The dignity and moral standing of the human foetus and the human being cannot be read back or grounded in a claim that certain cell types—the fertilised ovum—have that status already and others do not, for we find that many cells have that potential if things happen in the right order. The skin cells that I would destroy by scratching the skin on my hand could have been reprogrammed by insertion of a nucleus into a human egg, which would have created cells with the potential for a full range of development into different cell types, yielding, in effect, human embryonic stem cells. We would risk absurdity if we tied human dignity to a story about a unique route of development.

We now also know that the nucleus of a cell from one species can sometimes be reprogrammed so that it loses its specialised characteristics by placing it in the egg cell of another species, and may in turn yield human embryonic stem cells by that route, although we know that there are still many scientific questions to be answered because of the presence of mitochondrial DNA from the other species when that route is used.

Why should we sanction the exploration of this potential? Why should we sanction research of this type? We should do so because we still need fundamental research on cell reprogramming—on the dedifferentiation and redifferentiation of cells, which will be the basis of any stem cell therapies. That should not depend on the use either of human embryonic stem cells derived from donated human embryos, or on the regular use of human ova—human eggs—donated by generous women.

The Human Fertilisation and Embryology Act 1990 —I am all too aware that I am standing next to my former teacher and noble friend Lady Warnock, whose report led to that legislation—has an interesting default structure, which is retained in the 2001 regulations. The Act and the regulations permit the licensing of research that uses human embryos only for limited and specific serious purposes, and then only if there is no other way in which that research can be done. It is the double default structure.

If it were reliably possible to derive human stem cell lines by reprogramming cell nuclei using donated human eggs, that would be a reason for the Human Fertilisation and Embryology Authority to give licences for research using human eggs, rather than human embryos. However, human eggs are not readily available. Egg donation is a non-trivial

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procedure for the women who generously do it. Some, of course, do it as ancillary to their own fertility treatment, but that too is generous.

This gives us strong reason not merely to permit but to require the use of animal egg cells for fundamental research on the potentiality of reprogramming human cells. Such cell constructs are being variously spoken of as hybrid embryos and cybrid embryos. The terminology is unsettled and unsettling, as is invariably the case in a period of fundamental revision of understanding. “Hybrid embryo” is particularly unfortunate, as it falsely suggests an intention to allow a hybrid being to develop, which our current legislation rightly forbids. However the terminology settles down, we should encourage the scientific investigation of ways in which stem cell lines with therapeutic potential can be developed without either unnecessary research using human embryos or unnecessary research using human eggs.

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