Stem Cell Research In China: An Overview

Alex GottemollerSpecial Thanks: Zhang Xinqing

Embryonic Stem Cell 101

• Stem cells are a type of cell that has not yet differentiated into a specific type of cell (muscle, liver, skin, etc.).

• Pluripotent stem cells can be harvested from a human embryo after 7 or 8 days of growth. These cells can be manipulated to transform into any type of human cell.

• These embryonic stem cells (ESC) hold great promise in the field of medicine for treating all sorts of diseases and injuries, from Parkinson’s to spinal cord injuries to heart attacks.

• However, these cells cannot be harvested without destroying the human embryo.

Adult Stem Cells• Embryos are not the only source for stem cells.• Stem cells can be isolated from tissues taken

from adults, like skin cells or bone marrow.• These adult stem cells, as they are known, are

not pluripotent; they can only be transformed into a few limited types of cells, related to the type of tissue the stem cell was isolated from.

• As a result, they have fewer medical applications, but they do not result in the loss of an embryo.

• There is a new method of deriving pluripotent stem cells from human mesenchymal (skin) cells that does not require the destruction of an embryo, but so far it has only been accomplished by two laboratories.

So What’s The Problem?

• The problem is that the most promising stem cells can only be obtained by destroying a human embryo.

• This introduces a whole set of ethical problems, since the embryo has the potential to become a human being.

• There is great controversy in the Western World as to whether or not an embryo has the moral status of an adult human being.

Stem Cell Research In China:Regulations and Progress

• Research using embryonic stem cells is allowed by regulation in China.

• Government policy and financial aid promote and fund this research.

• This research is widely approved of by Chinese scientists and doctors.

2004 Ethical Guidelines for Research on Human ESC

• Reproductive cloning is prohibited, but therapeutic cloning is allowed.

• Experimentation on embryos older than 14 days is prohibited.

• Implantation of embryos used in research is prohibited.

• The buying and selling of tissues is prohibited.• Donors must sign forms indicating ‘informed

consent.’• Institutions must establish ethical boards to

oversee research, like the Institutional Review Boards (IRBs) in the US.

Gaps in Chinese Regulation

• Current regulations establish no licensing system for ESC research outside the Ministry of Science and Technology or the Ministry of Health.

• There is no effective way of enforcing the regulations.

• There are no penalties specified for disobeying the regulations.

• Public institutions not funded by the government and international corporations are not affected by the regulations; they only apply to research that is funded directly by the Chinese government.

Government Promotion• Between 2000 and 2005, China spent US$38 million on

stem cell research. They are expected to spend $250 million between 2005 and 2010.

• Spending on research and development doubled between 1999 and 2004.

• Over 1 million Chinese students graduate each year with science or engineering degrees.

• Over 1/3 of Chinese students studying abroad are in the biotechnology field.

• Although the return rate for these students is notoriously low (20-25%), in recent years more and more have returned.

• The ambiguous regulations in China and its surplus of cheap labor attract foreign business and investment into the ESC field and many others.

General Acceptance

• Scientists, researchers and physicians in China are accepting of the risks and enthusiastic about the potential benefits of therapeutic cloning and stem cell research.

• 50% of physicians surveyed in China believe the “early embryo is not a human being of moral significance” and 70% support embryonic stem cell research.

• Anecdotal evidence (interviews) suggests support for therapeutic cloning and stem cell research to achieve it is high.

Quality and Sophistication of Chinese Research

• So far, no researcher in China has successfully isolated a new stem cell line from a human embryo.

• But there have already been numerous clinical trials on human patients, starting in 2005 with a stem cell based treatment for leukemia.

• Most research is focused on animal models and adult stem cells, not embryonic stem cells.

• A 2005 survey conducted by researchers from the UK said the research here was first class.

• There is fraud occurring, not necessarily with research but with physicians selling miracle cures that they cannot possibly provide.

• However, in order for the Chinese biotechnology industry to be considered world-class, there are obstacles that still need to be overcome.

Wei Shen Me? How Did This Policy Develop?

• What influence do religious or cultural factors have?

• What about political factors?• And of course, how much influence

did development and the economy have?

Confucian Bioethics• Differences between Western bioethics and Confucian

bioethics can be traced to the Confucian view of the family and the related concept of ‘love of gradation.’

