rose to call attention to the potential benefits of stem cell research and related issues; and to move for Papers
The noble Lord said: My Lords, I am delighted that so many distinguished noble Lords will take part in this debate, and I look forward to listening to all the speeches. I am particularly pleased that my noble and right reverend friend Lord Harries of Pentregarth, the former Bishop of Oxford, who chaired the Stem Cell Select Committee, and the noble Lord, Lord Winston, an eminent stem cell scientist, will be taking part.
Stem cell research is undoubtedly the most exciting area of biomedical research. What makes it so exciting? Stem cell science has the potential to deliver cures for diseases that were hitherto untreatable, by harvesting the growth of cells and tissues in the laboratory and using them to replace diseased tissues with healthy cells.
Regrettably, there has been much premature hype, occasional misinformation and a lack of dialogue between those with opposing views in certain areas of stem cell research. The hope—not hype—is that stem cell research will, in combination with technologies such as tissue engineering, contribute to the field of regenerative medicine and help to develop therapies for diseases such as Parkinson’s, diabetes, heart failure, spinal cord injuries, and potentially Alzheimer’s.
There are several types of stem cells with varying capacities to give rise to other cell types. The embryonic stem cells, first identified by Sir Martin Evans in 1981, derived from early-phase embryo are the most versatile. Therefore, these cells are often referred to as pluripotent cells. Research on the basic biology of these cells—what regulates them, what programmes their differentiation, what is their behaviour in disease, including cancers, cell death, and so on—will be crucial if we are to find therapies for diseases.
Apart from these embryonic stem cells, there are several types of adult stem cells, which are multipotent and able to give rise to limited numbers of cell types. Such cells are found in bone marrow, blood, cord blood and other sites. Some—for example, bone marrow on rare occasions—have been found to demonstrate pluripotent capabilities. It is true that all the currently available stem cell therapies are based on adult stem cells. Bone marrow transplant started in the early 1970s. Today thousands of such treatments are carried out every year
There are other preliminary but none the less exciting developments showing early clinical success, such as eye stem cells for corneal damage, periodontal stem cells for gum damage, bone marrow mesenchymal cells for heart failure, using autologous—the patient's own—stem cells or donor cells from cord blood or bone marrow. Just last week I heard some preliminary successful clinical applications of using autologous stem cells to treat age-related macular degeneration, which affects some 3 million people over the age of 60 in the United Kingdom alone.
All adult stem cell therapies are patient-specific. Patient-specific treatment is expensive. Scaling up has challenges, both biological and technical. Because embryonic stem cells are easy to culture and keep in a stable undifferentiated form—and therefore potentially capable of mass production, using robotics to do so—they offer potential benefits in treatment on a large scale. Adult stem cells are currently harder to isolate, keep in culture and produce in large quantities. Studies of embryonic stem cells from different species will, in due course, provide better understanding of the factors that control differentiation and proliferation of stem cells, research that will make the wider use of adult stem cells possible.
What we already know makes me feel confident that, before too long, the way we treat some diseases today will have changed, using more cell therapy and tissue engineering. It is most important to realise that we need to pursue research on all types of stem cells, and see it as complementary rather than a competing alternative. Adult stem cell research has been going on for decades. Embryonic stem cell research has only been going for the last four years, and even then with a limited number of stem cell lines. None the less, studies on both animal and human stem cells have demonstrated some remarkable advances: stem cells restoring neuronal damage, developing kidneys, developing new neurons and generating pancreatic beta cells that could produce insulin, and reversing Parkinson’s disease damage. In addition, stem cell research has the potential to contribute to drug development, toxicology and immunology—studies with implications for animal and human testing of drugs and transplantation.
I shall say a little about the UK’s position in stem cell research and regulation. Before I do so, I declare my interests. I currently chair the Stem Cell Oversight Committee and the Stem Cell Bank committee, the UK National Stem Cell Network and the yet-to-be-funded steering group of the Stem Cell Immunology Programme. I am chancellor of the University of Dundee and vice-president of the Royal Society of Edinburgh, responsible for the section on life sciences.
Currently in stem cell research, the United Kingdom is undoubtedly the global leader. What we have put in place is the envy of much of the world, because of strong parliamentary and government support, measured but clearly defined legislation, an appropriate regulatory framework, funding from research councils being matched by charities and, above all, wide public support. In the last MORI poll, 70 per cent of the public supported all forms of stem cell research. The result has been that the UK has the world's first and largest stem cell bank, housing ethically sourced, quality controlled, fully characterised stem cell lines. The bank currently holds 40 such lines, and more are in the process of being considered. All will be available for research. We also now have several centres of excellence in stem cell research, far more than any other country in the world, including the United States. We have successfully recruited top stem cell scientists from across the world, including the USA. The United Kingdom punches well above its weight in scientific publications in key journals.
Recognising the importance of stem cell science to the economy, the Chancellor of the Exchequer, Gordon Brown, commissioned a report from Sir John Pattison, UK Stem Cell Initiative, to set out a 10-year vision on stem cell research to consolidate the UK’s current position and become a global leader in stem cell therapy and technology. The Government accepted the report in full, including all the recommendations, even those related to finance; the Chancellor said so in his Budget speech.
So far, it all sounds fantastic. Over the last year, however, we have begun to see evidence of a failure of commitment and mixed messages, particularly on funding for research and regulation from the Government. I will pick up on two key areas of recommendations in the Pattison report, related to funding and timely and judicious regulation. The report includes a chart of the cost of implementing the recommendations over a 10-year period in incremental stages. The total cost over that period is in the region of £630 million. Adding up the funding from both the charities and councils so far amounts to about £40 million up to last year. However, there is already evidence that year-on-year commitment to funding is not being maintained. We are probably already £30 million short of the recommended projection. It is important to note that this is at a time when other countries are scaling up their funding enormously, especially China and the United States of America, where the climate for stem cell research is changing. California alone will spend $300 million per year for 10 years from public funding and possibly $200 million per year from private funding. Other countries scaling up funding are Singapore, India, Australia, Sweden and South Korea. China is likely to outstrip even the USA in research and in facilities related to stem cells. It has state-of-the-art facilities and is recruiting scientists. Biomedical research is seen as a future economic driver.
It is important to realise that if we do not keep pace, we will lose momentum and our lead position. We will fail to recruit because all these countries are also trying to recruit. We will fail to develop further capacity. We will fail to train future generations of stem cell scientists. We will fail to translate science into therapy. Worse, we may lose our leaders in stem cell science and the technologies that we have developed. So I hope the Government will commit themselves at least to keeping up funding at the level recommended in the Pattison report and accepted by the Chancellor last year.
Let me now turn to regulation in relation to stem cell research. Two areas of regulation need fairly urgent attention. The first relates to the accreditation of good manufacturing practice—GMP—facilities for developing stem cell lines for research and therapy. Just now, there is confusion as to who is responsible for the accreditation of such facilities and the end result is that no regulatory authority is prepared to take it on. We need an authority with statutory responsibility to accredit such facilities. I have yet to be convinced that the new amalgamated HFEA and tissues authority—RATE—will be up to such tasks, but I have no doubt other noble Lords will refer to that. Regulations related to recognising, accrediting and, if required, monitoring GMP facilities for stem cell work are urgently needed.
Let me now turn to regulation related to embryo research. There is much debate and some concern about whether in vitro stem cell research should be allowed on hybrid and chimera embryos. The House of Commons Science and Technology Select Committee, having taken evidence, recommended that such research should be allowed. On the other hand, in the White Paper reviewing the Human Fertilisation and Embryology Act, the Government proposed that the creation of hybrid and chimera embryos in vitro should not be allowed. The HFEA is engaged in a public consultation; I hope it will be a properly informed consultation. The evidence given by research councils and charities to the Science and Technology Committee supported the need for such research. The Academy of Medical Sciences—in which I declare an interest as a fellow—will report and provide evidence to HFEA consultation.
It is important to understand what is proposed and why in terms of science. I fully accept that the public must finally decide whether such research should be allowed, not the scientists, so public consultation is absolutely important. What is proposed is using animal ova from cows or rabbits to carry out cell nuclear transfer, in which the nucleus from an ovum will be removed and a human somatic cell nucleus inserted. The resulting embryo in vitro will have 99.9 per cent human DNA and 0.1 per cent cytoplasmic—non-nuclear—animal DNA, hence the term cybrids. An embryonic stem cell will be obtained at the five- to six-day stage to develop stem cell lines. The use of animal ova would not be necessary if there was a plentiful supply of human ova, particularly fresh human ova, which there is not.
Why do scientists feel that they need this particular aspect of stem cell research? If we are to understand the behaviour and the biology of stem cell lines and develop therapies, it is necessary to develop stem cell lines that carry diseased genes, such as stem cell lines with genetic markers of motor neurone disease, diabetes, cancers and so on. This can best be achieved by using cells from affected individuals and by cell nuclear transfer techniques obtaining embryonic stem cell lines that carry the marker gene, which is a procedure allowed by the HFEA under licence in accordance with current legislation. But to do this in humans has proved difficult—scientists do not understand why—while cloning of embryos has worked in animals.
Research on cybrids will allow scientists to learn how to produce disease-based stem cell lines using embryonic stem cells efficiently, or even adult stem cells in the future. Scientists need only a few such stem cell lines. They will also be important because they will carry disease markers for future drug development. The submission of the Medical Research Council and Wellcome Trust to the House of Commons is detailed and well worth reading.
The key elements for the future success of the UK in stem cell research are: strengthening centres of excellence to enhance interdisciplinary and translational research; supporting high-quality clinical studies, which in the near term are likely to be of autologous stem cells, and the stimulation of endogenous stem cells; support for key infrastructure; the integration of biomedical advances with engineering—delivery systems, cell matrices and cell production; the involvement of bioindustry to accelerate therapeutic development; capacity building, including the encouragement of young researchers in related areas of UK strength, such as cancers and developmental biology; a permissive but strictly controlled regulatory structure that both encourages research in this area and reassures the public over ethical and safety issues; and continued international leadership.
Therefore, will the Minister emphatically reassure the House that the Government, first, will fulfil the commitment on funding as recommended in the Pattison report; and secondly, in revising the legislation related to embryo research, will look at the scientific evidence and the wider public opinion and do not intend to bring, even in the interim phase, legislation that damages the current positive environment for stem cell research? I beg to move for Papers.
