New Reproductive and Genetic Technologies
International versus National Campaign Issues

Summary

Many of the issues raised by new developments in genetic technologies are the same in every country. Is it ethical to experiment on embryos or on people who cannot give their consent? Will widespread gene testing of adults lead to discrimination? Does genetic research increase the likelihood of biological weapons being deployed and used? But some issues are not the same because different countries have different cultures, legislation, histories and economies. This presentation at the "Medicine and Conscience" conference held by International Physicians for the Prevention of Nuclear War (IPPNW) in Erlangen, Germany, considers how these genetic developments may play out in different places and explores what this means for building international alliances.

Main text

We've been hearing the past few days about new developments in genetic technologies, some of the issues they raise, their eugenic potential. In some respects, the issues -- or rather the questions -- are the same, whether one is in Germany or Britain or the US or wherever -- is it morally acceptable to experiment on embryos? Or on people who cannot give their consent? Will widespread gene testing of adults lead to discrimination? Does gene research increase the likelihood of biological weapons being deployed and used?

But in other respects, the issues and questions raised are not at all the same, because, despite 'globalisation' or 'McDonaldisation', our countries are still different, they have different cultures, legislation, histories, economies and so forth. How these genetic developments play out, what significance they have is thus different in different places for different people.

I've been involved in Britain over the past few years in analysing and lobbying against the change of the law to extend the purposes for which research on embryos is permitted -- in what has become more commonplace language, cloning and embryo stem cell research.

Given current pressures to change the 1990 Embryo Protection Act in Germany, it might be useful to describe the process in the UK, the arguments used for and against, and so forth -- but I'm not going to.

Or rather, instead of looking just at the national dynamics, I'd like to use the UK example of cloning and embryo stem cell research to think about the international dynamics of this research, the international dimension of these industries, and what that means for campaigning and lobbying, both on an international level but also on a national level, given our different national contexts.

I'm mainly going to refer to Britain, Germany and the US, but there are of course significant developments taking place elsewhere which are part of the dynamic: in France, in Italy, which has pushed the limits of IVF and where it's been announced that efforts will go ahead to produce the first cloned baby; in Australia, where Monash University, another IVF pioneer, has applied for a patent on 'breeding human embryos', while Amrad, an Australian company has been granted a European patent to produce human-animal hybrids using human embryonic stem cells.

For developing countries, meanwhile, the issues are quite different again: in countries which have rudimentary health care systems and which now have to charge people to use them anyway, which are often not allowed under IMF or World Bank programmes to spend any more on health care, far more pressing concerns are access to food, water and livelihoods and primary health care -- and concerns about becoming the experimental target for gene-based drugs.

So, first a quick round-up of the UK legislation and debate. The UK has legally allowed embryo research since 1990, not in general, but related to five specific purposes: infertility, miscarriage, congenital disease, chromosome disorders -- to detect these before embryo inplantation, ie. PID - and contraception. A researcher has to apply to a central authority, the Human Fertilisation and Embryology Authority, for a licence to carry out such research. British law also allows embryos to be created specifically for research, one of the few countries in the world to allow this legally, although in practice, by far the majority of research is carried out on embryos created for a pregnancy but implanted in women. You can't do human embryo research or even cloning without women having IVF -- after all, where are the eggs and embryos going to come from?

Dolly, the cloned sheep, born 4 years ago in February 1997, eventually prompted proposals to look into treatments for diseased or damaged tissues or organs.

By the time Parliament came to vote on changing the law, the main arguments put forward for allowing this research were that:

• people are suffering from untreatable and incurable diseases such as Parkinson's and Alzheimer's. The respect we give to an embryo in the laboratory does not outweigh our duty to alleviate suffering.
• we allow research on embryos anyway, this is just another purpose. It makes no sense to allow embryo research for reproductive disorders but not for serious disease. The embryos are going to waste anyway.
• early embryos, before 14 days, are just are a ball of cells. "There are trillions of cells in the human body and shed millions of them everyday like we shed dead skin."

And against were that:

• the embryo is being turned into a resource for the embryonic stem cells
• other less controversial research angles could yield similar results, such as adult stem cells
• safety issues, such as the potential, if embryonic stem cells are implanted on someone, to develop tumours.
• it paves the way for further genetic engineering of people, of cloning.

The majority in the British Parliament did vote to change the law -- but the controversy lingers on. A Parliamentary committee has been appointed to look into the effects of changing the law -- a rather peculiarly eccentric British thing to do, to investigate after changing the law rather than before.

