ABC RADIO NATIONAL

Stem cell discussion 14 August 2006

Presenter: Fran Kelly
Guests: Professor Perry Bartlett, Professor Bernie Tuch and Professor Bob Williamson

Fran Kelly: Last week, the federal Health Minister, Tony Abbott, accused enthusiastic advocates of stem cell research of 'over-peddling hope to vulnerable people'. The minister made it clear that he didn't think we were about to enter a new age of 'health nirvana'.

Our federal politicians will soon debate proposed reforms that could liberalise stem cell research in Australia, although Cabinet has already decided that the ban on human cloning will remain. Cabinet has also decided to deny the Parliament a conscience vote on this issue. ¹

To explain where this research could be taking us we're joined by three leading medical researchers.

Bob Williamson is Professor of Medical Genetics at the University of Melbourne. He is also chair of the National Committee for Medicine at the Australian Academy of Science.

Professor Bernie Tuch is director of the Diabetes Transplant Unit at the University of New South Wales.

Perry Bartlett is Professor of Neurobiology and Director of the Queensland Brain Institute at the University of Queensland.

Good morning to you all.

Perry Bartlett:Good morning, Fran.

Kelly: Professor Tuch, let's begin with you. Let's start with that quote from the Health Minister a week or two ago: 'over-peddling hope to vulnerable people'. Now, this is a basic and important question. What opportunities does stem cell research offer that other forms of research don't?

Bernie Tuch: Fran, basically the concept of being able to provide a form of cell therapy to people who do not have such therapies available is really what it's about.

Kelly: Okay. In your lab you've got human embryonic stem cell lines set up. What do you think that's going to do to help 130,000 young Australians with type 1 diabetes, in the case of your research?

Tuch: Given patience, given time and given resources, effectively you will be able to convert those cells into insulin producing cells which could be used as a form of therapy for such people.

Kelly: Okay.

Tuch: But you need the patience, you need the time and you need to make sure there are no blockages put in the way to allow those sorts of processes to occur.

Kelly: Well, in terms of blockages what do you mean? Do you mean blockages in terms of what the Parliament might do?

Tuch: Correct. I mean, you've got to be able to use your brains, your minds, you've got to be able to use all your being and the desire to be able to produce an outcome to assist such people. What the final outcome will be, only time will tell, but you must allow that opportunity and not deny the people the possible hope that in fact you could be able to develop something which could assist them.

Kelly: So you're not 'over-peddling hope', in your view?

Tuch: I don't believe so. I think what you're doing, effectively, by effectively saying no to certain forms of embryonic stem cell research is you are encouraging people to go elsewhere to achieve those goals – that's already happened this week. As you know, Professor Paul Simmons has left from the Peter McCallum Institute this week to go to Texas; our top embryonic stem cell scientist left earlier this year to go to California. That's Professor Martin Pera, from Monash University. Where it's happening elsewhere, all you can do, effectively, in Australia is you can either delay the process, you can decide it won't happen here. But it will happen. It will happen in the States, it will happen in England, it will happen in Singapore and other countries where this form of research is approved.

Kelly: All right. Well, I'll come to the blockages in a moment. Let's just ask all the panellists that first question, that quote from Tony Abbott. Professor Bob Williamson, is Tony Abbott right? Have advocates of stem cells been overselling this, overselling hope?

Bob Williamson: Politicians are notorious for living in a three-year time zone. I mean, they've all got to be re-elected in three years. People like Perry and Bernie and myself, we've been in medical research for 30, 35, 40 years. We have a somewhat longer term perspective. We have patients. I've worked on cystic fibrosis most of that time.

From the point of view of the patients, they understand that we're looking at a five-year, 10-year, 15-year perspective. And in terms of the diseases we're looking at, that's incredibly important. I think that stem cells offer very, very real promise, and I think that in particular for young people, young people with cystic fibrosis, with Friedreich's ataxia, with type 1 diabetes, stem cells are certainly the most promising thing on the horizon.

Now, having said that, they're not the be-all and end-all. I mean, obviously they are going to be used in combination with new medications – and with lifestyle changes. Lifestyle changes are also really important. But stem cells are an extremely promising tool for the future.