My Lords, I shall concentrate entirely on human embryonic stem cell research. At some stage in the debate it will be said by some Members of the House that science is moving too quickly. Perhaps I may point out that embryonic stem cells were first grown satisfactorily in 1966. They were recognised to be able to invade tissues by Richard Gardner in Oxford in 1968. That is 40 years ago. It was Thomson who first grew human embryonic stem cells some 10 years ago. During that time scientists well understood the power and potential of stem cells. The fact is that we did not proceed with this area of science because we recognised that there was a question of its acceptability to the public. Scientists have been extremely cautious and entirely responsible throughout in the way they have conducted this research. There was one major case of fraud in Korea, but, that aside, there has never been a suggestion of lack of probity by anyone conducting this research in university centres.
It is interesting to look at the publications regarding human embryonic stem cell research. We frequently boast in Britain that we lead the field and that we provide the ideal liberal environment for this research to be carried out. This week I trawled through 2,600 papers on the PubMed index which cite human embryonic stem cells. Of these some 530 report individual research of a novel nature.
Despite the presidential ban on embryonic stem cells, which has existed since 2001 in the United States, the United States leads by far with this research; indeed, consistently year on year it has published one-third more papers than all the other countries put together. Currently, some 208 publications are from the United States. Israel comes next—a country with half the population of London—with 55 publications. These publications are generally in higher impact journals than the publications from the United Kingdom, which comes third with 50 publications. Thereafter, there are a total of seven other countries which lead in this research, all of them smaller than the UK, some of them tiny by comparison, including Singapore, Sweden, Korea—which is a larger country with a bigger base—China, which has been mentioned, and Australia.
It is also interesting to look at funding in those countries; I have some figures on that. My noble colleague Lord Patel has already pointed out that Proposition 71 in California resulted in the promise of $3 billion in that state alone, which has roughly the population of the United Kingdom. In Wisconsin, $750 million has been promised and in New Jersey, $270 million. By 2005, Korea had promised $27 million, Singapore $600 million, and there is substantial funding in Canada and Israel. In China, perhaps the poorest country, although it is starting to gear up more rapidly, $132 million has been committed to such research. In Australia, just one centre in Melbourne received almost 100 million Australian dollars in 2003, I think, to set up the stem cell research centre headed by Alan Trounson. The following question has already been asked but I need to reiterate it. Will my noble friend the Minister kindly tell the House exactly how much money has been promised by the UK Government for stem cell research and how much has already been allocated and spent?
Despite what is widely thought, at least 33 countries worldwide have relatively permissive legislation along the lines of that in the United Kingdom. It is not clear how effective the regulations for that research in Britain are. Undoubtedly, the current system under the HFEA results in extremely long delays to research licences being granted. A researcher must first apply to his local ethics committee. On average, in a research area in Britain, that takes six months because of the overload on those committees. If there is anything wrong with the wording of the application, one can expect a further delay as it is rewritten and resubmitted. Thereafter, and only thereafter, can the application go to the HFEA. It is usual for there to be a delay of three months before it sees it. Again, if there is a need to correct the informed consent form, for example, that must go back to the local research ethics committee and the whole procedure starts again.
Thereafter, it is sent out for peer review. My impression from my experience is that the peer review process is deeply flawed. For one application that I made, one peer reviewer did not even bother to reply to the HFEA’s correspondence. The HFEA never explained why not to my research group. After that—let us say that at least a year has elapsed, and that is an underestimate—one can apply for funding for research. Let us consider a PhD student. It is unthinkable that the backbone of British science, the PhD student, will wait for a year or year and a half for ethical and funding approval of a project. In effect, that means that we are losing young scientists in that area. So even though it seems that we are progressing that science well, in fact it is severely inhibited and there is a serious need to re-evaluate the legislation, not because the legislation is wrong, but because the way in which it is implemented is deeply flawed. That is just one example.
In the long term, we live in a complex world and I am not convinced that regulation is ideal. Germany, which bans such research, can import cells from the UK; Italians buy eggs from Oregon; Australians do their work in Singapore; the Chinese have a different view of embryos from that in almost any other country. We need a change in attitude to how we control the work that is going on, with a better understanding of the responsibility of scientists.
My Lords, in the 17 years between the isolation of embryo cells in mice and humans, there was a realisation about the enormous potential that stem cell technology offered in the treatment of some of the most devastating and distressing diseases of man, which are sadly on the increase as the age of our population increases. Stem cell technology, the regulatory framework for its use, and the ethical issues that surround it are complex and bewildering, and we should be grateful that the noble Lord, Lord Patel, has initiated this debate, to which some very knowledgeable noble Lords who participate will bring their knowledge and wisdom to bear on the various issues which the noble Lord, Lord Patel, laid out in his opening remarks.
In the period between the isolation of ES cells from mice and humans, much work has been done to isolate those cells from other species such as rats, hamsters, cows, sheep and pigs. The ES cells of the rat, the mouse and the hamster have been used to generate transgenic animals, which serve as models for human disease and the creation of chimeras—embryos containing a mixture of cells from distinct cell lines—has proved to be an incredibly useful approach in biochemical and biomedical research to understanding the effects of specific mutations and their role in human disease. An important outcome has been the production of much more specific targets for pharmaceutical research and the reduction in the number of animals required for such work, along with the concepts of refinement and replacement—the three Rs of experimental animal use.
In the time available, however, I shall concentrate on two points. The first is the use of hybrid and chimera embryos, which the noble Lord, Lord Patel, mentioned, in motor neurone disease studies. The ultimate goal of stem cell research is, of course, to provide genetically matched tissue to the recipient, thereby avoiding rejection and the need to administer anti-rejection drugs. This is done by placing the nucleus from a normal body cell into an unfertilised egg, where it behaves as if it were in an embryo. Stem cells exactly matching the donor of the nucleus can then be cultured into specific cell types needed to repair the damage in the patient.
The success rate of this procedure in animals is low; it has not yet been achieved in humans, at least in this country. As the noble Lord, Lord Patel, said, human eggs are in poor supply. An alternative approach is to use animal eggs as a recipient for human nuclei, from which human ES cells can be harvested. The animal eggs—cow eggs or rabbit eggs are often used—serve as nurse cells, and the procedure is governed by the regulations on harvesting ES cells. However, as has been mentioned, the Government have published a White Paper, in which it is proposed that the creation of hybrid or chimera embryos should not be allowed on ethical grounds. The House of Commons Science and Technology Select Committee reviewed this and concluded that the Government’s proposals are too prohibitive, would stifle research on transgenic disease models, and would have a negative impact on medical research. Some 200 medical charities have petitioned the Prime Minister, no less, to allow such hybrid embryos to be developed. I sincerely hope that they are successful.
I wish to give an example of the use of ES cells in situations other than the human patient—in this case, the horse. In 2007, ES cells have been isolated from horse blastocysts—the early fertilised cell—at the Thoroughbred Breeders’ Association Equine Fertility Unit in Newmarket, in which I should declare an interest as chairman of its ethics committee. Such ES cells have the potential for therapeutic uses in racing and high-performance horses that suffer from sprained tendons, which, as anyone who deals with horses will know, are extraordinarily difficult to treat; treatment may extend over several months and often the horse breaks down again with a sprained tendon. Hitherto, treatment has been conservative, but recent work at the Royal Veterinary College has shown that, when injected into the damaged tendons, cells from the bone marrow—not stem cells—give temporary relief in the healing process. But the availability of ES cells from the Newmarket work will probably mean that those cells that are not rejected by the horse on an immunological basis can be used, stored and characterised, which will lead to a much more rapid and effective cure of sprained tendons.
Finally, mention has been made of the funding of research. I will not repeat what the noble Lord, Lord Winston, said, but I believe that we are living in an unsound paradise if we think that we are ahead in all research and funding; we are not. I hope that the Minister will take note of the absolute importance of funding.
My Lords, I, too, am grateful to the noble Lord, Lord Patel, not only for introducing this debate but for his distinguished contribution to this area of research.
Stem cell research is one of the most exciting, exacting, complicated and, for some people, anxiety-inducing areas of research today. Living as I do in the city of Newcastle, I cannot but be aware both of the possibilities that stem cell research seems to promise and of the ethical questions that it raises. The scientists at the Newcastle Centre for Life were the first group in this country to make a human embryo through cell nuclear replacement. Last summer, academic scientists and industrialists gathered in our city to look at the technology required to enable stem cell products to be made on a marketable scale. More recently, the North East England Stem Cell Institute has been set up through collaboration between the universities of Newcastle and Durham, the Centre for Life and the Newcastle upon Tyne Hospitals NHS Foundation Trust. Noteworthy to me is that this new institute has received significant funding from the regional development agency. The development of stem cell research is rapid, and considerable expertise has already been gained and established in the north-east.
The potential that this research offers in treating serious diseases and injuries is great. It is hardly surprising that interest groups and charities representing those diseases that may be cured through advances in stem cell research want to press on and to promote the research as far and as widely as they can. One of the key questions is simply whether the ends, laudable as they are, justify the means. Should there be any limits and, if so, where should the boundaries be drawn? Does the potential of the knowledge, the techniques and the cell lines developed through research on embryonic stem cells justify the generation, manipulation and destruction of human embryos? Is it appropriate to make human embryos purely for research purposes, never having any intention of implanting them in the womb?
Those are the kinds of issues that we continue to face, and more have been raised in the responses to the White Paper, not least to the proposal that the creation of hybrid embryos in vitro should not be allowed. Scientists argue strongly that hybrid embryos made through cell nuclear replacement have great potential in the development of human cell lines. As we have heard, one of the current difficulties is that human eggs available for research are in short supply. Most come from women undergoing IVF treatment. I am told that some researchers are having to wait three months for eggs before they can begin their work. Even then, the eggs released for research purposes will be those that are not regarded as suitable for fertilisation.
It is for those reasons that scientists in Newcastle have asked permission to make hybrids using adult cells and enucleated eggs from animals. The argument is that the resulting embryo—or “cybrid”, as it is called—will be 99 per cent human and could be a valuable source of stem cell lines. There would never be any intention to implant such embryos, and they would be destroyed after 14 days. Such cell lines, it is argued, will be invaluable in testing drug treatments and in understanding the way diseases develop to help those suffering from a variety of genetically related diseases.
Not surprisingly, the White Paper proposal to ban hybrid embryos has raised considerable disquiet, not only from scientists but from the House of Commons Science and Technology Select Committee and of course from patients’ groups. That is why the HFEA public consultation has been launched, and why all the implications raised by human-animal cybrids, not just the possible medical and scientific advances, need to be given careful consideration.
To my mind there are a number of key questions that need to be addressed. What course of action will be the most honouring to the dignity of human life? Will it be the prevention of human suffering by the curing or treating of disease, or will it be in recognising that human embryonic material must be treated with the utmost care, reverence and respect? In any case, are those two options to be regarded as mutually exclusive? I, for one, do not believe so.
