Dictionary of Music and Musicians.

DATE July 17, 2001 ACCOUNT NUMBER N/A
TIME 12:00 Noon-1:00 PM AUDIENCE N/A
NETWORK NPR
PROGRAM Fresh Air

Interview: Bioethicist Arthur Caplan talks about the controversy
surrounding embryonic stem cell research, including cloning and
in vitro fertilization
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

President Bush is expected to decide this month whether the government will
fund research using embryonic stem cells. The research, if successful, could
help reverse Alzheimer's disease, Parkinson's disease and spinal cord
injuries. Opponents believe that destroying embryos to harvest the stem cells
is killing human life. President Bush's party is divided over the issue.
Opponents of abortion are divided.

We invited medical ethicist Art Caplan to explain stem cell research and its
medical possibilities, and to discuss the questions he asks as a bioethicist
when he's examining the ethical implications of such research. He joins us
from time to time on FRESH AIR to discuss medical issues. Caplan is the
director of the Center for Bioethics at the University of Pennsylvania, where
he's also a professor of molecular and cellular engineering and professor of
philosophy. In 1993 he became the first president of the American Association
of Bioethics.

Let's start with the basics. What are stem cells?

Dr. ARTHUR CAPLAN (University of Pennsylvania): There's always been this
understanding that one part of the embryo becomes the support system,
umbilical cord, placenta, amniotic fluid. It's what supports the life of the
embryo. And the other part of the embryo becomes the body, if you will, of
the fetus and ultimately the baby and ultimately us. Somewhere inside that
embryo, the cells have to differentiate. One part becomes support system.
One part becomes, if you will, baby. It was three years ago now that
scientists figured out what part of the embryo becomes the baby. That's the
stem cell. So the stem cells are those cells that have the capability to turn
into a fetus, a baby, a person, and to produce all kinds of cells. Because,
obviously, to make us they have to be able to make skin cells, bone cells, lip
cells, whatever.

GROSS: And so when the stem cells are in the early embryonic stage, they're
undifferentiated. They don't know yet whether they're going to be assigned to
be lip cells or nose cells or kidney cells.

Dr. CAPLAN: Exactly right.

GROSS: And they're capable of becoming any of those.

Dr. CAPLAN: Anything. In fact, there's a kind of cute or technical word for
their. They're totipotent. They can turn into anything that you want or
need.

GROSS: And how does that relate to medical research?

Dr. CAPLAN: Well, if you looked at the human body and you tried to figure out
what diseases are caused by underlying cellular dysfunction, you'd see that
some diseases, like Parkinsonism, are due to the fact that brain cells wear
out and they're not making the chemicals they're supposed to anymore. If you
could get a stem cell to put into an adult brain and rejuvenate that part of
the brain, you could presumably reverse the symptoms of Parkinsonism.

Similarly, in our bodies, the spinal cord, once it's damaged, it doesn't
regrow. Embryo cells should be able to make those same spinal-cord tissues
and cause healing to take place in a paralyzed person.

Less dramatic, but still very important, sometimes children are born with
islet cells that don't function. That's the part of the pancreas that makes
insulin. So if you have juvenile diabetes, you can't make that chemical. If
you could get embryo cells to turn into these islet cells and make the
chemicals that are missing, you could transplant them, just like we would a
transplant, into the body of a child and then have them making the missing
insulin substance.

So for a lot of the body's diseases, its underlying damage to cells that don't
regrow, and that's what stem cells really are targeted to fix.

GROSS: How far are we along in the research? Is this just like speculation
that stem cells could maybe reverse these diseases, or is there any evidence
that they can?

Dr. CAPLAN: Well, there's animal work that shows that it's possible to
regenerate the spinal cord. And there's been some animal studies that have
grown peripheral nerves, the sort you'd find in your hand or your foot that
might get injured in a burn or in a traumatic injury. It's all animal work.
If we're really going to be honest about this, the demonstration that you
could take these stem cells, make a lot of them, put them into somebody's
body and have them do what they're supposed to do, I'd say we're talking
years; nothing like months.

GROSS: Now the debate right now has to do whether it is ethically correct to
harvest stem cells from an embryo. What is the state of the embryo that
we're talking about with stem cell research, 'cause I think a lot of people
are confused about whether it's an embryo or a fetus and what the difference
is between the two.

Dr. CAPLAN: There really a lot of confusion about what an embryo is. Every
once in a while I hear people debating this and I think, `No, no, no, no,
you're confusing embryo research with fetal research.' Embryos are potential
or possible people. They are not yet fetuses. They haven't developed or
differentiated at all. We're talking about taking cells from something that
is eight cells big or sixteen cells big. So it's the size of a period at the
end of a typewritten sentence; very teeny, undifferentiated thing.