The law as changed is actually much broader than even the debates were about: it adds on 3 extra purposes for research:

• to increase knowledge about the development of embryos (this doesn't even define a purpose for the knowledge, and in effect means you can do just what you like);
• to increase knowledge about serious disease;
• to enable any such knowledge to be applied in developing treatments for serious disease.

Also, there is a current legal challenge arguing that actually the licensing Authority, the HFEA, has no authority over cloned embryos, because the existing law defines an embryo as the result of fertilisation, and with cloning -- or cell nuclear transfer, the Dolly process -- no fertilisation has taken place. This court case is likely to be heard in October this year, and the Authority has said that it will not issue a licence for cell nuclear transfer until it knows the result of the court case. While much is made of cloning, bans and the like, there is in fact no ban in British law on cloning. Cloning is simply not legal or illegal.

Both the parliamentary committee and the court case have the potential to put embryonic stem cell research and cloning on hold.

Someone asked me recently "Why was Britain the first country in the world to legalise embryo stem cell research for any purpose at all, in effect to legalise cloning?'

Saying in response that people are suffering is not good enough, in my opinion. The British national health service no longer provides care to those with long-term illnesses such as Parkinson's and Alzheimer's; it allows a range of chemicals, including common garden pesticides, which are known to trigger neuro-degenerative diseases to be sold openly. Thus I don't believe that, in an institutional setting, alleviating suffering is really the goal -- which is not to say that individual researchers are not highly committed to this goal.

Why Britain changed the law was, I think, simply that Britain wanted to gain an edge on the US -- and on Germany -- for economic as well as scientific reasons. This is an international dimension that did not really come into the public debate.

IVF doctor Robert Winston writes that once Britain led the world in reproductive research, but that "now there are chances to actually save lives [through using stem cells derived from embryos], other countries are overtaking us." A Financial Times correspondent commented that "a change in the regulations governing the use of human embryo cells could ... put the UK back at the forefront of cloning research". He concludes that a change in the UK law represents "a chance to extend embryo research into regenerative medicine [which] would put the UK ahead of the US". Regeneration or regenerative medicine is the term some would prefer over cloning.

And Germany is also a competitor. The business section of a national newspaper commented some months back, "The US has led the biotech revolution for three decades, but since the 1980s, Britain has established its own niche as a powerhouse of innovation. Now, however, it is being outshone by Germany, which did not even have an industry to speak of five years ago". The solution has been to change another law in Britain governing the listing of biotech companies on the stock exchange so that it is easier for new companies to raise cash.

It is something of an irony, however, that because of the UK change of embryo research law, Chancellor Gerhard Schroder now feels that Germany now has to catch up with Britain.

Thus I conclude, the push and the race to change the law was not really because people are suffering and dying but because Britain wants to get there first. Thus one bioethicist in the US has concluded "Where law and funding are concerned, the Brits have the right stuff to win the stem cell war". Note the use of language. And a point about funding: much of the initial stem cell research and cloning research is funded with public money in the UK; the companies come in later although with lots more of it.

And if it seems slightly old-fashioned to say, this is just about money, I'd refer anyone to a recent study by Greenpeace Germany and the group 'No patents on life', the results of 2 years' research into over 1,000 patent applications at the European Patent Office: besides 2 patents already granted governing human embryo stem cells, including procedures to genetically engineer these embryos and germ line manipulation, there are at least:

• 10 more patent applications on human embryos;
• over 30 patent applications covering genetic engineering or cloning humans
• 9 patent applications governing manipulation of human germ cells -- sperms and eggs
• over 60 patent applications on human stem cells
• 10 patent applications on human-animal embryos.

Greenpeace's comment on the dramatically increasing number of patent applications on humans is quite restrained "an indication of the commercial interests driving this kind of research".

Thus although the debate in Britain about embryo research and cloning has focused on ethics, morals and science, we haven't looked into economic aspects, the profits, the funding, the jobs, etc. nor this international dimension. Given that the cloning division of Roslin, which has a patent on cell nuclear transfer on mammals, including humans, is now owned by a US company, Geron, which has patents on embryo stem cell procedures, given that money can travel freely across international borders, given that researchers can travel quite freely, given that even frozen embryos can travel across borders -- witness the recommendations of the DFG to allow the import of embryos for research here in Germany -- I'm a little puzzled as to why the UK has to catch up with anyone. Any profits from UK research can just as easily flow out of the country.

