COLUMN ONE : Abortion War Snags Research : Administration’s ban on funding medical studies that use fetal tissue is the focus of controversy. A House panel has approved Waxman’s measure to overturn the prohibition.
Don Nelson didn’t think of himself as a pioneer on that November day nearly two years ago when the Denver surgical team began to numb his head in preparation for brain-transplant surgery.
The former factory manager, then 52, knew only that the ravages of more than two decades of Parkinson’s disease had left him abruptly paralyzed several times a day. “I had no alternative,” he says. “Nothing else was working.”
As Nelson watched, surgeons from the University of Colorado Health Sciences Center began painstakingly to implant 10 tiny bits of fetal brain tissue, sliced from a single piece the size of a grain of rice--into the right side of his brain.
In doing so, they became the first researchers in the United States to perform transplant surgery using fetal tissue obtained from a legal abortion.
They also became the first to defy a ban initially imposed by the Ronald Reagan Administration and maintained by the Bush Administration on federal funding for such work.
The ban has ignited a national controversy with global reverberations, pitting the anti-abortion movement against the scientific research community and organizations that represent those suffering from diseases that might benefit from fetal tissue research.
Scientists believe that fetal tissue research holds great promise for the treatment not only of Parkinson’s disease but of conditions such as diabetes, epilepsy, Alzheimer’s disease, and spinal cord injuries.
Nevertheless, the work has been at a virtual standstill in this country since the April, 1988, moratorium. Anti-abortion advocates believe that the research, no matter how beneficial, is tainted because it uses material obtained from a procedure that they consider immoral.
They argue that using fetal tissue for research purposes will only encourage more abortions.
“It is unworthy of us, as a nation, to kill our unborn children and then use them for spare parts,” says Dr. John C. Wilke, president of the National Right to Life Committee. “The government should protect unborn babies, not strip-mine them.”
By contrast, scientists view the ban as censorship of basic research, contending that as long as abortion is legal in this country they should be allowed to continue their work.
More than 1.3 million abortions already are being performed here each year--more than enough to satisfy research needs. That valuable tissue is now being wasted, the scientists contend.
The scientists’ position was bolstered by a report issued in late 1988 by a National Institutes of Health advisory panel of outside scientists and medical ethicists, which concluded that fetal tissue research was morally acceptable and should be allowed to proceed--but with safeguards. Among them was a proposal to prohibit women who were considering an abortion to designate where the tissue could be used.
The recommendation was later rejected by the Bush Administration. Health and Human Services Secretary Louis W. Sullivan said he continued to believe that the research would “increase the incidence of abortion across the country.” The knowledge that the abortion would be “directly advancing the cause of human therapeutics” would “tilt some already vulnerable women toward a decision to have an abortion,” Sullivan said.
Rejection Less Likely
Fetal tissue is much more desirable for transplants than adult tissue because it grows more easily and rapidly when it is implanted, and also is less likely to be rejected by the body’s immune system.
Partly because of the sensitivities, both of the institutions where the new procedures are being done obtain permission from the woman who is undergoing an abortion before the fetal tissue is used for transplant.
And in both cases, the permission isn’t sought until after the woman has decided to have an abortion--to be sure that the prospect that the fetus would be used for medical research doesn’t influence her thinking.
Nowhere has the fetal transplant work advanced as quickly as it has in Parkinson’s disease, which afflicts an estimated 500,000 or more Americans.
Parkinson’s disease results when an area of the brain called the substantia nigra is damaged or destroyed.
Cells in that portion of the brain are responsible for manufacturing and secreting dopamine, a chemical needed by nerve cells to control muscle movement. This shortage of dopamine causes the tremors and muscle rigidity that are characteristic of the disease.
Typically, the condition is progressive, worsening over time.
There are new drugs designed to treat Parkinson’s, but they aren’t always effective. Even with drugs, symptoms can persist and often include what is frequently called “on-off syndrome”--where patients unexpectedly experience freezing spells and are unable to move.
Neurologists believe that the greatest hope for these persons is in perfecting fetal transplant surgery. Unlike some areas of the fetal brain, the section containing the key cells needed for dopamine production is fully developed and the cells can be easily transplanted.
Since the federal ban was imposed, however, only one other medical team--this one at Yale University--has been able to raise enough money to perform the procedure.
The impact of the ban has been to drive researchers away from fetal tissue work. Raising money has been a major problem, but it hasn’t been the only one. The ban has also made such research politically dangerous, prompting many scientists to steer clear of it.
