Life, Death and Money
Amid the Christmas rush at the Mall of the Mainland in Texas City, Ruth Pavelko's back scrunched into a prickly knot. The 49-year-old mom stumbled through the Foley's parking lot to her Pontiac, her lungs feeling as if they were filled with Jell-O. Three blocks down the street, Pavelko lurched to a stop and heaved up mucus. She clawed herself out along the side of her idling car and collapsed.
"I didn't know what was wrong with me," she says timidly. "I just thought it would go away."
Pavelko spent Christmas in 1999 recovering from a massive heart attack. A surgeon sliced through her ribs with an electric saw and conducted a bypass operation on two of her arteries.
Most people Pavelko's age can get by for at least 15 years on a double bypass; she made it six months. She was at home watching television when the clogged arteries turned her heart into a pressure cooker. A surgeon installed stents--mesh tubes like Chinese finger cuffs--to keep the passages open, but they stopped up again four months later.
Doctors gave Pavelko less than two years to live. Her goopy blood, strawlike arteries and high blood pressure made beating coronary heart disease nearly impossible. A fourth heart attack late last year left her desperate.
"It seemed hopeless," she says.
Her situation was so hopeless, in fact, that she qualified in January for an experimental treatment developed by Dr. Yong J. Geng, a researcher at the Texas Medical Center. In one of the first attempts to use his technique in a human, Geng's doctors sucked bone marrow from Pavelko's hip with a syringe and parsed out 30,000 stem cells. They injected the cells through a catheter, straight into her arteries, in hopes that the cells would reconstruct them.
Pavelko waited three months without noticing any improvement. About a month ago, she decided to clean the dishes and washed them all, by herself and without resting, for the first time in six years. A week later, she made her bed faster, did more laundry and started climbing stairs at will.
By many accounts, Geng's stem cell treatment is one of the biggest medical breakthroughs of the decade. Expanding on the work with better cells from frozen and cloned embryos, Geng and other researchers eventually could unlock cures for everything from heart disease to hair loss. But it's just as likely that this cutting-edge research will be shut down and shipped off.
A growing cadre of activists in Texas is convinced that scientists shouldn't save lives by killing what they believe are babies, and they're aiming this month to back up their beliefs with law.
Think of modern medicine without donated organs, without blood banks and without chemotherapy--tools scientists helped develop over the past 30 years at the Texas Medical Center in Houston. A new generation of Texas researchers expects that, in years to come, those advances could look almost quaint, all thanks to stem cells.
Doctors at the M.D. Anderson Cancer Center use the cells to treat leukemia. Baylor College of Medicine professor Peggy Goodell studies stem cells with an eye toward someday manufacturing human blood. And colleague Thomas Zwaka hopes his research eventually will allow scientists to use the cells in place of animals and human subjects in the study of diseases and drugs.
Even so, support for embryonic stem cell research across most of the country is extremely conditional. Citing moral concerns, President George W. Bush four years ago approved federal funding for the work on the condition that it be limited to cells already extracted. The move left fewer than two dozen highly imperfect cell lines available for federally funded research.
But the restrictions haven't yet done much to slow down researchers such as Geng, director of the Center for Cardiovascular Biology and Atherosclerosis Research in Houston, who has studied the effects of stem cells in heart tissue using pigs.
After receiving Geng's stem cell treatments, some patients have responded more dramatically than Pavelko: They've gone jogging on the beach and have had sex for the first time in years. No wonder scientists during a recent visit to Geng's lab were overheard referring to him as "the Master of the Universe."
Scientists close to Geng aren't the only ones thinking big. Stem cells are widely valued for their unique ability to create and repair tissue. Adult human stem cells, discovered in bone marrow roughly 30 years ago, sometimes don't serve this function as well as the more recently discovered embryonic stem cells, which scientists are now harnessing in hopes of rebuilding ailing human bodies.
William Brinkley, dean of the Graduate School of Biomedical Sciences at Baylor College of Medicine, takes the promise of stem cells seriously. "We are going to be able to potentially replace most of the organs and tissues of the body," he says. "It is going to be, potentially, one of the greatest medical breakthroughs in the history of the universe."
As the field matures, Houston's Med Center could be especially well-positioned to attract more top scientists. Its 13 hospitals and 11 educational institutions form the largest medical center in the world.