As one Member of the British Parliament said, "We are not talking about balancing the moral argument for research [ie. that people are suffering] against the moral hazard of exploiting embryos, but about the moral hazard of exploiting embryos ... against the risks to our biotechnology and pharmaceutical industry of not proceeding." Phrased this way, the moral dilemma is quite different. As even a supporter of embryo stem cell research said, "it is not good enough ... to say that because our biotechnology industry needs to be supported we should allow it to do shady things."

This international dynamic and dialectic clearly indicates that for those who are concerned about these developments, opposition clearly has to be international too -- or rather opposition has to take account of developments in other countries, and I would argue, the context of developments in other places as well, and in solidarity with those elsewhere.

This is nothing new -- and ought to be constantly in the minds of campaigners, in my view. Witness the export of toxic and hazardous waste and industries from the developed North to the countries of the South; opposition and campaigns in the North have helped clean up many communities, but may have also displaced the problem onto others. Witness the campaigns in Europe against genetically modified food -- Britain is considered a model of resistance -- only for such food to surface in food aid to the countries of the South. It is hard to carry out trials of GM crops in Britain -- so more are taking place in Eastern Europe.

A second aspect which I think the British case of embryo research and embryo cloning shows and which is relevant to international lobbying is the deep connections of all these technologies and developments have with each other.

When Dolly the sheep was born, the world said that the techniques must never be applied to humans. But soon after, the vocabulary divided into reproductive cloning and therapeutic cloning. I don't know where it first came from, but certainly within Britain, the distinction was quickly taken up. Reproductive cloning was producing a cloned person, while therapeutic cloning was everything else, to put it crudely. One is bad, no thanks; one is good, we should have it.

There are clear indications, however, that they are more or less one and the same, even if one's common sense didn't tell you this. The most obvious is that the two Italian and US doctors who announced that they plan to go ahead with cloning a child said that the British decision on therapeutic cloning had encouraged them. "Thank you Mr Blair", they are reported as saying. Scientists in Britain who support the use of embryonic stem cells and embryo cloning have admitted that, if this research is allowed, reproductive cloning is "inevitable". The first British government consultation on cloning issues recommended that the licensing authority allow therapeutic cloning go ahead but not to allow reproductive cloning. It recommended that a specific national ban on reproductive cloning be introduced -- but qualified its recommendation by stating that it would be difficult to find language that did not preclude therapeutic cloning. As for international bans, it said, "it will be necessary to consider how carefully international initiatives have been drafted lest they should preclude the therapeutic use of cell nucleus replacement as well as human reproductive cloning." The Financial Times has estimated that once the public has got used to the idea of cloning for spare organs and the like, bans on human replication could be reviewed -- it gives a time frame of five years. This shows the social connection between them as well as the technological one. Once we all become accustomed to prenatal testing, then preimplantation diagnosis is not such a large step after all. Once we've become accustomed to PID to get rid of certain undesirable traits, it's only a little hop towards putting in certain desirable ones.

Since the flurry of attention paid to Dolly the sheep, I've come to think of all these developments as being something like being in the theatre when the scenery is being changed between different acts in a play. The whole stage has gone dark, pitch black -- except for a spotlight in one corner where someone sings or talks to keep us all amused. We can perhaps hear noises across the rest of the stage, perhaps think we see shadowy figures in black moving, but our attention is on the spotlight. And then suddenly the lights go up and the stage has been transformed while our attention was elsewhere. If cloning and germ line engineering are in the spotlight -- which is good because they are major concern -- what else is happening in the shadows that fundamentally shores up cloning escapes notice and critique until it's too late.

Incidentally, a recent British publication, sponsored by pharmaceutical giant AstraZeneca, commented on articles about human germline engineering that the "worst outcome would not be a future of genetic underclasses or designer babies, but one where genetic science has failed to develop because of our fear of how it might be abused". I thought about this for a while -- and concluded that I am not afraid of how it might be abused -- but how it might be used.

For the industry and scientists, restrictions on reproductive cloning represent something of a dilemma: accept it and you accept the principle that some areas are not to be ventured into -- what else might be forbidden? Better say no to a ban. Accept it, however, and you appear responsible, ethical, after all, there's not much interest or profit to be made in human replication per se, accept the ban and everything else can go ahead, a good PR tactic. Better say yes. And I would argue that the majority of those involved in this research have opted for this line, better say yes to a ban on reproductive cloning, albeit a carefully worded one -- they're not really interested in going there anyway so have little to lose -- so as to get the rest. After all, biotechnology is racing ahead on a broad front.