Now there are different ways to get embryos. One is you can take sperm and
egg from normal people, put them in a dish and make embryos. So you could
create them. Secondly, there are people who go around making embryos because
they want to have babies. They do this in dishes at what we call in vitro
fertilization clinics. So there are people paying a lot of money when they
have fertility problems, and they're trying to make embryos because they
want to have a baby. That process doesn't work very well, so they're often a
lot of extra embryos made and they'll be stored or frozen. So when we
sometimes hear about embryos, what we're hearing about is frozen embryos,
literally, in a tank of nitrogen--liquid nitrogen that is at 450
degrees--minus 450. And there they sit kind of in this frozen, suspended
animation. Every once in a while at the infertility clinic when you make an
embryo--say you're a couple and you make five embryos--the doctor may look
at those under the microscope right after they're created and say, `One of
these doesn't look good. We're not gonna put that one in.' But instead of
destroying it or throwing it away, they may freeze that, too.

So there are embryos made in a dish, sperm and egg, just for the sake of
creating them. That's what we heard about at the Howard Jones Institute in
Virginia, where people were making embryos for research. Then there are
embryos out there that are being made by couples who want to have babies, but
sometimes they make too many. There are surplus embryos. Sometimes they make
embryos that don't work right or don't look good. Those are what's called
damaged embryos. Both of those are around and frozen.

And interesting and important fact about embryos. Under the best of
circumstances, healthy people, no infertility problems, having sexual
intercourse and making embryos kind of the birds and bees way, you probably
get a pregnancy about one out of four times. In the best clinics you
probably get a pregnancy at an in vitro fertilization clinic maybe one out of
five times. What that means is even though people argue that an embryo is a
person from the moment of conception, I think that's wrong. Most embryos are
potential people and some of them are not wired or programmed correctly, so
they're not gonna turn into anything ever.

GROSS: So even in a woman's body, if her egg is fertilized and forms an
embryo, only one out of four or five...

Dr. CAPLAN: Make it.

GROSS: ...is actually going to make it into developing into a fetus and the
others will...

Dr. CAPLAN: There is tremendous loss...

GROSS: Mm-hmm.

Dr. CAPLAN: ...of embryos in the normal course of reproduction. Or another
way to put it is people are having sex frequently enough that if they had a
baby every time they made an embryo, we'd be in an even more populated planet
that we're in. A lot of them simply fall out of the woman's body and she
never notices. There's a conception, but it doesn't implant. And even when
it does implant, the spontaneous abortion rate is pretty high, so a lot of
embryos just are not gonna come to term. And that's why, ethically, I've
never been comfortable saying that an embryo is a person or an embryo is alive
from the moment it's conceived. A lot of them have chemical, genetic
problems that they're just gonna make people no matter what we did.

GROSS: Now could those that have problems still be used for stem cell
research?

Dr. CAPLAN: The one thing I began to realize when I looked at the biology
of embryos was there's this large number of embryos that are damaged.
There's a large number of embryos that have been frozen so long that no one
is going to try and turn them into babies. They're simply too old. They
still are valuable for research. So for some time now I've thought the best
candidates, the less morally contentious embryos, if you will, are the ones
that are least likely to turn into people under any circumstance. So, yes,
you can use, for research purposes, a damaged embryo or you could use one
that had been frozen so long that no one would really want to try to use it
to make a baby.

GROSS: My guest is Art Caplan. He directs the Center for Bioethics at the
University of Pennsylvania. We'll talk more about stem cell research after a
break. This is FRESH AIR.

(Soundbite of music)

GROSS: My guest is bioethicist Art Caplan and we're talking about stem cell
research.

As a bioethicist, what questions do you ask yourself about whether it's
ethically OK to use embryos for stem cell research? And lets look first at
embryos that have been made at fertility clinics with the idea that a
couple's trying to get pregnant--or a woman is trying to get pregnant and
they've put these embryos--they've created these embryos and put them aside
in the hopes that one of them will turn into a baby.

Dr. CAPLAN: Well...

GROSS: So the ones that are left over that would be discarded, how do you,
as an ethicist, ask whether this is ethically OK?

Dr. CAPLAN: I mean, I think the first thing I think about is what is the
intention or motive behind the creation of the embryo? So let's presume your
case, Terry, there is a couple. They want to have a baby. They're trying
very hard to have a baby. They're very interested in life. They're very
interested in becoming parents. They make a baby in good faith. Their motive
is not to benefit research, to sell an embryo to somebody. It's simply to
have their own child. It turns out that the technology is such that they're
probably going to have to overproduce embryos in order to have any chance.
And then some of the ones they make are simply going to be damaged. First, is
the motive a good one? I think when you're at the IVF clinic, the motive is a
good one. Let's say that's in contrast to the person who says, `I think I'll
go sell my eggs. I'll sell my sperm. I'll just get paid to make embryos.'
That motive seems to me less morally laudable. So why you create the embryos
becomes important.