"We will be able to attract not only attractive companies but brilliant minds," says Representative Senfronia Thompson, a Democrat from north Houston. "And we will be able to help find critical cures."
Thompson and Democrat Elliott Naishtat of Austin authored separate bills this session to provide more than $1 billion in state funding for Texas stem cell research, but neither bill went to a vote by this month's voting deadline.
A more modest proposal passed the House last Thursday as a rider that Houston Republican Beverly Woolley attached to an education bill. It provides $41 million for an "adult stem cell research center" at the Texas Medical Center.
Woolley says the bill's wording also would allow embryonic cell research.
California already has wagered heavily on the same ideas. Its voters last year approved Proposition 71, which created the California Institute for Regenerative Medicine and authorized a whopping $3 billion in state bonds for the research. Proposals in nine other states this year would together nearly match California's wad of cash.
Bush's cold shoulder has allowed California to woo Houston's stem cell experts. Geng has been offered positions in Los Angeles, San Diego and San Francisco. His lab recently lost two job candidates to labs in California, where they said they could find more funding.
Woolley's rider still must pass the Senate, escape a finance committee's ax and somehow slide past Governor Rick Perry, who has said he'll oppose any legislation that funds the destruction of a human embryo. Perry knows what he's doing. The conservative right is the home team in Texas, and its players are swinging for the bleachers.
On a Little League field in Red Oak, south of Dallas, the Mustangs send their slightly pudgy right fielder to the plate. Riley Boswell ignores the other team's fourth-grade taunts. He gets a walk, steals second and takes third off a grounder--all with a $5,000 computer jostling in his pocket.
The inning ends, and he jogs into the dugout. "Riley, you all right?" a coach asks. The 10-year-old silently unzips a black medical kit, pricks his arm twice with a needle and watches it pool with blood. He might need to adjust the computer--an insulin pump--but the other team's batter is already swinging. The coach says, "Riley, you've got to move."
Riley knows that juvenile diabetes is a constant pain in the ass, the back, the arm and everywhere else he has to prick himself. That could change now that doctors are working on a cure for the disease using embryonic stem cells.
His mom, Amy Boswell, knows such a cure could extend her son's life. But that doesn't matter to her. "If they found a cure from embryonic stem cells," says the former nurse, "Riley would never be cured. We just wouldn't do it.
"I feel like human life begins at conception," explains Boswell, 33. "And every human life is precious and unique and should be respected, should be protected."
Despite its black-and-white simplicity, or because of it, Boswell's view is gaining increasing support. Texas Right to Life, a group lobbying hard against embryonic stem cell research, has more than tripled its membership in the past 10 years.
Thanks to ousters of incumbents last year in the wake of Republican-led redistricting, "We have a more pro-life Legislature than we've ever had in 130 years," says Stacey Emick, Texas Right to Life's legislative director. "So this is a big time for us."
Of course, states such as Texas can't simply outlaw abortion, so pro-life groups focus on related hot-button topics, such as embryonic stem cell research. "Our mission is to protect innocent human life from fertilization until natural death," Emick says, "so embryos that are...subjects of experimental research and would die because of that fall under our purview of protecting human life."
Emick and Boswell oppose embryonic stem cell research in both of its forms.
The traditional form involves extracting stem cells from a fertilized egg--usually only a few days old--which can be obtained, for example, from an in-vitro fertilization clinic with the consent of the parents. There are an estimated 400,000 such embryos in frozen storage, many of which will be destroyed if they are not used for research.
The newer form, therapeutic cloning, involves the same methods used to clone Dolly the sheep but cut off at a much earlier stage. In a process known as somatic cell nuclear transfer, scientists take a nucleus from almost any cell in the human body, implant it into a human egg, grow the resulting cloned embryo for a few days and harvest its cells.
Texas Right to Life conducted a poll in 2002 that found that 69 percent of respondents in Texas opposed medical research using therapeutic cloning. Some national polls, however, show mild overall support for the practice. Even so, five states have banned it.
Last session, Texas nearly joined them, when Texas legislators narrowly rejected a similar measure.