But there's another point I'd want to make, Fran, before I leave this. If the legislation that has been recommended by this really, really high-powered government committee² that sat for six months, if we're not allowed to do those kinds of experiments in Australia, we won't be able to understand the basic causes of type 1 diabetes, of motor neurone disease, of other conditions.

It isn't primarily for therapy. We're not looking for thousands and thousands and thousands of transfers. What we're really interested in is finding out why these pancreas cells don't work properly in type 1 diabetes, and somatic cell nuclear transfer is one of the very, very best, most promising ways to study the disease.

Kelly: Okay. Before we come to Professor Bartlett, I think we'd better sort this out. When you say 'those kinds of experiments', you're talking about therapeutic cloning, aren't you?

Williamson: Yes. Therapeutic cloning is where you take a cell from a patient, pop it into an empty egg – so there is no sperm, there is no change of the genetic material – and study it in the lab. Everyone in this country is agreed there should be a total ban on cloning people, and I don't care if they say that anyone who tries to clone a person is put away, they throw the keys away. That's fine. I'm totally opposed to cloning people. But therapeutic cloning, where the cells stay in the laboratory and we're able to study the way in which they behave, seems to me to be a totally different thing. I believe not only is it not unethical, it is ethical to do it because it is the best way to help people with these very, very serious diseases – and we're talking about diseases that affect thousands of children in Australia: cystic fibrosis, type 1 diabetes and so on.

Kelly: Professor Perry Bartlett, what do you think? You're involved with neural regeneration. What does stem cell technology promise for you, and do you need therapeutic cloning?

Bartlett: Well, Fran, I would like to follow on from Bob: the most exciting thing from my perspective is the somatic cell nuclear transfer, also known as stem cell cloning, whereby we can take a cell from a diseased patient and immortalise it and turn it into another nerve cell, so that we can study what actually goes wrong. Remember that something like 45 per cent of the burden of disease of our community is due to nervous systems disorders and at the moment we have no treatment for those. So my perspective on this is that the Lockhart report was a very sound, sane report which addressed this very great advance in terms of being able to take a cell from a diseased person – a skin cell – and to be able to use that in the lab to study what's actually wrong in that disease process.

So having said that, Fran, from that point of view I think it's very promising.

From the therapy point of view, I have some reservations. As Bob said, it's likely that stem cell therapy is going to be an adjunct to many other therapies. Now, there is a great hope in the future for the new biology to deliver newer cures, and stem cell therapy might be one of those, but certainly in many ways we have moved on beyond stem cell therapy into understanding exactly what the molecular regulation of these diseases is, and perhaps stem cell therapy will only be an adjunct. Certainly in the nervous system I doubt very much whether we are going to be able to transplant nerve cells in a meaningful way to cure disease.

Kelly: Can I just interrupt you there. When you say you have some reservations, do you have ethical reservations?

Bartlett: No, I have scientific reservations. For example, in some ways, as I have said, the field has moved on. We now known in the nervous system, for example, that in fact the brain is capable of making new nerve cells itself. There are stem cells in there, in your and my brain, that every day of the week are making large numbers of nerve cells. So from my perspective the big questions are: how do we regulate that production, how do we make sure that those nerve cells can be used to repair a damaged brain, not how can we be able to transfer new nerve cells into the brain?

Kelly: Bernie Tuch, the Health Minister, Tony Abbott, also said that this whole notion of therapeutic cloning is basically 'translating Dolly the Sheep type situations to human beings, and I think we should think long and hard before going down that path'. I mean, is that what we're talking about here?

Tuch: Not at all. I think basically the Health Minister may be hung up on the word 'cloning'. So if we actually define and utilise the term 'nuclear transfer', because that's precisely what we're talking about, effectively with the aim of being able to produce cells of potential benefit to people with diabetes, as Bob says, to people with cystic fibrosis and perhaps to people with neurological disorders, then effectively your prime aim of this process (using unfertilised eggs, without sperm) is to produce cells which might be of potential benefit – and of course to understand the molecular basis of the disorder as well.

Kelly: And to be clear here, when we talk about producing 'cells' for this purpose, we're talking about producing very early-stage embryos, aren't we?

Tuch: That is correct. And therefore –

Kelly: And that's what people are worried about, the 'slippery slope'.