• Confucian moral thinking considers the family the most important basic unit in society, above the individual.

• “Love of gradation” shows that there are natural variations in the amount of love one should give. One should love one’s family above friends, and friends above strangers.

• These concepts manifest themselves in bioethics through strong family involvement in medical decision making, a family-based moral strategy for assessing biotechnology (including ESC research), and a Confucian view of the moral status of a human embryo.

Confucian Familism• In the Confucian family, each member has its own

place and set of relationships which allow it to contribute to the family in a unique way.

• Each member has a unique but different responsibility to the family, and the family in turn has a responsibility to each member.

• Many seemingly individual choices, such as marriage, education, career and health care, are made with the help and input of the family.

• This includes disclosure of a patient’s diagnosis to him/her; often the family of a patient will find out first and have to decide what to tell him/her.

• Individual rights are not the most important factor in a Confucian family.

Basis of Confucian Morality• 1 - Individuals and their communities ultimately count.• 2 - Individuals do not count equally.• The individual is only valuable if it contributes to the family or

community. With the ‘love of gradation’ concept, more respect and moral standing are given to individuals that contribute more to the family and the community.

• The value of each individual being or entity must always be considered in terms of it’s family or community, never on its own.

• Ideally, there is never a conflict between the interests of an individual and its family, but obviously we don’t live in an ideal world.

• Conflicts between individual and family interests are decided with a two-part decision making process. First, the interests of both the individual and the family are accounted for. Second, any solution must satisfy the Confucian moral requirement of ‘yi,’ so the action decided upon must be appropriate, fair or righteous.

Moral Status of an Embryo• The ‘love of gradation’ concept requires one to

show love and respect towards other people and things, by degree, according to the distance and moral status between them.

• This fits well with a ‘gradualist’ view of the human embryo; that is, as an embryo grows and becomes more mature, its moral status grows closer to that of an adult human being.

• But no matter what status an embryo is given, its interests are still subject to the interests of the family. Ultimately, even if an embryo was given the moral status of an adult, it would still have a lower moral value than other members of the family because it hasn’t contributed anything yet.

Confucian Views on ESC Research

• Confucian bioethics recognizes that the destruction of an embryo is not ideal.

• If there is a conflict between the life of the embryo and the good of another family member or the family as a whole, the embryo is not assumed to have any inviolable rights.

• In therapeutic cloning, the ultimate goal of ESC research, the primary intent is to clone and harvest stem cells to save a family member. The second effect, however, is the destruction of the human embryo.

• This second effect, while still considered ‘not ideal,’ is not enough to call the entire process immoral because it is well intended to save a family member’s life.

• But what about research? No one is being helped immediately by research performed on embryos.

• Does the source of the embryo matter? Embryos left over from IVF treatments are acceptable, but the creation of embryos from SCNT specifically for research might just be creating more suffering.

Is China’s ESC Policy Consistent with Confucian

Bioethics?• If all basic and non-clinical research can

use SCNT to create stem cells for research, which will not necessarily help anyone, then it is not consistent.

• Is the creation of human-animal hybrid embryos consistent with Confucianism?

• But in actuality, how much research is really happening that would violate these Confucian ideals?

Scientific History Since 1978

• Since 1978, the biology and biotechnology fields have undergone as much change as the rest of the economy.

• The ‘danwei’ in is gone.• There is greater research training abroad, with

more students returning home than ever before.• There is acceptance of foreign investment.• There is the founding of the National Natural

Science Foundation (modeled on the United States National Science Foundation), the 863 High-Technology Program, the Torch Program and other biotech funding programs.

China Compared to Other East Asian Developing/Developed

Economies• China may be trying to follow the path laid out for

it by other East Asian countries in high-technology fields.

• Countries like South Korea, Singapore and Japan made investments in the semi-conductor and computer science fields when they were new, and now the investments are paying off.

• I think China is following the same path with the stem cell research and biotechnology field.

• Stem cells were only isolated for the first time 10 years ago; the field is new and since they are investing early they have the opportunity to become a world leader, the way other East Asian countries did in the electronics and computer fields.

Conclusion

• So what factors influenced the formation of China’s ESC research policy?