And then what's the status of the thing you've created? If it really doesn't
have the potential to become a person or because it's been stored so long
it's kind of lost is fertilizability, then while some people might want to
argue all human embryos have to be treated as the same, I would say the moral
status of the embryo begins to weaken, in terms of showing respect to it or
treating it as anything other than tissue, once it begins to lose that
capacity to become a baby or if it's damaged from the point of creation.

So the two key factors are why did we make it? And I think we do find
ourselves in situations where people are making embryos for good reasons, but
it turns out, sadly, they have more than they could use or some of them are
damaged. And then we get in situations where not all embryos are equal. And
if we can figure out which ones, if you will, are unlikely to become people,
that might be the set to go to for research.

GROSS: So from your point of view, you're OK with the idea of using embryos
that would otherwise be discarded that were made at fertilization clinics.

Dr. CAPLAN: I am. And let me sort of reinforce that by saying the embryos
that are left behind at IVF clinics in this liquid nitrogen, once they get
past five years of storage, I don't know any doctor who would say, `Well,
let's try and use one of those embryos if you want to have a baby,' as
opposed to making a new one. Because they start to lose their potency; not
drastically, and it is true than an embryo that's been frozen 10, 15 or even
20 years could become a baby, but it's really losing some of its ability to
do that. So I would say the spare or unwanted embryos that have lost their
power, somewhat, to become babies, that's the category that I'm very
comfortable in using for research.

GROSS: Let's look at another category and that is the category of a clinic
that is creating embryos in vitro especially and only for the idea of
harvesting the stem cells in these embryos. So these are embryos being
created strictly for research. And there was one clinic that announced last
week that that's what they're doing.

Dr. CAPLAN: Right. The Howard Jones Institute in Virginia said, `We're
making embryos.' And the suspicion is, by the way, that some other companies
are doing this, too. The just haven't talked about it; private companies
doing it with their own money, if you will.

GROSS: Now, again, as a bioethicist, what questions do you ask to help you
determine whether you think it's ethically OK to create embryos especially
for the idea of harvesting the stem cells?

Dr. CAPLAN: Well, I would ask the similar sorts of questions. I'd say,
`What's the motive?' and then `What's the status of the embryo that's been
created?' So let's look at the motive. If it's a private company, they may
be making embryos for research ultimately for profit. So the question is
should we create embryos to sell them, if you will, and then turn them to
commercial gain? I think that that is somewhat disrespectful of human
procreation or human reproduction. So I don't like the motive of saying, `I'm
going to do this for money.' The people who come and donate their sperm and
eggs for specially creating embryos, they, too, are doing it because they want
to get paid. So that adds an element of commercialization, of business, if
you will, to the creation of embryos; less morally commendable than simply
saying, `I'm trying to have a baby and, unfortunately, I've got these
leftovers as a result or I made some that don't work well.'

Then, what kind of embryos are made? Well, when you're using sperm and egg
from healthy people, not infertile people, the chances are greater that
they're going to create normal embryos. So the odds of finding bad ones or
keeping them a long time and then seeing them, as I said before, losing their
potency, are far less. It's much more likely you're going to have potential
people if you specially create embryos than if you just use extra ones or the
less desirable ones that pop up in the IVF setting.

So I think, if you compare the two, specially created embryos are morally more
problematic because you're introducing commerce into the creation of human
life. You're simply making things to destroy them. And you're probably
destroying, if you will, healthier embryos.

GROSS: So you have a personal position on the creation of embryos for
scientific research.

Dr. CAPLAN: A long time ago when I first realized that stem cell research
was likely--I think six years ago now--I tried to write an article that said
this is going to become a major controversy. The moral thing to do is first
think about, `Do we need these embryos for research?' And I think the answer
to that is yes. While there are some people proposing other ways, perhaps, to
do research on stem cells, the fact is to grow nerve tissue, to grow spinal
cord tissue, to grow many types of tissue, embryo stem cells are going to be
the best bet. It seems to me the people who are in wheelchairs, who are
suffering from terrible brain diseases like Parkinson's or Alzheimer's have a
moral claim on us.