Tuch: Yes. Therefore, quite correctly, you could be worried that those by-products of this process – and remember, they are by-products – could be used by some to be implanted into a uterus, and perhaps that's what the Health Minister is afraid of. However, if the intent of this process is to produce cells for working with in the laboratory as well as for therapeutic purposes, then I don't understand and I don't see the problem associated with this.

You have in process at the moment, in Australia, an excellent control mechanism. You have a licensing board ³ which was established to allow the use of 'spare' fertilised eggs; that process has stood the test of time and has done its job well. If you wish, you could call it a policeman of a benign nature. It certainly could be utilised in this process to ensure that we don't go off the rails, that we do in fact produce cells by nuclear transfer without the possibility of producing Dolly the Sheep et cetera.

Kelly: Professor Williamson, when Justice Lockhart handed down his recommendations he said, 'I suppose technically Parliament could ignore most reports, but it would be very unlikely that the Parliament would ignore this report, having framed the legislation to lead this committee to be established and come up with this.' Now, Cabinet has seemed to ignore this recommendation. The legislation that will go forward bans therapeutic cloning. Where does that leave it – apart from the potential brain drain, which we have already mentioned this morning – in terms of states like Victoria suggesting they will go it alone? Is that feasible?

Williamson: No. I find it really remarkable that the government set up a committee with six top medical, scientific, legal, ethical and religious leaders, who took evidence for six months from several thousand people around Australia, deliberated on it, came down with this really balanced judgment, and then the government has decided to throw it away.

Now, I have a lot of respect for the religious views of other people, even if I don't fully agree with them, and in this particular case we're seeing something which is basically based on religious views of a few members of Cabinet. They have a right to those views; they have a right not to participate in somatic cell nuclear transfer, in therapeutic cloning. They have a right to say, as one or two have, that they will not make use of the cures that might come, the knowledge that might come from this.

But I really think that, from the point of view of Australia, we're very proud of our science, particularly our biomedical science, and we have every right to be. Australia bats above its weight when it comes to biomedical research. And this puts that at risk. I have PhD students and postdocs here in Melbourne who are very, very seriously asking themselves, 'Do I stay in a country where a prejudice takes precedence over a government committee headed by the best legal, ethical and scientific brains?' And I think that's the real risk.

Kelly: Well, Professor Bartlett, a final comment from you on parliamentary deliberations this week. But also, to be clear: if Parliament does vote against the use of therapeutic cloning and stem cell research, we still have stem cell research going on and being used and developed here in this country, don't we?

Bartlett: Yes, of course, we do. And look, I'd like to follow up from Bob. I mean, it's now clear that even the US have come to grips with somatic cell nuclear transfer. Harvard has agreed to go ahead and allow this to occur – not funded by government funds, because of course the US government is against that, but certainly Harvard and the University of California San Francisco are both going ahead with this. So, as Bob said, this real opportunity to be able to study diseases in a scientific way, in a manner that might address all those unsolved mysteries of neurological disease, is something we really do need to be part of.

So, having said that, on your question about stem cell therapy, I think we still need desperately for the stem cell therapy science to go the next step and show proof of principle. I think there is great hope for using stem cells, but I think perhaps we've chosen those diseases in which it's going to be used somewhat unadroitly. For example, I think spinal cord therapy is unlikely to be the recipient of stem cell therapy; it's most likely to be an adjunct but certainly not likely to be a cure.

Kelly: And so we should go for some that are more likely to achieve results?

Bartlett: Exactly. Exactly. I think this has taken the focus off the fact that medical research is moving ahead tremendously in all areas, and this is but one field.

Kelly: Okay.

Bartlett: And I think we all agree that all areas of science should go forward, but let's focus on results and not so much on the hope.

Kelly: All right. Perry Bartlett, Bernie Tuch and Bob Williamson, thank you very much for joining us.

Williamson: Thank you.

Tuch: Thank you.

Kelly: Bob Williamson is Professor of Medical Genetics at the University of Melbourne, Bernie Tuch is Director of the Diabetes Transplant Unit at the University of New South Wales, and Perry Bartlett is Professor of Neurobiology and director of the Queensland Brain Institute at the University of Queensland.