I see something of a parallel with the recent controversy involving pharmaceutical companies and AIDS drugs in South Africa. Accept that South Africa can manufacture its own versions of patented drugs or import them more cheaply -- and it may open the floodgates to other countries doing the same for other drugs, particularly the largest pharmaceutical market of them all -- the United States. Oppose South African manufacture and, because of activist campaigns, pharmaceutical companies' reputation gets even more damaged.

As a campaigner, does one lobby for a ban on reproductive cloning? Or against all types of cloning? Against cloning and germ line engineering? Against technologies and practices with eugenic implications? Where does one draw the line? Who is drawing it? Who has the power to draw it? Who has the power to enforce it?

Thus given the international inter-relatedness and the technological and social inter-relatedness of these developments, given that a legislative development in one country has an impact elsewhere, it makes sense for those concerned about these developments to work together, too.

But we all have different national contexts to contend with. In the United States, 'anything goes', someone described this field to me. The little legislation there is at a national level relates to public funding rather than to what you can and can't do. In Germany at the moment, little is allowed legally in the area of embryo research or testing of embryos. Britain is somewhere in the middle, (although rapidly drifting towards the US) supposedly regulating so that the worst excesses are not allowed, and licensing so that what is done is monitored, data collected and so on.

In this context, calling for a ban on reproductive cloning and genetic engineering in the US is something of a radical step, one which could be used to raise concerns more generally about such developments -- but in Germany, I interpret it more as a call for everything else to be allowed and to go ahead. Different contexts lead to different interpretations. We can carry on discussing the technical issues, even the social issues, but if we're not to undermine each other's efforts, we need to be aware of the international dimension and of each other's national or regional context.

Drawing on the work of my colleagues over the years on a range of environmental and social justice issues, we've found it useful as a guide to consider the following when thinking about who to work with and how, who to make alliances with. Asking the questions is more important than policing the answers:

• what are we working against? Are we against the same the thing, or are there enough similarities of enough things? Why are we opposed to something?
• more positively, what are we working for? Are we actually working for the same things?

In the campaigning world, it's easy to get locked into short-term, immediate goals -- such as a particular piece of legislation or a particular practice -- and to lose sight of more broad aims.

I'm reminded of colleagues in India campaigning against the introduction of one hazardous contraceptive after another. At one point, one of them said that she was exhausted because as soon as one campaign had been successful, then another contraceptive appeared and she had to start all over again. What we need to focus on, she concluded, was not the specifics of the contraceptive but the overall themes: against hazardous contraceptives under the control of a third party which prioritised effectiveness over women's health -- and for women's self-determination.

• who are you aiming to support? What other goals and aims do they have? Can you support them in these goals too?
• looking at not just what is said but who is saying it? What are the other things someone is saying and doing? Does it all match up?

For instance, given that public money in Britain has been cut for caring for people with Parkinson's and Alzheimer's, I question whether the public money recently promised to embryonic stem cell research is really about caring for them.

Or AIDS in Africa again. HIV-positive people in Africa can't get AIDS drugs because they're too expensive. Thus a campaign to get access to these drugs. But some public health campaigners have pointed out that the issue of AIDS in Africa should not become defined as one of access to drugs, because in some places the health care infrastructure is so rudimentary and because a drugs approach doesn't tackle what is causing the spread of the disease and that people get sick quicker in many African countries than elsewhere because nutrition and overall health levels are lower. I've heard African public health workers lay AIDS at the foot of the IMF and World Bank rather than at pharmaceutical companies. So when I heard at one stage, a pharmaceutical company representative coming up with some of the best primary health care advocacy I've heard in a long time, that AIDS was a matter of livelihood and food, rather than medicines, I was impressed -- until I realised that of course it was in the pharmaceutical company's interest because it doesn't want its patented drugs manufactured in Africa. Who is saying what and why makes a difference.

If everyone is talking the right-on language of, for instance, equitable access, relieving suffering, public interest, and so on, it becomes very difficult to know what to do. I conclude with some words adapted from a colleague talking about who to make alliances with in resisting the multinationals in a globalising world:

"It is not enough to simply look for expressed 'common concerns'. Everyone from Shell Oil to neo-fascist intellectuals now talk the language of 'empowerment', 'community, 'environment' and 'participation'. [in the areas under scrutiny at this conference, I'd add in 'women's choice]

"It is necessary to look beyond the slogans to the politics of those who espouse them. And to build up relationships of trust with those whose politics we share.

"For my part, I am willing to make common cause with those whose politics, like mine, aim to be based on a rejection of all forms of oppression. With those who reject racism. Who reject chauvinism. Who reject patriarchy. Who reject the right of any one individual to dominate another ... and who want to talk about reclaiming political and economic power, who want to talk about democracy."