Book Review

Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical and Political Issues

N Engl J Med 2008; 358:2188-2189May 15, 2008

Article

Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical and Political Issues
Edited by Kristen Renwick Monroe, Ronald B. Miller, and Jerome Tobis. 218 pp., illustrated. Berkeley, University of California Press, 2008. $50 (cloth); $19.95 (paper). ISBN: 978-0-520-25210-3 (cloth); 978-0-520-25212-7 (paper).

Human embryonic stem cells were isolated 10 years ago with the use of knowledge that had been gained from more than 20 years of research in rodents and nonhuman primates. The scientific goalposts have changed constantly since then, and each change has sent ripples through the religious, ethical, and political issues that are related to stem-cell research. This book is drawn from conference presentations that were made in May 2004 by 13 faculty members and students, mostly from the University of California at Irvine. It now serves as a marker in what has been a turbulent 10-year period. Yet it contains some valuable material that demonstrates the fundamentals of the research, the pace of change, and the constantly evolving debate.

The book's eight chapters provide clear definitions and an account of the scientific and clinical knowledge in 2004, with some partial revisions and references as recent as 2006. I found the chapters on ethics and religion to be useful factual summaries, and the chapters on politics — although largely focused on California — were instructive. Stronger editing could have removed some duplication among chapters, but the chapters do stand alone in their individual interpretations and represent the range of opinions of the authors.

New discoveries have been made in several areas of stem-cell research since the book went to press. More is now known about the regulation of the transdifferentiation of cells; it is now possible to produce a stem-cell line from a single cell taken from an 8-day-old human embryo; and the startling finding has been made that a few genes, carried on a viral vector, can reprogram an adult cell to the equivalent of a pluripotent stem cell. Alongside these positive developments are some that may be negative, such as the questionable, costly, and high-risk emergence of “stem-cell tourism,” the practice of traveling to distant countries for stem-cell treatments; and prospective egg donors advertising the sale of their ova on Web sites. A plethora of ethical issues comes with each of these developments. Rigorous clinical trials are essential to prevent stem-cell therapy from becoming the snake oil of our times.

Color-Enhanced Scanning Electron Micrograph of a Human Embryonic Stem Cell Growing on a Layer of Fibroblasts.

The new achievements change the ongoing debate about the sources, ethics, and regulation of stem-cell science and therapeutics and provide hope that tailored stem cells from selected adult or neonatal cells can be developed for regenerative therapies, so that it will no longer be necessary to use human embryos. The complication of viral vectors must still be overcome, and the road to turning these new findings into clinical treatments remains unpredictable. Is the stem-cell debate over? Certainly a new era is under way, and the debate will regenerate around the new issues.

This book is a valuable compendium of the various dimensions of the story of stem-cell research, in which the science continues to outpace any attempts at fixed religious, ethical, or political positions. This is not surprising, because it is impossible to resolve differences that derive from incompatible religious and ethical views of the status of the human embryo. Plenty of challenges lie ahead in the drive toward the regeneration revolution, but a consensus may be possible as the alternatives to embryos are defined further. The 10-year experience has been a fine example of public engagement in science. Complex concepts of cell differentiation and regulation have been communicated and understood rapidly, and appreciation of the potential for new scientific discoveries to contribute to improved health and well-being has been enhanced. The more fundamental the questions being asked by scientists are, the more widespread the applications and benefits of their answers may be, yielding more valuable returns on our investments in science and medicine.

John Hearn, Ph.D.
University of Sydney, Sydney, NSW 2006, Australia
j.hearn@usyd.edu.au