If we're going to then say that that claim is legitimate, that we ought to try
some research to help them, then it seems to me we ought to go to the embryos
that are, if you will, the least ethically contentious. And to me that's the
spares and the leftovers and the damaged embryos. And I think, if you really
put this one the scales of justice and say, `I've got an embryo in a freezer.
It's been there five years. It will never be adopted. It will never be used
and, in fact, no doctor in good conscience would try to have somebody make a
baby with it because it's not going to work very well' and there's a person
in a wheelchair saying, `I'd like you to try some research that would help me
get me out of this,' the moral equation comes down heavily to use some of
those embryos.

GROSS: Now there's another issue, and that is cloning. Another lab has
announced that it has begun cloning embryos strictly for the purpose of stem
cell research. What questions do you ask about cloning embryos for research?

Dr. CAPLAN: Well, I'm glad that they announced that because they are doing
everything they can to keep me in business. The more announcements they keep
coming out with about cloning embryos--cloning embryos is a different trick
entirely. Instead of making them from sperm and eggs, either kind of
specially created by paid people giving their sperm and eggs, or by leftover
embryos from the IVF clinic, this company--and it is companies--Advanced Cell
Technology has said, `What we do is we take an egg, we core the DNA out of it,
like an apple, just (makes noise), take that part right out, drop in DNA from
another cell--it could come from your toe or your lip--and that is fused
together and turns into an embryo-like thing.'

One reason that people are worried about this procedure of making stem cells
this way is it's the first steps toward making human clones. And a lot of
people have ethical difficulties with cloning humans, so they say, `Well, we
don't want you to do anything like transfer DNA from your foot or your skin
cells into an egg and then start this process. There will be no stopping
human cloning if we let any of this happen.'

GROSS: Well, the controversy right now is about harvesting stem cells from
embryos after in vitro fertilization. But what about the question of in
vitro fertilization? Have we really addressed that publicly yet?

Dr. CAPLAN: One of the toughest issues that George Bush has not been asked
to address is what's his position, in general, on in vitro fertilization?
Remember, the place that I turn and I think some people turn in hoping for a
compromise is to spare embryos or unwanted embryos. They are inherently
something that's generated whenever somebody goes down to try a round of in
vitro fertilization. They're just going to make more embryos than they're
ever going to be able to use. Is Bush comfortable with this? Are those in
the Republican Party who either are for or against stem cell research--what
do they think about this constant creation of spare embryos and what do they
propose to do with them? There are 100,000 of them right now in the United
States. There may be 250,000 worldwide; the number keeps growing. And what's
the status of these? We talk as if, well, they're just going to be
destroyed. They're not going to just be destroyed. Their fate right now is
in the hands of utility companies. As long as the electricity holds out,
they stay frozen. No clinic wants to destroy them. They don't know what to
do with them.

And in the broader context of stem-cell research, we keep making more and
more embryos, more and more unwanted ones, some damaged ones. We should stop
doing this? We should turn back the clock and not allow infertility
treatment to go forward? It's one of the tough issues from a pro-life point
of view. Is there anything more pro-life than infertile couples who want to
have babies? I can't think of anything off hand. At the same time they're
making extra embryos all the time. What are we going to do with them?

GROSS: Art Caplan directs the Center for Bioethics at the University of
Pennsylvania. He'll be back in the second half of the show.

I'm Terry Gross and this is FRESH AIR.

(Soundbite of music)

GROSS: Coming up, we continue our conversation with bioethicist Art Caplan
about the controversy surrounding embryonic stem-cell research.

And classical music critic Lloyd Schwartz reviews the new edition of the Grove
Dictionary of Music and Musicians.

(Soundbite of music)

GROSS: This is FRESH AIR. I'm Terry Gross, back with bioethicist Art Caplan.
We're talking about embryonic stem cell research, the science behind it and
the controversy surrounding it. Caplan directs The Center for Bioethics at
the University of Pennsylvania, where he's also a professor of cellular
engineering and a professor of philosophy.

You know, how does the debate over stem cell research, over embryonic stem
cell research relate to the abortion debate? In the sense that in abortion,
we're talking about a fetus that is in the uterus in a woman's body, and in
the embryonic stem cell debate, we're talking about embryos that are in a
petri dish in a laboratory.

Prof. CAPLAN: Well, I have a view about this. It's probably one that not
everyone will agree with but it seems to me embryos in a dish and, for that
matter, embryos that are fertilized inside a fallopian tube before they've
implanted anywhere, before they've gotten into a uterus, before they've gotten
into an environment in which they can grow, they are the blueprints of life,
but they are not people. They're not the same as a fetus, a baby or an adult.
They are possible people because they have the genetic instructions, but until
they get into an environment--a uterus normally, a womb--where they can
implant and grow, then it's just a set of blueprints, and that's what the
embryo is. Once you get an implanted embryo, then you do have an entity that,
in theory, is down the road toward personhood. So I would say a fetus is more
than a possible person. It's now moved over to a potential person. So the
way I would think about embryos is they're possible. Put them in the right
place, could become something. Once they implant and become fetuses, they're
potential babies.