Is it appropriate or indeed accurate to consider these hybrids as embryos, or is an adult cell that has had its genetic differentiation somehow rewound no different from the human tissue from which it was extracted, as long as it is never implanted? That is the implication, as far as I can see, of the use of the term “cybrid” rather than “embryo”, and if that is the case, does it matter that the genetic rewinding was facilitated by an animal cell? Again, is it possible to define living cells and organisms simply in terms of their genetic make-up? Is it appropriate to call a cybrid 99.9 per cent human simply because that is the proportion of human DNA that it contains?
If it should be concluded that it is not right to make hybrids of human cells and enucleated animal eggs, what implications will that have for situations where animals are already being raised with small quantities of human DNA in their genetic material? I am aware, for example, of sheep that secrete human protein in their milk and of a mouse that is a model for Huntingdon’s disease, both the result of human genes being incorporated into their genetic material. Are these hybrids acceptable? If they are, what is the proportion of human DNA in an animal that would constitute either an appropriate or an inappropriate hybrid?
These are complicated matters in terms of both the scientific method and the ethical issues raised. That is why the HFEA consultation must include not only scientists, medical practitioners and patients’ groups but also ethicists and theologians. It is vital that future stem cell research in the UK, which will continue to pioneer new techniques if allowed, must do so within the clearly drawn boundaries and controls of a robust regulatory framework.
My Lords, I congratulate the noble Lord, Lord Patel, on bringing forward this timely and wide-ranging debate. I shall focus on just one aspect: the potential application of stem cell therapy in my own particular area of research, which is neurodegeneration. While other conditions such as heart disease and cancer are devastating, we all fear in particular the disorders that destroy the brain. They target the ability to stand up, to smile, to converse, to relate to others and to cherish memories of those relationships; indeed, to enjoy the full experience of being a unique individual. Yet the big problem is that we do not yet know why certain key brain cells embark on the pernicious cycle of self-destruction that we call neurodegeneration. The best we can do is combat the symptoms.
Current strategies consist of using drugs to replace the dwindling levels of the chemical messengers that result from the dwindling numbers of brain cells. But there are problems. First, inevitably, drugs will permeate into areas of the brain or body where they are not needed, and these cause side effects. In Parkinson’s disease, for example, treatment with a drug that will promote the chemical messenger in the area that is degenerating will also increase erstwhile normal levels of that same chemical elsewhere in the brain, so that the now excessive amounts risk psychotic side effects, such as hallucinations. Even where such treatment offers a temporary alleviation in the patient’s basic condition or a slowing down of the deterioration, it is hard to convince organisations such as the National Institute for Health and Clinical Excellence that the costs are worth while.
The situation is made even worse when we consider how many more of us will need such treatment in the future. At the moment, 700,000 people in the UK are suffering from Alzheimer’s and 120,000 from Parkinson’s, at a cost of £25,000 per year per patient. A study commissioned by the Motor Neurone Disease Association, to be completed by the summer of 2007, puts the cost of caring for someone with motor neurone disease in their final year of life at around £170,000. With around 1,600 people dying of MND each year, the total cost to the NHS and the social services is estimated to be more than £270 million a year.
More insidious than the economics is the human cost. For every one person suffering from degenerative disorders, let us say that there are 10 who care about that individual. Hence, by the middle of this century, as the numbers in the UK climb to around 2 million, we could be looking at 20 million lives that are completely devastated. So there is a huge and growing need—a need that is unmet by current treatments.
Stem cell therapy offers an exciting and realistic alternative. Stem cells can also offer a very valuable tool to gain a better understanding of the diseases themselves. The rationale is completely different from conventional treatments. The idea is not to treat the symptoms but to harness regenerative biological mechanisms, so that new cells are produced and ailing cells are supported by the natural chemicals they produce. This would amount to a true cure. It would not merely replace the chemicals that are lost as a result of cell death but actually replace the cells themselves, from the microscopic ball of some 200 that make up the early stage embryo.
Embryonic stem cells are extraordinary as they have the capacity to produce every single type of cell in the body. Many of the chemical and micro-environmental signals that determine their fate are now known. Thus we are able to make the type of cells that degenerate in Parkinson’s disease, and the different type of cells that are lost, in a different part of the brain, in Alzheimer’s. By introducing such cells into the appropriate environment within the brain, they will become those lost neurons.
What are the potential arguments against this approach? I shall restrict my comments to the often overlooked technical aspects. On the potential for immune rejection, this hazard can be overcome, as is being researched in Oxford, by immunotolarising patients or by immunosuppression. Such therapies have side effects but the risk-benefit ratio compared with that seen with conventional drugs is greatly shifted in favour of the therapeutic benefit.
A further potential problem is that stem cells in an uncontrolled state will proliferate and thereby constitute a tumour. To date, there is no clinical evidence that this has occurred with stem cell therapy and, in any event, strategies to overcome this problem are well advanced. For example, you can manipulate stem cells so that they only divide at a few degrees hotter than would normally be the case in the living brain. Another way would be to initiate cellular suicide genes if the implant attempts division.
Another issue is that the chemical messenger produced by the implanted stem cells may be excessive or not appropriate compared with the normal levels that will be produced. Again, this anxiety could be offset by considering the likelihood that brain cells, once they are in place, will behave like their naturally occurring predecessors and release chemicals at normal levels, as and when they are stimulated and interacting in their normal micro-environment. In any event, the excessive amounts of chemical messenger released as a result of drugs will be far more likely to go beyond the normal range seen with stem cells, and be far more widespread.
Finally, some might say that the method of delivery could be problematic, involving major brain surgery. In fact, this is not the case: with so-called stereotaxic neurosurgery, the procedure can be performed under local anaesthetic. Only a small hole is made in the skull and a fine needle is introduced, using precise three-dimensional co-ordinates—it is a little like drilling for oil. The diseased area can then be specifically targeted and the injection of cells kept as strictly localised as required.
In summary, we have reason to be confident that, although not without risks and downsides, stem cell therapy could be not just a treatment of choice but a chance to turn the clock back to a situation where we are harnessing the nervous system’s natural mechanisms. For an ever-growing number of individuals condemned to a severely compromised lifestyle and an even bleaker future, there is, for the first time—and not just for those suffering from neurodegeneration but for everyone who cares about them—the very real prospect of hope.
I, too, congratulate the noble Lord, Lord Patel, on securing this debate, although having listened to him and subsequent speakers I am beginning to feel slightly redundant. I will press on.
My position both as a clinical scientist and as a physician on the value of research using embryonic stem cells is clearly in favour: as a physician because when I practised medicine I was faced every day with patients desperate for cures for diseases for which I could only hope to palliate; and as a scientist because I see research as the only way in which it will be possible to answer patients’ needs in the future.
As we have heard, research on stem cells shows promise for many patients. Clearly, they will not be the answer to all our ills, but they have the potential to help patients with some pretty nasty diseases. But today I want to concentrate my remarks on the views of the Association of Medical Research Charities of which I have had the pleasure of being the scientific advisor for some years.
Well over 100 charities belong to the AMRC, all of which fund medical research. Some are very large, such as Cancer Research UK, the British Heart Foundation, the Arthritis Research Campaign, some are medium sized, such as the Cystic Fibrosis Trust, Parkinson's Disease Society, Alzheimer's Disease Society and Diabetes UK and some are quite small, but vital for the patients whom they are concerned about, such as the Motor Neurone Disease Society, Epilepsy Research Foundation, Muscular Dystrophy Campaign and the Juvenile Diabetes Research Foundation.
They all have in common the need to support research into the causes and treatments of diseases for which they raise money, largely from the public. Collectively, they fund more than £700 million per annum—which is larger than the Medical Research Council’s contribution. If you add up all the diseases that they cover—cancer, stroke, heart attacks, diabetes, Parkinson's disease and so forth—you cover a very large proportion of the population either as sufferers or carers. Scarcely a family is not affected by one or more of those diseases.
All these charities are desperate to support good research. They do not all fund research into stem cells, although a considerable proportion does. They all believe that research using embryonic stem cells is sufficiently promising for them to be very concerned if that research was to be prevented.
These charities have their fingers very much on the pulse of public opinion. Most rely on public support to fund them and have lay trustees, and many have active public and patient involvement programmes. They know how much those who experience the reality of suffering disease support research of this type, which is inevitably going to be at the edge of existing knowledge. Of course, they want research on stem cells to be well regulated, ethical and carefully planned, so that results can be relied on. Transparent regulation of a high standard—of which I hope the HFEA will be capable—is vital, but it will be important not to fetter the HFEA on the basis of misunderstandings of the science.
One example is the use of eggs derived from animals. These are the eggs from which the nucleus containing all the genes which make an animal an animal has been removed, leaving an empty cell to act as a nest which can provide the protective and supportive environment into which a human cell nucleus can be placed. No mixing of the relevant human and animal genes is involved. A human cell line is developed from these cells which can be used for research into the causes and treatments of serious diseases. The cells are not allowed in any case to develop into embryos beyond the 14-day stage. The sole reason for using empty animal cells is, as has been described, because of the great paucity of human eggs for research. The animal egg cell is an attractive and, to my mind, entirely ethical alternative.
A number of applications are currently before the HFEA for research using stem cells in this way. They are from Newcastle, King's College and Edinburgh for research into diseases such as motor neurone disease, Alzheimer's and Parkinson’s disease. I hope— and, much more importantly, the patients hope—that this research will be encouraged rather than discouraged.
My Lords, I shall say a brief word about human embryonic cell research. Undoubtedly, stem cell research is near the top of the list of the world’s most hopeful enterprises. We in the UK are at the forefront of that endeavour, so my heart sank when last weekend at a party I met a young Roman Catholic priest and I mentioned this debate. “Tell them,” he said, “there are plenty of ways of doing that without killing babies”.
I might almost have agreed with that young man when in 1990 I became involved in this House in the passage of the Human Fertilisation and Embryology Bill. That process and the visits, meetings and Committee reports that went with it, changed my mind. The big decision that had to be made then was whether to allow the minute cluster of cells that form the very beginning of the human embryo to be used during the first few days of its existence for research. As someone with a deeply Christian perception of life and a bit of a layman’s interest in theology, I gradually came to the conclusion that it was right to allow that research but only for 14 days, only for medical research and under strict licence. Yes, the embryo had the potential to become a person, but at 14 days it was still a tiny cell cluster the size of a grain of sand and as yet without even the earliest development of what would become the spinal cord and nervous system. Importantly, because it would be an embryo surplus to a couple’s in vitro fertilisation need, it was in any case destined to be thrown away. The potential benefits of research as seen at that time, weighed against those facts, convinced me and the majority in Parliament—and so the Bill became law.
