By Rob Stein
Washington Post Staff Writer
Friday, June 26, 2009
New York has become the first state to allow taxpayer-funded researchers to pay women for giving their eggs for embryonic stem cell research, a move welcomed by many scientists but condemned by critics who fear it will lead to the exploitation of vulnerable women.
The Empire State Stem Cell Board, which decides how to spend $600 million in state funding for stem cell studies, will allow researchers to compensate women up to $10,000 for the time, discomfort and expenses associated with donating eggs for experiments.
"We want to enhance the potential of stem cell research. If we are going to encourage stem cell research as a solution for a variety of diseases, we should remove barriers to the greatest extent possible," said David Hohn, vice chairman of the board's two committees that endorsed the move. "We decided to break some new territory."
The little-noted decision two weeks ago puts New York at odds with policies in every other state that provides funding for human embryonic stem cell research and with prevailing guidelines from scientific organizations, including the National Academy of Sciences.
The move was welcomed, however, by proponents of stem cell research, stem cell scientists and some bioethicists, who said it would remove a major obstacle to pursuing some of the most exciting goals of the research -- including producing replacement tissues tailored to individual patients.
"This is a really great, appropriate policy," said Susan Solomon, co-founder of the New York Stem Cell Foundation, a private, nonprofit research organization. "This could help us to pursue some critical experiments that we hope will lead to treatments for devastating diseases."
But the decision was questioned by others, including opponents and some proponents of stem cell research.
"In a field that's already the object of a great deal of controversy, the question is, are we at the point where we really need to go that route in order to do the science?" said Jonathan D. Moreno, a professor of bioethics at the University of Pennsylvania. "I'm not convinced."A Controversial Field
Supporters consider human embryonic stem cell research one of most promising fields in biomedical science. Because the cells are believed capable of becoming virtually any tissue in the body, researchers hope they will lead to cures for a host of major afflictions, including diabetes, Parkinson's disease and paralysis. But the field is highly controversial, largely because the cells are derived by destroying days-old embryos, a process some consider the equivalent of killing a person.
One of the goals of the research is to produce cells tailored to individual patients through a process known as somatic cell nuclear transfer. Also called therapeutic cloning, the procedure involves replacing the genetic material in a human egg with genes from the nucleus of a patient's cell, and stimulating the egg to develop into an early embryo. That could, theoretically, produce stem cells that would not be rejected by the recipient's immune system.
Although no one has succeeded in producing human stem cells that way, researchers are trying and have been frustrated by the difficulty of obtaining eggs. Attempts to solicit women to donate eggs for such research have largely failed.
"The lack of compensation has meant it's been nearly impossible to get enough eggs," said Douglas A. Melton, co-director of the Harvard Stem Cell Institute in Boston.
Donors must undergo weeks of hormone injections to stimulate their ovaries to produce eggs and then a painful procedure to extract the eggs. The procedure can in rare cases cause a dangerous overstimulation of the ovaries, and there are concerns about the possible long-term risks of hormonal stimulation.
But proponents of reimbursing women have argued that fertility clinics routinely pay women thousands of dollars to donate eggs to help infertile women have children.
In making its decision on June 11, the New York board argued that there was no reason that stem cell researchers should be precluded from offering women equivalent sums, although they stressed that researchers should follow the same guidelines as fertility clinics: Anything over $5,000 must be justified, and anything over $10,000 would be excessive.
"We could not distinguish ethically between the payment for in vitro fertilization, which is very well precedented, and the compensation for donation for research," Hohn said.
Ronald M. Green, a Dartmouth College bioethicist, agreed. "It is discriminatory against women to ban them from receiving payment," he said. "We pay for participation in research that has risks associated with it for other procedures. So why not this? The idea that women cannot make that decision on their own strikes me as sexist."Ethical Concerns
But Moreno, at the University of Pennsylvania, questioned whether enough effort had been made to persuade women to donate eggs without compensation. "I wonder if all the expertise that could be brought to be bear on this problem of getting unreimbursed donation have been explored," he said.
Moreno and others also questioned equating egg donation for research with donation to help infertile women.
"People recognize that eggs can make a baby. That's a very concrete good for society. But you can't be sure any biological material you collect for research will be part of a medical breakthrough. That's the goal, but you can't be sure," Moreno said.
Moreover, critics worry that the move could lead to the exploitation of women, especially poor women, who tend not to be in demand for infertility donation.
"With the economy the way it is, you don't need to be a rocket scientist to know that when a woman is looking at receiving up to $10,000 to sign up for research project, that's an undue inducement," said Thomas Berg, a Catholic priest who directs the Westchester Institute for Ethics & the Human Person and serves on the Empire State Stem Cell Board's ethics committee. He opposed the decision. "I think it manipulates women. I think it creates a trafficking in human body parts."
Others agreed, calling it an unnerving precedent. "Whenever society starts to pay for relationships that are traditionally done with altruism and generosity within families, it raises the issue of whether there is anything that is not for sale," said Laurie Zoloth, a Northwestern University bioethicist.
But supporters disputed such arguments. "Women are perfectly capable in our society in deciding to get plastic surgery, Botox, donate a kidney. I find it patronizing beyond belief. We compensate people in clinical trails for time and burden all the time," Solomon said.
Although some argued that therapeutic cloning is no longer necessary because of the development of induced pluripotent stem cells (iPS) -- adult cells converted into the equivalent of embryonic ones -- others said that remains far from clear.
"IPS technology still to date has not produced cells that have all the properties of embryonic stem cells," said Melton at Harvard. "I believe those cells will be as good as embryonic stem cells, but we're not there yet."