GROSS: Now I think both sides of the abortion debate have a vested interest
in the embryo stem cell research debate, and both sides feel that if the
embryo debate goes in their direction, that they'll be ahead of the game, and
if it goes against them, that they're in this kind of losing battle, and
they'll be falling behind. Can you elaborate on that a little bit?

Prof. CAPLAN: There's a cynical side of me that says the whole argument over
stem cells is a diversion so that we don't have to go back to the abortion
debate. And here's why. Let's say what we're talking about now is should the
president and Congress allow federal funds to be used to do embryo research?
And, I mean, the amount of discussion and agonizing that's gone on about this
is probably unmeasurable. If I know my stem cell research, there are probably
20 scientists in the United States right now who could submit grants to do
embryo research. And if listeners understand the NIH process, let's say 20
people said, `I want money,' they'd probably award 10 grants. That is you'd
have to compete in that. They wouldn't give money to everybody. They'd give
it to the 10 strongest researchers.

If they did that, and let's assume that next year, every one of those
researchers used five embryos to start off cell lines, the whole fight, in one
sense, is a battle over the fate of 50 embryos. Now if you think embryos are
people, that's the fate over 50 lives, but most people don't subscribe to that
view. I don't. The only way to understand the level of this debate is that
it's a stalking-horse or a surrogate for the abortion controversy. Because if
we really went on the rounds and said, `Look, there are 50 frozen embryos out
of a hundred thousand frozen embryos. We're going to take 50 of them and do a
year's worth of research,' I don't know that this debate merits the kind of
attention it's getting. But if you flip it around the way you presented it
and said, `The real question here is abortion,' if we can see that embryos are
not people, then we're going to lose the abortion fight. If we can see that
they are people, but still there's choices to be made about how to put them in
research, then we keep the pro-choice side alive. Abortion politics drives
the whole debate.

GROSS: Now as a medical ethicist, do you think that what--the decision we
make about embryonic stem cell research, do you think it should necessarily
affect the abortion debate or do you see those two issues as being separate?

Prof. CAPLAN: I see them as completely separate. I am a little sad that we
don't make some nuanced distinctions in this debate, but if you're going to
allow abortion, it's normally because you might say something like a woman
should not be forced to have to bring to term a child in her body that she
does not want. So part of the question becomes can you force compel women to
do something with their bodies? In that sense, there's a question about
abortion, of a woman's right to control her body. Whether it's a person in
there or someone else, if she doesn't want to house it, then she may have the
right to remove it.

Embryo research is about embryos that are outside the body. They're hanging
around in public places, petri dishes, tanks of nitrogen. There's no one's
body that has to be invaded, forced to do anything. So at its heart, the
abortion debate forces a confrontation between the interests of a fetus that
has already started down the path toward development and the right of a woman
to say, `Well, I'm sorry, but I don't have to put my body to the nourishment
or housing of this person that I choose not to house.' The embryo debate is
about possible people; that is genetic blueprints that are in dishes or tanks,
for the most part, and who's going to control them. And I don't think the one
really has much to do with the other.

GROSS: This is a big debate now I think particularly in the Republican Party,
because both sides of the party, the side that's for abortion and against
abortion, the side that's for the research and against the stem cell research,
are battling for George Bush's attention; they each want President Bush to go
the way that they want. And he hasn't decided yet, but he's supposed to
decide--it's said he will decide sometime later this month. What's it like
for a medical ethicist like you to watch a medical-ethical debate be in the
hands of political people at least as much as it is in the hands of medical
people?

Prof. CAPLAN: It can be bothersome, because one thing that happens is because
it's such a core political debate, if you will, over the soul of the
Republican Party, where you've got the social conservatives squared off
against, to some extent, the libertarian part of the party. I've seen people
like Bill Safire, Orrin Hatch, Connie Mack, Strom Thurmond saying, `Well,
there's really benefit here. I don't see embryos the same way.' And others
in the social conservative part of the Christian right saying they're people
from the point of conception. They escalate the rhetoric. So one side is
yelling `baby killer' and the other side is kind of yelling `benefits that can
be obtained.' The moral nuances about where embryos come from, understanding
why stem cell research isn't the same as the abortion debate because the issue
of women's bodies, women's rights, privacy, that gets lost. You tend to see
an escalation in rhetoric that is pure politics.

GROSS: Now one way opponents of embryo research have tried to get around the
issue is to say, `Well, let's use adult stem cell tissues,' stem cell tissues
that would come from what instead of embryos?