The current anxiety about embryonic stem cell research, which is mainly about the use of human embryos, is the same anxiety as that in 1990. It is, indeed, the same as the anxiety that existed 40 years ago when the noble Lord, Lord Steel, put the Abortion Act on the statute book. That anxiety is linked to people’s understanding of what it is to be human and how and when that understanding grows in response to the revelations of science. It grows at different speeds in different parts of the community.
For us in this country, the seminal legal decision was made in 1990, and it still stands. Embryonic stem cells currently show by far the greatest promise and they can be used for research up to 14 days. The question today is a lesser one by far—whether the type of that research should be extended, how more embryos can become available and how regulation needs improving to enable the extension. Given the facts and with the assurance of careful regulation and the involvement of local ethics committees, which is very important, I believe that the majority of the public are ready for these new developments.
Four years ago, 70 per cent of our population showed support for the use of human embryos. Since then, the media have been full of the possibilities of embryonic stem cells. They have been discussing the unsuccessful attempt by President Bush to slow up research in the United States and progress all over the world.
On the whole, public reaction seems strongly positive on condition that proper regulation exists. After all, most people have family or friends whose medical problems might be alleviated and GPs, who are closest to the public, support progress. We simply must not dally. The Government should think very hard about increasing funding. We should legislate carefully to extend embryonic stem cell research now with matching supervision and licensing. At the moment the United Kingdom is in the vanguard; let us stay there.
My Lords, the scientific community, all those with degenerative diseases and those concerned about the ethics of different aspects of research should be grateful to the noble Lord, Lord Patel, for instigating this important debate.
“Stem cells” is an umbrella term, often used far too broadly, inappropriately and with little understanding. Fantasy has fuelled scaremongering and the finger has been pointed inappropriately at researchers carrying out high-quality research. Meanwhile, vulnerable patients in desperate situations travel abroad for expensive treatments, where they are effectively robbed in undergoing non-evidence-based interventions, some of which may be harmful. That is a desperate situation for those patients and demonstrates the lack of understanding in the public domain about stem cells.
The science is developing and has huge potential, particularly to halt the progression of slowly degenerative diseases. Haematology pioneered this with haemopoetic stem cell research, which has now been translated into routine bone marrow transplants. Using cord stem cells has resulted in more than 2,500 patients receiving bone marrow transplants and doing well as a result. All that gets little publicity now. Cardiology, too, has started to enter the realm of stem cell research. Such research is in its early days. An editorial in the New England Journal of Medicine summed it up very well. It states:
“Recent randomized studies of cell therapy for heart disease represent a milestone in this rapidly developing field while serving as a cogent reminder that many important clinical and fundamental questions have yet to be addressed. We should guard against both premature declaration of victory and premature abandonment of a promising therapeutic strategy. The ultimate success … is likely to depend on continued and effective coordination of rigorous basic and clinical investigations”.
Stem cells, sometimes called progenitor cells, are pluripotent. Immaturity gives the ability to differentiate into different cell lines; hence the appeal of embryonic cells, but the ethical dilemmas abound. I shall confine my remarks to cord blood stem cells and even adult stem cells as they have also been shown to be able to differentiate into tissues such as cartilage, bone, adipose tissue and muscle. Normal adult tissue seems to have a few stem cells present which are responsible for ongoing tissue repair and protection from injury. Many of these are present in normal bone marrow and can be harvested for transplantation. Some are present in the liver and can regenerate, but a few also appear to be present in other tissues as well such as cardiac muscle. These nursemaid cells have an important role and warrant research as well.
It is difficult to know just what we are dealing with when people talk about stem cell research in scientific papers. The immature cell has poorly developed surface markers making it difficult to identify accurately. The only way really to know that a cell is pluripotent is to culture it on different media and see it differentiate. The lack of cell surface markers makes comparison of one research project with another difficult at present. CD34 cells are haemopoetic stem cells that are now relatively easily identified using cytofluorometric analysis, which basically gives the cell a coloured marker. Then you can extract the cell and know what you are dealing with. Those are the ones used in bone marrow transplant.
Intra-coronary and intra-muscular injection of stem cells is promising in cardiology but it is interesting to note that the benefits are marginal and short-lived because these cells die off quite quickly. An important development in the UK is the establishment of cord blood donation through the National Blood Service Banking Centre. Cord blood contains relatively immature cells that would otherwise be discarded. Interestingly, Virgin has entered this area with combined private/public banking whereby 20 per cent of the sample is cryopreserved for that family and 80 per cent donated for public use. It costs the parents about £1,500 but this does not cover the cost of collection in the delivery suite. The National Blood Service’s three collection centres in Barnet, Northwick Park and Luton and Dunstable now have a 40 per cent ethnic minority mix of these cells for transplant. These are also very important cells for research.
These are expensive developments. They are within the framework of the NHS and deserve to be supported. They will cost—it will be many years before we get financial return—but we have an important start here in the UK. Even US Republican senators are seeing the value of such research. If research is encouraged, high-quality groups will develop. If not, poorly conducted research using non-vigorous methods will continue. It will only discredit this important area and result in patients continuing to seek quack cures abroad being robbed under false claims. We must support research. We must streamline the regulation of it. We must make sure that the monitoring is done by an expert central body of people who really understand the science, not people who are unduly cautious. That is the only way high-quality research will continue for the benefit of our country.
My Lords, the noble Lord, Lord Patel, is one of the great men of medicine and I thank him for initiating this very timely debate.
I am the chair of the Human Genetics Commission, the Government’s advisory body on developments in human genetics and their implications for healthcare, ethics, law and society. We see ourselves as a model for how public bodies should operate because all the commission’s work is held in public. Our minutes are on our website and our agenda is there, too. We travel the country to have our meetings; we do not just have them in London. We hold evidence-gathering sessions. We have public information fora and we make sure that the public can be present when we hold our meetings. We have a consultative panel of more than 100 people, all of whom have, for whatever reason, an interest in this area of genetic developments, usually because they have a genetic trait within their own family.
While the Human Genetics Commission does not advise government on stem cell research specifically, many of its stakeholders, including members of the consultative panel I mentioned, have a very strong interest in genetic disease and, therefore, in the therapeutic possibilities offered by stem cell research. Recently, the commission discussed the specific issue of the creation of human/animal hybrid embryos. One of the strongest arguments for this research is that it would provide a much needed material resource for projects of stem cell research. One of the strongest reasons for carrying out this research is that it promises to provide therapeutic benefits for people suffering serious and life-limiting diseases. The case which those involved in the research make is strong, both intellectually and morally.
However, work that the Human Genetics Commission has carried out has revealed that there is a wide range of views about the ethics and prospects of stem cell research. For example, our consultative panel of people personally affected by genetic diseases says that research to find treatments for genetic conditions is important to them—they want this research to take place—but that there should be balance and realism to avoid giving false hope.
Our stakeholders, who are in regular contact with us and attend our open meetings and public information-gathering sessions, and the people who respond to our consultations give a mixture of very nuanced views. I emphasise that word “nuance”, because it is very often missing from press reports on stem cell research, which describe it either as monstrous or miraculous, but seldom as anything in between.
Some of our stakeholders are concerned about what the enthusiasm for possible cures means for those living with such diseases and our attitudes towards them. Understandably, they feel that the single-minded pursuit of treatments actively devalues those affected by genetic disease and encourages others to treat them as a problem, and sometimes diverts valuable resources from care for those facing such diseases towards possible cures. They would like to see a better balance in how resources are used. Some hold that the eradication of genetic disease amounts to the eradication of a distinct and important genetic group and that it means a form of modern eugenics, but I want to avoid that kind of hyperbole. What is really an issue of concern is that we could be creating a climate whereby the pursuit of perfection is paramount. That coarsens our values, and it dehumanises those who are less than perfect, which means most of us.
In my position as chair of the commission, I have always strongly advocated having such discussions in public so that scientists have to make their case in the public realm, explaining that the work that they do will not involve the devaluing of humanity or risk the creation of alarming new forms of life. It means that we should have those debates even if it means revisiting familiar moral arguments. I urge on this House today the importance of public debate and engagement of the public in science policy development. Good policy and progress in science are made in a context of public acceptance, and that public acceptance allows the establishment of good and successful regulatory regimes. Public engagement is essential to achieving that acceptance. From experience, what we have seen is that where science outpaces public acceptance, for example with genetically modified foods, it can lead to the inhibition of research and of the benefits of that research.
We remember the good side, on the other hand, of assisted reproduction, where early public engagement on the part of the scientific community and efforts to communicate the benefits in terms that could be grasped on a human scale led to widespread public acceptance and greater confidence for the future. Scientific discovery and biomedical innovation are necessarily the area of specialists, but we have to have good public debate. Our work has revealed that the public—non-specialists—are perfectly capable of understanding complex scientific and moral problems if they are dealt with properly. They have an appetite to engage with those issues, but we need to have transparency and clarity in our communications. The public is suspicious of science that is carried out behind closed doors.
I urge the Government to put more money into the work that the Human Genetics Commission does on public engagement. Public confidence is hard won and very easily squandered. To maintain it, it is important that the benefits of stem cell research are communicated honestly and without hyperbole. That is what I urge on the Government today.
My Lords, we must all be very grateful to the noble Lord, Lord Patel, for initiating this debate on such an important area of research. The debate has been utterly fascinating and so informative; it has certainly increased my knowledge base. The absolute imperative that there should be much greater public understanding of stem cell research has just been so wonderfully explained by the noble Baroness, Lady Kennedy of The Shaws. I had a 10-page speech ready, and I could tear it up and just say, “Amen to that”. However, I have a couple of points to make, but I will stay within six minutes.
As a non-scientist, I have approached this subject from the point of view of caring for humanity, which is probably not unaffected by the fact that all the members of my immediate family, who are now dead and died far too young, would almost certainly have benefited from this type of research had it occurred 10 or 20 years earlier. There is a tremor in my voice even as I think about it. I absolutely agree with the noble Baroness when she asked whether we are in pursuit of perfection. Is it not better to have much happier, better lives, accepting all the flaws and frailties that we have, and try to make the best for all humanity, not just for those who will benefit from this research?
I could not agree more with the point about public opinion. When I heard the noble Lord, Lord Patel, say that 70 per cent of the general public supported stem cell research, I thought to myself, “70 per cent? Do they really understand it? Am I a complete moron? I am a non-scientist, but I do not really understand it”. It was only the opportunity to speak in this debate that made me pore over so much of the information. I am convinced that 70 per cent of the public have not done that. I suspect it is like all things scientific; lay people feel that they have to cringe in a corner because scientists have so much more information and such bigger brains, and we probably feel inadequate and just agree with them. That is a serious issue. I have spoken to many non-scientific members of the public about this, and they think that embryonic cell research is a bridge too far. There have been undoubted successes with adult stem cell research. According to my research, something like 72 conditions have been helped by adult stem cell research. The other types of research deal with the sanctity of human life, which I know does not come high on everyone’s agenda, but it does so for quite a lot of people.