Stem cell debate this session kicked off with an overflowing, 13-hour hearing before the House State Affairs Committee. Representative Phil King, a Weatherford Republican, showed up with his laptop and beamed onto the wall a drawing of petri dishes filled with identical googling babies. "I think this is really a crossroads time for Texas," he said. "I think the public wants a cloning ban."
King's own anti-cloning bill failed to reach the House floor, however. An identical bill, pushed by GOP Senator Ken Armbrister of Victoria, is still pending. (Three other Senate bills would protect therapeutic cloning.)
One King comrade at the recent hearing was Amy Boswell, who carted her son Riley up to the podium and testified in favor of the ban, eliciting audible gasps from diabetics in the audience.
Getting down to the corporeal nitty-gritty of why embryonic stem cell research is wrong, most opponents present a simple secular argument: All that any petri-dish embryo needs to grow into an adult is time and nourishment. Boswell's analogy: "I have the potential to be an old lady," she says, "but you put me out in the desert with no food and no water and the poor conditions, I'm going to die...That doesn't make me any less human."
But advocates of the research note that human embryos cloned in petri dishes could never become grown humans based on current scientific knowledge. Birthing a clone would also require implanting an embryo in a human womb. "Oddly, a cloned embryo may be less ethically controversial once the facts are understood," says Arthur Caplan, a University of Pennsylvania bioethicist, "because it has the least potential to turn into an adult human being."
Regardless, opponents say, the research isn't even necessary. A handout distributed by Texas Right to Life points out a variety of problems with the cells, such as their tendency to form strange tumors consisting of clumps of teeth, eyes and hair. "Some scientists think that stem cells extracted from cloned human embryos will be useful for the treatment of human diseases," it says. These "claims are unfounded."
Physically, the foundation for Geng's science is a petri dish filled with gel and proteins--nourishment for a smattering of embryonic cells. In his laboratory at the Texas Heart Institute, Geng places one of these dishes beneath a microscope.
The view, a few years ago, admittedly might have been a Frankenstein mix of skin, bone and intestine cells--almost anything the cells wanted to form. But Geng has refined the mixture of proteins to direct the cells' growth. "These are heart muscle cells," he says, "derived from the stem cells."
Every second or so, the cells throb in unison. "The mature cardio cells are spontaneously beating; they have a pulse," Geng says. "It's like you grow a heart, in vitro, in a petri dish. A small, tiny heart."
Eventually, Geng wants to know whether embryonic stem cells can be grown into full-sized hearts for transplants. But in the near term, he's investigating how well the cells repair existing hearts. "What we want to do is find out how we can use embryonic stem cells and adult stem cells," he says, "and which ones can do better."
Adult stem cells so far have done a better job patching things up than embryonic cells. Despite Geng's ability to control the embryonic cells in the early stages, they often revolt once injected into the mice and form cancerlike tumors.
But Geng thinks he can overcome this hurdle. Research on embryonic cells is incredibly young--they were discovered in 1998--while adult stem cells have been studied for decades. Given more time, he says, he will be able to develop "molecular manipulation pathways" to guide the cells' development. "Using these techniques," he says, "we can selectively change these cells into heart muscle cells or vascular cells."
To Geng's credit, some of the shortcomings in his embryonic stem cell work are due less to science than to a lack of political support. Geng's embryonic cells come by necessity from one of the lines preapproved by President Bush, but those cells don't differentiate into heart cells as well as newer, unfunded lines of cells. All of the Bush-approved cells are also contaminated with mouse viruses and thus can't be used in clinical trials in humans.
"We need better stem cells," Geng says. "I hope that the Texas government can provide us with some funding for this."
Geng suspects that adult stem cells ultimately will face firmer limitations. So far, they've just been made to differentiate into only a small range of cell and tissue types, which means that researchers who want to grow a kidney from scratch or cure diabetes, for instance, might not be able to use them. And though adult stem cells work in patients such as Pavelko, they don't work in all patients, especially older ones, who lack enough stem cells in their bone marrow to harvest for treatments.
It's precisely this supply problem, in fact, that scientists believe could be solved with therapeutic cloning. An embryo cloned from a patient could yield plenty of new stem cells, which could form new, genetically identical tissue. The tissue could be implanted in the patient's body without being rejected by his immune system. "I believe this is one direction we could go in this century," Geng says. "I would say therapeutic cloning really will eventually prolong our lives."
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