Prof. CAPLAN: Ah, yet another confusing twist here. Scientists being
scientists refer to stem cells as anything that can make another kind of cell.
So there are stem cells in our body right now that don't come from embryos.
Your skin is constantly being replaced. Somewhere inside of our skin layers,
there are cells making new skin cells. They are skin stem cells. As many
of us will remember from high school biology, our blood system is constantly
being replaced in our bodies. The place where those stem cells live is in our
bone marrow. There are bone marrow stem cells that make blood. It is true
that adult stem cell research on cells like bone marrow could come up with
many useful things for people. But we also know that there are parts of the
body, most particularly the nervous system, that doesn't grow, that doesn't
appear to have any kind of--once it's set in, it's sort of finished. And it
doesn't have the capacity to regrow or regenerate. Embryo stem cells, I
suspect, are the only hope for treating those kinds of diseases.

If I was trying to argue the ethics here, I'd say, let's do some moderate
amount of research on embryo stem cells. Let's do some aggressive amount of
research on adult stem cells. But you're not going to really replace
completely embryo stem cell research by adult stem cell research, because that
just makes already specialized cells.

GROSS: My guest is Art Caplan. He directs The Center for Bioethics at the
University of Pennsylvania. We'll talk more about stem cell research after a
break. This is FRESH AIR.

(Soundbite of music)

GROSS: We're discussing embryonic stem cell research with Art Caplan,
director of The Center for Bioethics at the University of Pennsylvania.

Now correct me if I'm wrong, but the decision President Bush has to make is
whether he will allow federal funding for embryonic stem cell research. He's
not deciding whether it should be legal or illegal, but rather should it be
funded with taxpayer dollars.

Prof. CAPLAN: Lost in all the screaming is the fact that whatever President
Bush decides, private companies and private clinics that use their own money
or investors' money in other countries are going to do stem cell research.
Embryo stem cell research is going to proceed. Britain has already made it
legal. There's already embryo stem cell research going on in Sweden. The
clinic in Virginia that made the specially created stem cells did so with its
own money. And there are at least two companies out there that I suspect are
making human embryos to study them with pure private money.

The debate more accurately should be will stem cell research go on more
quickly or slowly and will it go on with oversight or is it simply going to be
left to the marketplace to determine what happens? If it's done by a company
using their money, well, the fact is they will keep it as a trade secret. No
one will know what they're doing, and in all likelihood, they're probably
going to patent or license their discoveries. It's going to cost a lot more
money to get the benefits of privately sponsored stem cell research than it
would be to have publicly funded stem cell research.

GROSS: What are some of the other differences between publicly funded
research and private research? Do you think that the government would have
more oversight if there were more publicly funded research? Are there...

Prof. CAPLAN: I guess I'd say flat out...

GROSS: What are some of the controls that the government might put into
effect for research involving public funding?

Prof. CAPLAN: If the government were to come in and say, `Regretfully, sadly,
some types of research can only proceed using embryos; we want to restrict
what kinds of embryos are used. So we would like to keep it to spare embryos
or damaged embryos, if you will. We don't want to see anybody going out and
making embryos commercially. We don't want anybody paid to go out and make
embryos,' they could put those restrictions over what's taking place. They
could also say, `Look, we don't want redundant research. Let's try to use the
fewest number of embryos in doing embryo research.' If companies are doing
it, they'll compete against one another, and they may do the exact same
research using many more embryos because they're not going to tell each other
what they're doing; whereas if it's a federally sponsored study, it's public,
it's out there, you're not going to have redundancy. If you want the fewest
number of embryos used and you want to restrict where they come from, probably
to, let's say, spare embryos left behind at clinics, you should favor
government-sponsored embryo research.

GROSS: Is there any chance that the government will outlaw this kind of
research or put restrictions on it even if there isn't federal funding?

Prof. CAPLAN: If I was going to guess, I would say we will either see
Congress and the president do nothing, in which case there won't be federal
funds de facto. They just won't put any money forward for it, and it will be
in the private sector and it will be driven by the marketplace. Or we'll get
a compromise that says, `We'll fund a limited number of studies using only
spare embryos. We're going to go slowly down that road.' I think they might
have gotten that compromise. The announcement by this clinic in Virginia that
they were specially creating embryos kind of put the whole movement toward a
compromise into a tizzy.