I would guess that the public feel that adult stem cell research is fine, particularly bearing in mind that 72 conditions can be treated with it. People ask about embryonic research, but as far as I can see no treatments have come from embryonic stem cell research. There has been the huge scare story that has already been referred to today of the Korean experiment. People feel that this is an area of potential abuse, and that feeling will grow unless there is a greater understanding of the basic science. The possibility of human-animal hybrids, or chimera embryos, seems to really scare people. It smacks too much of eugenics and of what we are led to believe happened in the 1940s in central Europe. In any case, if such entities were permitted, it would raise huge questions over what is classed as human and what is classed as animal. Some scientists may think that it is an irrelevant question for the purposes of research, but it causes a problem and it raises profound questions about the nature of man and what it means to be human. It also raises significant legal questions. What legislation would cover any formed embryo; legislation affecting animals, or legislation affecting humans? That really concerns me. Maybe I am not aware of enough of the science to be able to make a judgment. We all know that the difference between an animal and a human in genetic terms is very small indeed, and it is not far-fetched to imagine a situation where a court could rule that an embryonic entity is actually an animal and allow it to develop past the 14 day cut-off period for human embryos.
I am almost at the end of my time. I have difficulties understanding much of the hype that surrounds embryo research and, given its lack of success to date and the availability of ethical alternatives that are proving successful, I share concerns about the proposals to amend the law and the possible development of animal-human hybrid embryos, as set out in the recent White Paper. If we insist on pursuing that route, I hope that we will have at least an assurance that there will be fantastic regulation, and monitoring of that regulation, to eliminate the potential for abuse. I am genuinely anxious and concerned. I do not want to knock the science; I am in awe of the science, but many other lay people like me feel exactly the same.
I shall end on this note: until the scientists communicate in the manner of the noble Lords, Lord Patel and Lord Winston, and bearing in mind everything said by the noble Baroness, Lady Kennedy of the Shaws, I will remain concerned.
My Lords, I, too, thank the noble Lord, Lord Patel, my friend, for introducing this debate. It is an exercise in education and I am delighted to follow the previous two speakers, both of whom have stressed the importance of public understanding of the issues. I appreciated the words of the noble Baroness, Lady Carnegy, who introduced that theme into the debate.
I shall speak from a particular perspective. I have the honour to be president of Alzheimer Scotland, which recently carried out a major survey of its members and staff about the issues that concern us today. They are not in the position of assuming that miracles will happen and that the problems of dementia can be solved quickly, but they see this as one avenue of research that could contribute to dealing with a significant human problem.
As a result of that survey, the organisation has formulated a clear policy in support of the development of stem cell research. It is clear in supporting the possibility of hybrids being developed. We need to ask ourselves: who are those people articulating that positive view? They do not assume that there will quickly be a solution to the problems, they are well aware that that is a long way down the road, but they are in the front line of caring for those who suffer from dementia and Alzheimer’s. Significantly, there were 1,000 returns from members and staff who know at first hand the dark shadow of forms of dementia in people’s homes among their nearest and dearest and their friends; they face that and move forward. They are people who give of their time and energy.
Of those 1,000, the vast majority—I would say 100 per cent, but well up in the 90s—are volunteers who provide help and support to those who care. Their viewpoint must be heard and taken into account. This is part of the ethical discussion; they are aware of huge suffering, although they are also aware of the lighter moments and even joys that come from their work—it is not totally dark. On the other hand, they face this issue and their voices should be heard. Of those who responded to the survey, 76 per cent felt that the use of human embryos in dementia research was acceptable; 83 per cent agreed with the use of embryos donated by couples having fertility treatment; and over 80 per cent agreed with the use of aborted foetuses that would otherwise be disposed of. These are significant figures.
The people who took part in the survey think about these issues very carefully, however. There was also support for the use of therapeutic cloning, but it was much less clear cut; 43 per cent agreed that it was acceptable, 34 per cent were against and 22 per cent responded “don’t know”. The “don’t knows” are critical, which is why the points made by the previous two speakers on the importance of educating the public are fundamental.
That set of views comes from an organisation that deals with the issue of caring in the most direct way. That organisation, however, is aware not simply of the cost of caring in individual human and family terms, but of the costs to the economy. I recently took part in a conference in Newcastle on the issues of changes in demography and ageing, and this was identified as one of the major issues facing our civilisation. Rightly, we hear of other issues such as global warming and so on, but if you look at the demography of developing countries as well as that of developed countries, there are changes in the structure of our communities that will be dramatic. The costs are already significant. We have heard some of the figures: in Scotland, between 60,000 and 65,000 people suffer from one form of dementia or another. You can roughly multiply by 11 to obtain the UK figure. The costs in Scotland are already between £1.5 billion and £2 billion and it is estimated that they will double by 2031. Again, one can multiply by 11 to obtain the comparable UK figures. We have already heard that the average cost of caring for a person with dementia is more than £25,000 per annum. The cost of someone in supported accommodation is some £31,000 per annum. There is a growing number of such people, because of the demography of our country and the costs will rise dramatically.
I ask three things of the Government. First, there needs to be more education; that was eloquently put by the noble Baroness, Lady Kennedy. Secondly, there should be adequate and sensible regulation. In the minds of many people, regulation quickly becomes over-regulation so a fundamental question is “What is the minimum regulation required?” “What new roles can we think up?”. Thirdly, funds must be targeted. The Science and Technology Committee of this House issued a paper more than a year ago on science and ageing. It asked for strategies in the spending of research money to be followed and encouraged by government. I put it to the Minister that this is one of the areas where such a strategy is required. If we ask these questions properly, the pay-off will be significant to the economy and even more so to the individuals who face this problem daily.
My Lords, my thanks go to the noble Lord, Lord Patel, for introducing this debate, which is in large part about principles—whether existing medical and research techniques should conform to current ethical and moral norms in our society, or whether society should recognise the advances in medical science that are made every day and develop new standards to accommodate those advances. There is, as lawyers point out, a fundamental rule in international law, especially that which governs human rights: customary law obliges states to adhere to standards that have been developed throughout the world—for example certain human rights abuses are subject to customary law and can never in any circumstances be condoned. Stem cell research in one of its aspects at least falls into this category of a widely accepted or customary practice. As we have heard, the UK is a global leader in stem cell research and there are centres throughout the world. Nowhere is this research better regulated than in this country, it would appear. The HFE Act 1990 is clear about what is allowed and what is not, and how research should be monitored.
The point here is that stem cell research is an ongoing and major programme in the UK with many successes. Ethical and moral concerns will not cause it suddenly to cease but can guide its procedures as inevitably scientific progress comes up with new techniques to address human suffering. Where should the line be drawn? To assert categorically that it is impermissible to destroy embryos and/or to use animal cells to further this research is to ignore the long path, dating from the early 1970s when the first bone marrow transplant took place, of careful and diligent scientific inquiry and public debate that has accompanied each stage. Earlier legislation has allowed us to reach this stage, where radical techniques are now possible. The regulatory safeguards have been amended accordingly.
Given that in vitro fertilisation has become almost standard practice, it has to be acknowledged that there will always be excess embryos which will be destroyed whether or not they are objects of research. I understand that, in the normal course of events, up to 30 per cent of fertilised embryos are lost before implantation by women who may not even be aware that they have conceived. It is neither logical nor necessarily ethical to be concerned with preserving excess embryos, especially if there is a strict time limit on their use.
I ask your Lordships to consider whether it is moral to deny people access to medical techniques that already exist under stringent conditions. Would we be happy to do so if those we most loved faced degenerative conditions such as motor neurone disease, diabetes and/or dementia? Do we want to ignore the animal rights constituency and continue indefinitely with animal models when cellular ones may become more easily available?
My final point concerns the use of embryos as well as of hybrids and chimeras in order to find alternative sources of cells. Much research is going on in these areas and a Stem Cell Bank with international links has already been set up, but needs far more investment to become a genuine alternative resource for medical science. For example, the challenges of safe, long-term storage, if met, could obviate the need for the future collection of embryonic stem cells. In the US, it is claimed that a case of sickle cell anaemia has been cured with transplanted cells harvested from umbilical cords. As I understand it, there is interest in amniotic fluid cells and autologous stem cells, which occur naturally in the body. The reprogramming of adult stem cells from brain, eyes, muscles and bone marrow is a fruitful area of research. All these procedures are waiting in the wings but need far more investment and far more research using embryonic and animal cells to become standard practice.
The history of medical research is replete with accompanying ethical concerns—rightly so. However, these concerns have to be resolved through public debate, public engagement, transparency, regulation and monitoring, and this process is now taking place. The principle that I adhere to is the harvesting with humanity of stem cells, whatever their origin, thereby continuing what scientists are already doing in the interests of public good and an end to some kinds of human suffering.
My Lords, I, too, congratulate the noble Lord, Lord Patel, on initiating this debate and on attracting an eminent group of speakers, such that I arise with great diffidence to make a few comments based on my background of having been involved in health service management for 20 years and in policy-making as a civil servant for the past nine of those. I had better declare the interestsof having been chief executive of the NHS and Permanent Secretary at the Department of Health. I think that those perspectives will allow me to make three points: one about services, one about research and one about public trust.
There has already been a great deal of talk about the potential benefits of stem cell research to individuals, patients and all of us—perhaps to whole services—and there has been some discussion about the cost to health services. As a health service manager, I want to hear more about how the development of stem cell research will make far more generic products available to a wide group of patients than is the case now. The noble Lord, Lord Patel, said clearly at the beginning that early research on adult stem cells has been very patient-specific and that the great goal in embryo research—I am looking at my notes to check that I have the science roughly right—is the ability to produce more generic products, which may then have an effect on a much wider group of patients. That must be the goal for which those of us who have been involved in managing health services will be looking from this research.
However, the issue goes slightly wider than that. This is part of a much broader and longer-term trend in health services. To put it very simply, it is about the importance of early intervention. Health costs are growing rapidly in every country, whether they are developing or developed countries, and, before we reach the sort of situation in America in which perhaps 20 per cent of costs go on healthcare, we need to reorient health services much more towards early intervention; the slogan needs to concentrate far more on early health than on late disease. This research has the potential to contribute greatly to that sort of development and to reduce costs both in health services and in the wider community, as the noble Lord said.