“People are afraid to even get close to it,” says Dr. Eugene Redmond Jr., program director for the Yale University Neural Transplant Program, where more than a half-dozen such surgeries have been performed during the last two years. “They’re afraid it will have an impact on funding they might get on other projects.”
At NIH, once considered the world’s premier biomedical research facility, the ban has seriously hurt morale and prompted some researchers to leave.
“Science is driven by enthusiasm and this has really suppressed enthusiasm,” says Dr. Edward H. Oldfield, chief of neurosurgery at NIH. “I have a lot of young people who come to NIH to learn. They spend a lot of their time learning how to do research, and then they develop projects. When a decision like this is made, it not only keeps us from helping patients, but it has a damaging impact on their (the researchers’) attitude about their capacity to get their work done.”
In 1987, Oldfield and his colleagues were preparing to perform the first fetal transplant surgery on a Parkinson’s patient when they were told by their NIH superiors less than two days before the procedure was to take place that it had been postponed indefinitely while the Administration reviewed the proposal. The go-ahead never came--and the ban was imposed the following year.
“It’s a bit of an insult to work several years on something and have it suddenly blocked totally by a political decision that makes no sense,” Oldfield said.
Further, experts say, the ban has cost the United States its competitive edge in research over other countries where no such restrictions exist.
There have been about 90 fetal tissue transplants performed on Parkinson’s patients worldwide; fewer than a dozen have taken place in this country.
Rep. Henry A. Waxman (D-Los Angeles), chairman of the House Energy and Commerce subcommittee on health, is sponsoring an amendment to the NIH reauthorization bill that would overturn the ban. The full Energy and Commerce Committee recently passed the bill, with the amendment intact. The approval--which came without so much as a whimper over the amendment--astonished its supporters, who had been braced for an abortion fight.
The bill is expected to come to the House floor soon. If it passes--with the amendment--a House-Senate conference will have to decide whether to retain it (the Senate measure does not contain a similar provision).
Bush Threatens Veto
Ultimately, the legislation will face its toughest hurdle at the White House, where President Bush has threatened to veto it. But, to kill the amendment, Bush must veto the entire bill--and risks placing all NIH programs in jeopardy.
“Funding has become a nightmare,” says Dr. Curt Freed, the lead researcher on the University of Colorado team, which has performed two such transplants already and is expected to carry out a third very soon. “I spend more time raising money than I do teaching or conducting research,” he laments.
Freed received considerable financial help from a local Denver philanthropist, Robert E. Stanton, whose brother Charles had died of Parkinson’s. Nevertheless, he says, “we really have to scrounge to make up for the cuts in federal support. There are some days when you just want to bash your head against a wall.”
Redmond, of Yale, who received donations from several private foundations and private individuals, agrees.
“We anticipated that this program was one we would have to do with private funds,” he says. “We raised enough money to begin. But it has been difficult. Our study has not gone at the speed with which we intended, partly because of the difficulty with funding.”
Redmond’s team plans to perform 20 transplants; only a little more than a half-dozen have taken place so far. He refuses to discuss the results until the program is complete, and the findings can be “analyzed in rigorous, statistical scientific fashion.”
Don Nelson, the Denver patient, has improved considerably since his surgery in 1988. He still takes drugs, but he requires smaller dosages--and has regained much more movement than he had before, Freed says.
“Before the surgery, even with drugs, he would only be able to walk 70% of the time,” Freed says. “Now he gets 100% effect--and on less drug. Before the surgery, his left hand was much worse than his right--he couldn’t work the hand signals on his car. Now both hands work normally.”
Before the surgery, Nelson suffered freezing spells four or five times in a typical day. Now it usually happens only once, Freed says.
Nelson says he recently remodeled his kitchen and bathroom, and even did some of the wallpapering himself.
“I’ve been doing things I couldn’t have done before,” he said. “I spent Labor Day weekend playing baseball. I didn’t do much running, but I still played--which I haven’t done in years.”
FETAL TISSUE TRANSPLANT Treating Parkinson’s disease by using fetal tissue 1. Donor of aborted fetus grants formal consent for physicians to use the remains in medical research. Time form abortion to injection of fetal tissue into the patient is 12 hours. Size and age of fetal brain used for transplant 2. Technicians separate the brain stem from the remains of the fetus, and cool it to 8 degrees Celsius in a suspension of saline and glucose. The portion containing dopamine cells is about the size of a grain of rice. This small piece is identified and cooled. View of the nuclei targeted in the recipient’s brain 3. Surgeons make a hole the size of a quarter in the skull and, using a long needle, insert the fetal tissue into the caudate an putamen. The treatment requires several passes of the needle.
Source: University of Colorado Health Sciences Center