As somebody who's argued for many years now that the spare embryos are the
place to go, I was bitterly disappointed to see what I thought was an emerging
consensus on a very contentious ethical question, devastated by this, shall we
say, untimely announcement that this clinic was just going to go out and do
what it wanted to do. On the other hand, if you're going to stop that clinic,
I don't think they're going to ban research in the United States. It's almost
unconstitutional to tell somebody in science you can't pursue a line of
inquiry with your own money, so I don't think we'll see that banned.
Ironically, the best way to control what the clinic in Virginia is doing is by
having a federal restriction on what federal funds can do, and then you shame
or guilt the private sector into coming along with your rules. You kind of
use that as the model and then anyone who's not doing that, you're kind of, if
you will, guilting them and saying, `You should be doing this, too.'

GROSS: Now what was the Clinton administration policy on stem cell research?
Because they were in the middle, too, on this issue.

Prof. CAPLAN: They had a very funny policy. This was the `don't ask, don't
tell' policy of embryos. What they wound up saying was, `Look, we want to
fund stem cell research, but we don't want to know where the stem cells come
from. So if you get them by specially creating them or you make an
arrangement with an infertility clinic to send you spare embryos, don't talk
about it. We won't ask where they came from. Once you've got the stem cells,
we'd like to fund that.' So they had this kind of almost Werner von Braun
kind of thing, you know, `I build missiles, but where they fall, I don't
know.' Their policy was, `Where they come from, these embryos, we don't know.
Where you got your stem cells, we're not going to ask, but once you've got
them, then you can use federal funds to do research on them.'

GROSS: So in other words, they wouldn't fund any of the development of the
embryos or the harvesting of the cells.

Prof. CAPLAN: Correct.

GROSS: But once the cells were harvested...

Prof. CAPLAN: Then they...

GROSS: ...that research would be funded.

Prof. CAPLAN: Correct. And I have to say that met with a unanimous chorus of
skepticism. I mean, nobody was buying that.

GROSS: The president is scheduled to meet later this month with the pope, and
it's assumed that one of the issues they will talk about is stem cell
research. What has the pope's stand on this been?

Prof. CAPLAN: The hierarchy of the Catholic Church has said absolutely no to
stem cell research. It sees life beginning at conception. It basically does
not draw the distinction that I've drawn between damaged embryos or embryos
losing potency. All embryos are to be treated with reverence and cannot be
destroyed for even noble purposes, like battling disease. And the church has
gone further. Remember, it doesn't like in vitro fertilization. While it
doesn't consider it a major sin, it still finds the creation of life by
non-sexual means morally troubling. So the pope has said that he's not
comfortable with in vitro fertilization, with artificial reproductive
technologies. He's not--anything that separates baby-making from sexual
activity is not acceptable. And the results of that absolutely cannot be used
for research, can't be destroyed in any way.

GROSS: Do you think that our medical technology is moving at a quicker rate
than our ethical decision-making is and our ethical comprehension?

Prof. CAPLAN: No, I don't.

GROSS: Our policies is, I guess, what I'm saying, ethical policies.

Prof. CAPLAN: I'll tell you why I don't.

GROSS: Yeah.

Prof. CAPLAN: I think the ethicists, even ones that I disagree with and,
therefore, we could define as wrong, but even when you do battles in
bioethics, I think the ethicists have been pretty good about anticipating
cloning, artificial hearts, stem cell research. Where we fall behind is in
our political ability to grapple with these technologies. I can show you a
mountain of literature that would say, `Ooh, cloning is going to happen. We'd
better get ready for that.' But politicians, in general, particularly around
reproductive matters, anything that gets near the abortion debate, they really
don't want to go there. And so we don't have the political will in a divided
society to try and find forums or avenues for reaching consensus. Politically,
let's face it, President Bush is in a terrible position. Whatever he decides,
he's irritated either half of his own party or a large number of the American
people. If he had his choice, I think he'd prefer not to be talking about
stem cells at all.

GROSS: And you think that's the way a lot of politicians are. With new
medical technology, it's easier to just not deal with it.

Prof. CAPLAN: You look at do we want to use animals for transplant? You see
people trying to wrestle with questions of do we want to clone human beings?
Generally speaking, from a political point of view, these are terrible issues
because they're highly divisive and you wind up alienating half your base. So
I think the political response often is ostrichlike, just head in the ground,
forget it, we don't want to talk about it. What that does in the American
context--and it kind of puzzles the rest of the world--is that it leaves all
of our technology moving solely by business ethics. It's the marketplace.

If you looked at--just to give an example, we have almost no laws and
regulations involving reproductive technology in general. You see people
selling their eggs on the Internet, the infamous coed eggs, Ivy League eggs
where people are selling them. We see people involved in surrogate
arrangements where they sell their wombs. We see clinics making seven and
eight babies with no restriction on the number of embryos they can transfer.
There's no regulation. There's no control. I should add we often see couples
battling about who owns the embryos when they divorce or get in a situation
where somebody has died and somebody wants to make a claim. No rules, no
regulations. The only thing that is operative is basically who's paying. The
rest of the world kind of is startled at the fact that we're the leading
biomedical and technological innovators. We have more of this going on than
anywhere. We have the least regulation, the least political input, the least
oversight. It's basically just `Can you pay me? Then you'll get it done.'