My second point, which goes hand in hand with the first, is the importance of research going hand in hand with clinical application. Having run a teaching hospital, I know how crucial it is that our services are constantly informed by the latest knowledge and that our knowledge is constantly informed by service reality. There needs to be as rapid a transition as possible from the laboratory to the bedside and learning from the bedside to the laboratory.
However, the issue here—a point raised by my noble friend Lady Greenfield—is that we are talking about a substantial change in the way that medicine is conceived and therefore the way in which services will be delivered in the future. Therefore, alongside the science go important areas of research, which are about service delivery, sociology and economics. It is not enough for stem cell research to be purely at the scientific level. Science alone will not have the impact on services that we need; it needs to be accompanied by a wider range of research.
Those first two points are variations on the theme of why stem cell research is important, and they come from the perspective of the manager or the person involved in healthcare delivery. But all that is valueless if stem cell research is unethical, immoral or, for that matter, hugely opposed by the public.
That leads me to the issue of public trust, on which I want to make two short points. One is that, as a former policy-maker, I saw things very much from the decision-maker’s point of view. It is interesting that individuals may find it very easy to make a decision on this issue, as is the case with many other things that face people in government. They may, for a priori reasons, either see very clearly that it is inappropriate to do anything with human embryos, or equally see that, as a way of helping people who are crying out for help, it would be unethical not to do so. Many individuals will make those decisions easily but, for policy-makers, the issue is finely balanced. I urge the Government to be very clear about the messages that they give out in their forthcoming legislation, documentation and policy. The Government have been good in setting the right environment for stem cell research but it is important that a clear lead is given here. The Government must show that they have listened, understood and decided, and that they have a clear position on the ethical issues and on what will be allowed. They must not sit on the fence on this matter and give misleading signals to researchers or funders in this country.
My final point on public trust has already been made much better by the noble Baroness, Lady Kennedy, and others. On most topics, I am not convinced by surveys that show that 70 per cent of people have answered a question in a particular way. There is a deep need here for appropriate members of the public to be involved in the decision-making process. Prior to this debate, I carried out a short straw poll of people whom I know to find out what they knew about stem cell research. I was happy to learn that they knew even less than I do. I, too, have gone through a process of learning over the past few days. We cannot hope to get people up to the level where they can debate this issue in the way that many people in this Chamber can; nevertheless, having what I think the noble Baroness, Lady Kennedy, called the nuanced involvement of the public in this debate is absolutely essential.
My Lords, I, too, thank the noble Lord, Lord Patel, for initiating this debate on a very important topic. Much of the debate so far has concentrated on the question of using animal ova to reprogramme human cell nuclei for research purposes. I make no apologies for returning to that subject. It is a very difficult topic for us to think about, because the revolutionary discoveries in biology over the past 50 years which underlie the possibility of stem cell therapies constitute some of the rare occasions when scientific advance must lead us to being more cautious about some traditional ethical arguments.
The particular argument that I have in mind advances the claim that the unique moral status of the human embryo, from the earliest stage of its development as a fertilised ovum, derives from its unique potential—if many things occur in the right order—to become, in turn, an implanted embryo, a foetus, an infant and a person. However, once we appreciate the reality that cell nuclei can be reprogrammed—that is, that they can become less specialised and then be specialised in different directions—we can no longer be sure that this wide-open potential for developing into cells of all types will uniquely be found in the fertilised human ovum. So we have to rethink the traditional view that located the unique moral status of the human being in a view about a unique biological route to human life.
The dignity and moral standing of the human foetus and the human being cannot be read back or grounded in a claim that certain cell types—the fertilised ovum—have that status already and others do not, for we find that many cells have that potential if things happen in the right order. The skin cells that I would destroy by scratching the skin on my hand could have been reprogrammed by insertion of a nucleus into a human egg, which would have created cells with the potential for a full range of development into different cell types, yielding, in effect, human embryonic stem cells. We would risk absurdity if we tied human dignity to a story about a unique route of development.
We now also know that the nucleus of a cell from one species can sometimes be reprogrammed so that it loses its specialised characteristics by placing it in the egg cell of another species, and may in turn yield human embryonic stem cells by that route, although we know that there are still many scientific questions to be answered because of the presence of mitochondrial DNA from the other species when that route is used.
Why should we sanction the exploration of this potential? Why should we sanction research of this type? We should do so because we still need fundamental research on cell reprogramming—on the dedifferentiation and redifferentiation of cells, which will be the basis of any stem cell therapies. That should not depend on the use either of human embryonic stem cells derived from donated human embryos, or on the regular use of human ova—human eggs—donated by generous women.
The Human Fertilisation and Embryology Act 1990 —I am all too aware that I am standing next to my former teacher and noble friend Lady Warnock, whose report led to that legislation—has an interesting default structure, which is retained in the 2001 regulations. The Act and the regulations permit the licensing of research that uses human embryos only for limited and specific serious purposes, and then only if there is no other way in which that research can be done. It is the double default structure.
If it were reliably possible to derive human stem cell lines by reprogramming cell nuclei using donated human eggs, that would be a reason for the Human Fertilisation and Embryology Authority to give licences for research using human eggs, rather than human embryos. However, human eggs are not readily available. Egg donation is a non-trivial procedure for the women who generously do it. Some, of course, do it as ancillary to their own fertility treatment, but that too is generous.
This gives us strong reason not merely to permit but to require the use of animal egg cells for fundamental research on the potentiality of reprogramming human cells. Such cell constructs are being variously spoken of as hybrid embryos and cybrid embryos. The terminology is unsettled and unsettling, as is invariably the case in a period of fundamental revision of understanding. “Hybrid embryo” is particularly unfortunate, as it falsely suggests an intention to allow a hybrid being to develop, which our current legislation rightly forbids. However the terminology settles down, we should encourage the scientific investigation of ways in which stem cell lines with therapeutic potential can be developed without either unnecessary research using human embryos or unnecessary research using human eggs.
My Lords, like other noble Lords, I am extremely grateful to my noble friend for initiating this debate, which is extremely timely. I speak essentially as a lay contributor because, although I agree that there are moral considerations to take into account in finding the right framework of law within which stem cell research may go ahead, moral judgments cannot be properly made without a grasp of what is scientifically involved. Speaking for myself, I would not like to have to take an examination on the science that is involved.
Speaking as a lay member of society, I confess to a sense of urgency in the matter of settling how stem cell research and the implementation of the results of this research can best be carried forward. I do not detect much of that urgency in the Government’s White Paper. As a society we have been slower than might have been hoped in putting the theory of stem cell research into anything like useful practice, or even potentially useful practice. There are two reasons to regret this—indeed, to urge that we as a society should advance as rapidly as possible to the next stage, which means advancing the fundamental research that is necessary.
The first reason, roughly speaking, is that competition is strong and likely to get stronger. On economic grounds, therefore, it is important that we should not hang around. I want to be assured that funding is not lacking for the next crucial stage in moving towards the clinical outcomes that we all hope for, and which, I believe, lie ahead. I doubt, for example, whether a new president, when America gets one, will be so dogmatically hostile to stem cell research as President Bush has been; so competition from the USA may be even greater than it is now, and it is already, as we have heard, extremely strong. It is essential that the Government should be wholeheartedly—and show themselves to be so—behind the next stages of the work. It is all very well to pride ourselves, as we often do, that our regulation on all kinds of scientific research is better than in any other country, but I need to be reassured that such regulation is efficiently and speedily applied, and that there are not unnecessary and often absurd delays in issuing licences and carrying out the resolution that the Government may say that they have that the research should go ahead. I hear numerous stories of endless delays and illformed judgments by ethics committees, and so on, which hold things up. I want these reassurances, partly on economic grounds. We must not allow our wonderful research capabilities to go to waste.
I very much hope for these reasons, among others, that the Minister will promise to think again about paragraph 2.85 of the White Paper, where the proposition is made that the general use of hybrid embryos should be prohibited. I hope that the Minister has taken very good account of my noble friend’s speech, which preceded mine, on the need to rethink the status of the human embryo and to take into account the possibilities of the use of hybrid embryos.
My second reason for feeling a sense of urgency is even stronger. We have a moral duty to press ahead with providing the cures that we hear of for hitherto incurable conditions. When I say that “we” have a moral duty, I mean society. I take very much to heart the speech of my noble friend, Lord Crisp, who well understands the difference between private and public morality and between policy decisions and personal moral decisions. That is an extremely important point that the Government must be well aware of.
Nevertheless, we as a society have that moral duty. We cannot be content just to know that in future we may be able to restore damaged cells, but we need to decide to act on that knowledge now. I feel a certain despair at the length of time that it will take to carry out the consultations, as the now somewhat lame-duck HFEA and the Government propose to do. No good can come of consulting the public without first educating it—an important point which has been made again and again—but educating the public takes time. Without a better understanding no private or public moral judgments can be made. But there is no time to lose.
My Lords, I, too, am grateful to the noble Lord, Lord Patel, for initiating this debate on a subject of such scientific interest and importance. My entrée into the subject came as a result of having the privilege of chairing your Lordships’ Select Committee on the subject for the 2001 regulations.
One key issue in the debates in the House at that time, and still an issue for a number of your Lordships, is whether the research could not be done just as well using adult stem cells rather than embryonic cells. Adult stem cells obviously do not involve either the manipulation or destruction of the early embryo and therefore do not pose the same ethical problems as embryonic stem cells. Our committee discovered then that, from a scientific point of view—and this is still the case—research on both adult and embryonic stem cells is necessary. We simply do not know which route is going to be most beneficial for future therapies, and at this stage there is some essential research that can only be carried out on embryonic stem cells. There is, for example, still a great deal to find out about the process of differentiation and dedifferentiation, whereby the pluripotent cells which we obtain from embryos become one of the 200 or so specialist cells in the human body, or about how that process is reversed, as the noble Baroness, Lady O’Neill, has just so strongly stressed.
I respect the position of those who argue for work on adult stem cells, and research in this area must be fully supported. Leaving aside ethical considerations for a moment, however, there is no doubt that, from a scientific point of view, work on embryonic stem cells is essential both for basic research and because it holds out great promise for at least some future therapies. As the noble Lord, Lord Patel, said right at the beginning, the two forms of research on adult stem cells and embryonic cells are complementary, not rivals.
All research on early embryos must be done under licence from the Human Fertilisation and Embryology Authority; I declare an interest as a member of it and chair of its ethics and law committee. I stress two points. First, on the careful procedures that must be followed for any research licence to be granted, we have just heard from the noble Lord, Lord Winston, of his own unfortunate experience with the HFEA. It may be that that was some time ago. I will certainly write to the noble Lord, giving him an accurate and up-to-date picture of the amount of time a research licence application takes at the HFEA. I shall also write to the noble Baroness, Lady Warnock. I am obviously not in a position to know how long it might take to go through local ethics committees, but I do not believe that the time spent with the HFEA is undue delay. It clearly needs to be as speedy as possible.