GROSS: Well, Art Caplan, I want to thank you so much for talking with us.

Prof. CAPLAN: My pleasure.

GROSS: Art Caplan directs The Center for Bioethics at the University of
Pennsylvania.

Coming up, classical music critic Lloyd Schwartz reviews the new edition of
the Grove Dictionary of Music and Musicians. This is FRESH AIR.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Review: New updated 29-volume Grove's Musical Dictionary very
educational
TERRY GROSS, host:

For more than a century, the Grove Dictionary of Music and Musicians, first
edited in 1978 by Sir George Grove--that must be 1878--has been the most
extensive classical music reference work in English. It's gone through six
editions, and this year, an updated new 29-volume set was published. Our
classical music critic Lloyd Schwartz frequently turns to Grove's Dictionary
for all kinds of information.

LLOYD SCHWARTZ reporting:

On top of the filing cabinet next to my desk, I still have my copy of the
10-volume paperback reprint of Grove's Musical Dictionary that I got in 1973.
I still love dipping into it, though it was already 20 years out of date by
the time I bought it. There were great articles, some of them practically
small books, some of them extremely well-written. And there were those
amazing lists of composers' complete works, sometimes pages and pages.

But the history of music is constantly changing. There's new scholarship, new
music, new composers, even new subjects. The so-called New Grove's Dictionary
appeared in 1980, doubled to 20 volumes. Now there's a major new edition of
the New Grove, in 28 huge volumes, plus an entire separate volume for the
index. If Grove's has been the Encyclopedia Britannica of classical music,
this new edition even looks like the Encyclopedia Britannica. There are, of
course, timely new social and political entries on the Americas, feminism, gay
and lesbian music, undreamed of for an encyclopedia two decades ago. Grove's
used to concentrate on classical music, but now there are new or expanded
sections on jazz, rock and ethnic music, 29,500 entries in all by 6,000
different writers, 900 new articles on contemporary composers alone. It's
overwhelming. Very few readers will ever get through all of it.

Pianist Charles Rosen, who is one of the rare people qualified to evaluate the
entire set, has a complicated review in the New York Review of Books, admiring
some of the results, yet lamenting others. He both regrets cutting the old
article on Wagner's music, for example, while praising the new one.

I'm not a musicologist, which is one of the reasons I need the New Grove. But
I know it doesn't always have all the information I want. I recently looked
up a Verdi opera for a review I was writing, but I needed to go to Grove's
Dictionary of Opera for more details. In a new article on songwriter Lorenz
Hart, I discovered that his middle name was Milton, but there was no reference
to the very last show he worked on, the revival of "A Connecticut Yankee," for
which he added some of his most brilliant lyrics.

How can this be a musical bible if the Word of God can't be entirely trusted?
But this is an age of miraculous technology. The New Grove is also online,
which is both cheaper to access if you or your library can't afford the $4,850
price tag. And you don't have to wait 20 years for corrections and new
material to be added. The printed volumes may already be more obsolete than
the online version. But I still relish opening a book, turning the pages,
like browsing through the dictionary. So although I didn't find what I needed
about Verdi's "Macbeth," since I had Volume 26 in hand, 12-Note to Wagner
Tuba, I couldn't put it down. I found out about music from Uzbekistan and
that the movie theater organ was originally called the unit orchestra, that
the original name for Van Halen was Mammoth, that an ancient Roman scholar and
poet named Marcus Terentius Varro wrote an eloquent defense of music, and that
there's a 19th-century French dance I never heard of called the Varsovian.

I found a wonderful photograph of the legendary 19th-century soprano Pauline
Viardot. I looked at entries on gospel composer James Vaughan, Sarah Vaughan,
Stevie Ray Vaughan and Ralph Vaughan Williams, as well as articles on valves,
vamping, varnish, vaudeville, vibrato and the vibraphone. And I dipped into
the 42-page double-columned article about variations, one of the pieces
Charles Rosen singles out for high praise.

I don't need most of this information, but it's mysteriously gratifying. I
tell my students that learning is about discovering. Every now and then, I
need to remind myself.

GROSS: Lloyd Schwartz is classical musical editor of The Boston Phoenix and
director of the creative writing program at the University of
Massachusetts-Boston.

(Credits)

GROSS: I'm Terry Gross.
Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.