The research licence committee must obviously consider whether the research can be permitted under the 1990 Act as modified by the 2001 regulations. In particular, it has to decide whether the research is both necessary and desirable. In short, if the research could be done in some way other than by using early embryos, then a licence cannot be granted. The procedure is a careful and testing one, although, as I say, I do not believe that it takes an undue length of time.
The fact that we have this firm regulatory framework, respected the world over, has enabled public confidence in this research to be kept and valuable research to go ahead. Researchers know that there is a clear and firm but permissive framework within which to operate so that they know where they are, which is not always the case in some other countries. Parliament will shortly be revisiting the 1990 Act, which I welcome. It is remarkable, however, how robust that Act has been. Despite major scientific advances not envisaged in 1990, it has enabled research to proceed in an orderly, controlled way. It is essential that, if and when the new regulatory body—RATE—comes into being, with its much wider remit including human tissue and blood as well as embryos, public confidence is still retained. The Royal Society has recently raised important questions about whether the expertise built up in the HFEA in such an ethically sensitive area over the years will be able to be focused and utilised in such a necessarily specialist way in a body with such a wide remit as is proposed for RATE.
Finally, from a religious perspective, the whole scientific endeavour should been seen not as a rival to religion but as a way of exploring the wonder and miracle of nature. Walt Whitman began a poem with the words:
“WHY! who makes much of a miracle?
As to me, I know of nothing else but miracles”.
Many scientists, including atheistic scientists like Richard Dawkins, feel that sense of wonder. For those of us with religious beliefs, this is exploring the wonder of the divine source of the wisdom in all that.
Good research takes time. As a non-scientist, I am full of admiration for the painstaking, detailed and meticulous work which scientists do in their laboratories over many years, research which sometimes does not produce any very worthwhile results. This huge field is obviously very promising and a real gift. I think that we in this House would all wish researchers in the field well, because it will undoubtedly produce results which will ultimately enhance human health and well-being.
My Lords, we should all be grateful to the noble Lord, Lord Patel, for introducing this important and timely debate. As he emphasised, stem cells are crucial to understanding how living things develop. They offer immense long-term medical promise, but pose issues of special sensitivity in which the entire public have legitimate concerns.
I am a scientist but, unlike other noble Lords speaking in the debate, a lay man in respect of these technicalities. The Royal Society, of which I have the honour to be president, is actively engaged with the world's leading researchers in stem cells. Many of them are among our fellows. We have strong engagement with the policy and ethical issues and in advising on research priorities and protocols.
The regulatory framework in the UK, stemming from the Human Fertilisation and Embryology Act 1990, is widely admired internationally. It evolved from a broad consensus, brought about by effective dialogue and engagement between scientists, parliamentarians, ethicists and the wider public, led by some distinguished Members of this House. It was a model for how to regulate any research field involving safety and ethical concerns, but the science has moved on. There are consequently ever more ambiguities on how the existing guidelines should be applied.
The challenge to the regulators was exemplified by the HFEA’s stalling response on the issue of cybrid embryos earlier this year. We must cope with the idea that the everyday concept of species is blurred and unhelpful at the level of a gene, even of a single cell. It is not obvious what embryos should be classed as human and what should not, nor what groups of cells should be classed as embryos. In clarifying such conundrums, we will benefit from the kind of public engagement that has served so well in forging the present framework. I endorse everything that was said so eloquently about public consultation by the noble Baroness, Lady Kennedy. As a contribution to this end, the Royal Society has just produced a short document, in simple Q&A format, which should help the media and general public to understand the issues underlying cybrid research.
The cybrid issue exemplifies how the demands made on the HFEA are becoming ever more arduous as the science advances. In that context, we in the Royal Society have anxieties about some aspects of the Government’s White Paper. In particular, we are uneasy about the proposal to set up a single Regulatory Authority for Tissue and Embryos, with the acronym RATE, combining the role of the HFEA with that of the Human Tissue Authority. This new authority would regulate human reproductive technologies, including the use of human gametes and embryos for treatment and research, but it would also deal with the HTA’s current agenda—human bodies, body parts and tissues—and oversee transplantation and blood transfusion issues. The Royal Society’s concerns are shared by the Academy of Medical Sciences and the Wellcome Trust. We feel that a single body, as envisaged in the White Paper, cannot feasibly cover its huge remit without either diluting its expertise or delegating most key judgments to an infrastructure of expert panels.
However, I would like to end on an upbeat note. When the history of science is written, stem cells will surely rank as a highlight. This decade’s discoveries are just the beginning. It is a research field where the UK has pioneering achievements and retains world standing. We have escaped the strident politicisation and polarisation that bedevils the field in the US, and we have avoided the down sides—inadequate regulation or dubious ethical standards—that may taint research in some other parts of the world. We should sustain our research groups so that they remain a magnet for mobile talent in the face of growing international competition for that talent. To do so is surely good for UK science. More than that, it would be good for a field that, sensitively handled, promises great hope for human welfare. For all those reasons, we should welcome this debate and thank the noble Lord, Lord Patel, for obtaining it.
My Lords, although I disagree with my noble friend Lord Patel about the use of human embryos for these research purposes, I congratulate him on initiating today’s debate and on the way in which he introduced it.
Two seminars recently held in the Moses Room explored stem cell policy, the policy that led to our refusal to sign the 1997 European Convention on Human Rights and Biomedicine and aligned us in the General Assembly of the United Nations with countries such as China and Korea. In our overenthusiastic desire to become a sort of biotech El Dorado, we have become far too unquestioning about the ethical implications of what we have permitted. In other jurisdictions, such as Canada, France or Germany, scientists face prison sentences of up to seven years for what we have made legal. We cannot reduce these issues to opinion polls. Since the 1990 Act, with little regard for the special status of the human embryo, more than 1 million human embryos have been routinely manufactured, frozen, destroyed or experimented upon with only 4 per cent seeing the light of day.
Only last week, in a leader on 26 April, the Times reminded us that:
“Unfashionable as it may be to say so, destroying an embryo extinguishes the possibility of a life”.
That should surely be unconscionable when alternatives are available. It is probable that we all have experience in our families of degenerative diseases and want to see medical advances. But, as Thomas Okarma, the CEO of Geron, has revealingly admitted, embryonic stem cells have value for the biotech industry for research, not for cures.
During this debate, mention has been made of the lucrative research grants. According to a Written Answer that the Minister gave me on Monday, they amount to about £100 million from the Government between now and 2008. Those grants and the money involved often skew judgments and, through conflict of interest, can compromise debate. The Minister needs to tell us clearly the division of the £100 million between adult stem cells and embryonic stem cells. Why have they not been treated in the even-handed way that we were told that they would be during our debates in 2002? In his Written Answer on Monday, the Minister admitted that no statistics are kept centrally on the allocation of private funds. Why? What assessment has been made of the analysis in Forbes investments journal which says that only “dumb public money” is going into embryonic stem cells? By contrast, I hope that the Minister will list some of the more than 1,200 trials and 70 diseases and conditions that have been successfully treated with adult stem cells, and tell us what therapies exist using embryonic stem cells.
At the Moses Room seminar, Dr Peter Hollands, a leading scientist involved in cord blood stem cell research, pointed to the Cinderella status of and lack of funding for treatments using adult stem cells. Cord blood is used to treat leukaemia, lymphoma, sickle cell anaemia, thalassaemia and immune system disorders. He said that it is scandalous that 98 to 99 per cent of all UK cord blood is currently incinerated or discarded and less than 1 per cent goes into the NHS public bank at Edgware. The mother of Eva Winston Hart, a seriously ill three year-old suffering from leukaemia, was at the seminar. She said that, after months of uncertainty, she has found a suitable donor in the US and is taking Eva there for treatment. Why can she not be treated here? Why are there only four NHS hospitals in the whole of the UK that are collecting cord blood, and what we are doing to create public cord banks?
Dr Carlos Lima told the same seminar how his team in Portugal has used olfactory cells taken from the nose to repair spinal damage. We saw clips of people who had previously been unable to move learning to walk again. They included British patients who had to travel to Portugal because the same treatments are not available here. Dr Lima succinctly reminded us that, “Embryonic stem cells were made to proliferate and adult stem cells were made to repair. We shouldn’t use one to do the job of the other”.
Professor Neil Scolding, Burden Professor and director of the Institute of Clinical Neurosciences at Frenchay Hospital, Bristol, specialises in the treatment of multiple sclerosis. He contrasted adult stem cells with embryonic stem cells and quoted the Lancet, which said that it is “ethically unacceptable” to create human embryos with no purpose other than to use them for stem cells. He said, “We know adult bone marrow stem cells are safe, it’s not a guess”.
Throughout our debates, advocates of using embryonic stem cells have constantly cited pluripotency as those cells’ greatest asset, but what use is it if a cell is dazzlingly pluripotent if it is going to be rejected by a patient’s body or, worse, if its very pluripotency creates stem cell-derived tumours? Dr Lima said that he believed that the UK had entered a blind alley, become obsessed with embryonic stem cells and had been diverted away from the much greater untapped potential of adult stem cells, which could deliver so much more for patients and which carry no moral hazards.
As we now consider whether to create cloned animal-human embryos and animal hybrids, we are entitled to have an intelligent debate in which views contrary to those driving the research are properly heard. I would like to register the strongest possible opposition to the proposals to create cloned animal-human embryos and animal hybrids, and to the hotchpotch of other proposals—to remove reference to fathers, new arrangements for surrogacy, to make human embryos available for training purposes, and to alter the genetic structure of embryos. When he comes to reply, I hope that the Minister will specifically tell us whether these new animal-human entities are to be treated as embryos under the 1990 Act, as animals under the Animals (Scientific Procedures) Act 1986 or as something in between. Will they have no moral status or special moral status? Is a so-called cytoplasmic hybrid human or not, or does he agree with the Chief Medical Officer, Professor Sir Liam Donaldson, who in February told the House of Commons Select Committee on Science and Technology that,
“no sane person could give a yes/no answer”?
In the debate in your Lordships House’ in 2001, the Minister said that,
“the 1990 Act already provides the answer to the question of what happens if and when research into adult cells overtakes research using embryos: embryonic research would have to stop because the use of embryos would no longer be necessary for that research”.—[Official Report, 22/1/01; col. 120.]
Many people would argue that that time has now come.
My Lords, I join others in thanking my noble friend Lord Patel for introducing this topical and controversial debate. Unlike my noble friend Lord Alton of Liverpool, I am a great supporter of stem cell research, but I do not claim to be an expert and it is awesome to be speaking in such a long line of distinguished experts on this subject. For me, the key point in the wording of the Motion we are debating is,
“the potential benefits of stem cell research”,
which relate to their regenerative ability to treat future generations. I entirely agree with my noble friend Lady Finlay of Llandaff, who said that fantasy has fuelled scaremongering about stem cell research. Having said that, I entirely agree with the reasonable call of the noble Baroness, Lady Kennedy, that there should be greater public understanding of stem cell research.
My interest stems from seeing my 91 year-old mother suffer from a degenerative and degrading disease, and my desire that similar patients should have the chance through stem cell therapy to have a better quality of life. I have neither desire nor intention to debate the moral and controversial issues of embryonic stem cell research. My noble friend Lord Patel in his outstanding introduction mentioned that clear distinctions need to be made between different types of stem cells. I am interested in adult stem cell research and umbilical cord stem cells, which have been extensively researched around the world for several decades with no apparent ethical issues regarding obtaining them.
It is well known that the United Kingdom has permissive rules for embryonic stem cell research, but it is less clear about the policy on adult and umbilical cord blood stem cells, which are closer to application in patients. Given the extensive data on these cells, what is Her Majesty’s Government’s policy for doctors using this technology in the UK? I gather that we are a few years away from definitive stem cell therapy using adult and umbilical cord blood stem cells. As we all know, many patients are now in desperate need with dementia, Parkinson’s, Alzheimer’s and motor neurone disease, among many other ailments. My noble friends Lady Greenfield and Lord Sutherland spoke of the enormous costs of caring for these patients, and the enormous pain that not just their families but their carers go through. I commend the work of the AMRC, which supports the campaign about the need for and the potential therapeutic benefits of stem cell research.
There are already extensive clinical trials with a variety of stem cells, most notably in heart repair, including phase 1 FDA safety tests from the Johns Hopkins University in the United States in 2003, as well as similar trials in Germany, which show a clear clinical benefit for heart regeneration. As these tests have been successfully completed, why do we need to repeat them with neurological patients? While I agree that it is important to regulate therapy, are we not protecting these patients to death? They have a parlous quality of life with limited treatments available. Should we not now be exploring first-generation stem cell therapy, perhaps on a named patient basis?
If time permitted I would have liked to explore the potential benefits of stem cell research and therapy to the underdeveloped world, particularly in Africa, where my passion lies. I have no doubt that we shall have more opportunities to debate this topical subject.
Clearly stem cell research is moving in the right direction. However, we need to support and streamline research. Research needs to be promoted and not restricted. I share the views of my noble friend Lady Warnock, who urges that we should move to the next stage of clinical outcomes.
Finally, in the words of my noble friend Lord Crisp, I hope that the Government will not sit on the fence.
My Lords, I, too, pay tribute to the noble Lord, Lord Patel, for securing this important and timely debate. We have heard from considerable experts in the field—scientific, medical, legal and ethical. I am a little nervous at winding up at this stage. We have heard the experts speak with great authority. I want to add only a few points to what has been said. I need to declare a couple of interests. I am a former member of the Medical Research Council, the General Medical Council and the Human Fertilisation and Embryology Authority and its predecessor organisations.
First, I want to emphasise the extraordinary hope that stem cell work in its variety of settings offers to people with all sorts of deeply distressing conditions. The noble Baroness, Lady Greenfield, made that point very strongly, as have other noble Lords. We have heard from the scientists, the doctors and the ethicists, and from the noble Lord, Lord Turnberg, about the medical charities and how they have put on pressure to increase funding for this kind of research.
I want to speak from a pastoral point of view. I used to be a pastoral rabbi; these days I only do a little of that. I come from a tradition which is extremely life-affirming and where we believe that we should do everything possible to preserve life. I also come from a tradition which does not accord to the human embryo quite the status that Christian traditions have; and I think it is important to say that. However, like the noble and right reverend Lord, Lord Harries of Pentregarth, I believe that these scientific questions are also basically religious questions, giving us cause to wonder about it all.
Nobody suggests that we should prolong life unnecessarily, but these new advances give people huge hope that we will be able to stop the degenerative disorders and cause an end to some of these deeply distressing conditions for those who suffer from them and their families. Let me give a couple of examples: Duchenne muscular dystrophy—I am grateful to my noble friend Lady Thomas of Winchester for pointing this out to me—is a distressing, disabling and ultimately life-shortening illness. Stem cell research is well under way to look at ways to prevent muscle loss after the mechanism of the stem cells has stopped working, and to see whether there is a way to repair and replace the damaged muscle cells. That research is trying to prevent the muscle loss or to replace lost fibres and to understand the biology of the satellite cells and their potential to repair and replace muscle cells.
Thus far the researchers have shown that some satellite cells are capable of making large amounts of regenerative fibres. Not all satellite cells can do that, so they need to understand which can and which cannot. That might lead to satellite cell transplantation which could treat the various dystrophies; but there is a long way to go yet. There are no instant successes or cures here. There is no hype. We have been rightly warned by several noble Lords that sometimes some of this is overhyped. There is no false hope given here, and it is right that the noble Baroness, Lady Kennedy of The Shaws, reminded us that false hope should not be given. But work is taking place and it is giving people real hope, if not in the very short term. Researchers are working on developing a way to replace the dopamine-producing nerve cells that have died in Parkinson’s disease with healthy cells and on transplantation of healthy heart muscle cells for people with chronic heart disease—something that is immensely prevalent in my family from a relatively early age; so I shall be very grateful if they get on with that. They are working on slowing down the progression of type 1 diabetes by transplanting islets of Langerhans, which are the cells that specialise in the synthesis of pancreatic insulin. And so on. Previous speakers have cited examples: the noble Lord, Lord Soulsby of Swaffham Prior, on motor neurone disease; the noble Baroness, Lady Finlay, on heart disease; and the noble Lord, Lord St John of Bletso, on degenerative neurological disease.
For many people these techniques, which are in their very early stages of development, give hope to the individuals and their families. Many people are strongly opposed to this research, mostly for religious reasons, and we have heard from some of them today. The noble Baroness, Lady O’Cathain, raised many of the questions that disturb many people. The noble Lord, Lord Alton, made his opposition very clear to many of these advances. They believe it is wrong to use human embryos, even at the earlier stage for any purpose.
I think that the noble Baroness, Lady O’Neill of Bengarve, is right to ask us to think differently and to say that these scientific advances should make us reconsider what it means to have these clusters of cells, what is truly human and what is in fact animal. Do those terms still apply as we thought they did? However, many of us probably would agree with the BMA’s position that,
“if a similar level of success could be achieved using stem cells derived from adults, the use of adult rather than embryonic stem cells would be preferable because of the special status of human embryos”.
But, it continues,
“at this stage it is not evident that this will ever be the case”.
The noble and right reverend Lord, Lord Harries of Pentregarth, made the case clearly that we need to continue work on both adult and embryonic stem cells. But if it is right that we do not think at the moment that adult stem cells will take us to where we want and need to be to give hope to so many people, if we do not allow the use of embryonic stem cells, particularly those that go to waste, as the noble Baroness, Lady D’Souza, said, we would not only hamper scientific and medical research but destroy hope for many people.
It is very hard to justify a position that would destroy hope for hundreds of thousands of people. Like the right reverend Prelate the Bishop of Newcastle, who spoke earlier, I do not believe that using human embryos sensitively and with careful regulation means that we are destroying human life. One can have scientific advance and respect for human embryos at the same time. We have a strict and careful regulatory system in this country, and other noble Lords have made it clear how very much that is respected around the world. This is what leads me to make my second point. Government have flagged up their intention in their review of the Human Fertilisation and Embryology Act to ban the creation of hybrid and chimeric embryos.
We all know of the panic surrounding the publication of the story of two groups of scientists applying to the HFEA for licences to conduct research involving the transfer of human genetic material into animal eggs from which the nucleus had been removed. “Monsters”, said the headlines; “Chimera”, said the commentators. Yet this is desired only because human eggs from IVF patients are in short supply. Nor should we desire to so over-stimulate women’s ovaries that they produce masses more eggs, because it is dangerous for them. It is unclear why the Government are taking this view, particularly with 200 or more charities making great representation to the Prime Minister on this issue. It would be very good to hear from the Minister the exact reason for their view, particularly given the reassurance received thus far that there could be regulations later to allow such research using animal/human embryos in specific circumstances. Is it really necessary to have such a ban in the Bill?
There is general agreement around the world that the HFEA has done an excellent job analysing complex ethical and scientific issues, and it has developed a trusted and moderate approach to its regulatory functions. It is to be hoped that its proposed successor will be able to do the same, although its remit, as the noble Lord, Lord Rees of Ludlow, has said, and other noble Lords have agreed, seems to be extraordinarily wide. There is some doubt, as the noble Lord, Lord Patel, said in his introductory speech, that it will be given sufficient resources, both in funds and expertise, to do the job. Given our success in regulating and the approach that this country has taken since the very beginning of in vitro fertilisation, with its voluntary licensing authority, which eventually became the HFEA, should we not think differently about a total ban and instead allow the regulators to regulate? The HFEA has rightly launched a public consultation, and it will be very good to hear what it comes up with.
Stem cell research is already signalling that it will bring great benefits, and we are indeed among the world’s leaders in that area. In congratulating once again the noble Lord, Lord Patel, on securing the debate, I ask the Minister to reflect on whether it is really necessary to curtail scientific advance by imposing an outright ban on animal/human embryos. I also ask him what the Government will do to encourage this research, not only in terms of funding but by creating a climate of acceptance of scientific advance, even where some members of our society have real and understandable ethical concerns. Like the noble Lord, Lord Crisp, I believe that we need to think differently about how we will use all these technologies in our service design. Like the noble Baroness, Lady Carnegy of Lour, I believe that most of the public are ready for all this, but I think that we need to check. Like the noble Baroness, Lady Kennedy of The Shaws, I believe that this debate needs to be held in public, and that we need to create a climate of scientific education, scientific literacy, and an acceptance that scientific advance brings great benefits. I very much hope that the Minister can tell the House what the Government will do to ensure that this research is conducted in a climate of public debate, public education and scientific literacy.
My Lords, in listening to the successive contributions to this debate, I have come to the view that we have today witnessed the House of Lords at its very best. It is wholly characteristic of this House that it should have elicited from Peers on all sides that special combination of scientific expertise and balanced exposition that is so essential for a subject of this kind. I congratulate the noble Lord, Lord Patel, on tabling his Motion and on the quality of his opening speech, which set the scene most admirably for the speakers who have followed.
As we have heard, the subject of the noble Lord’s Motion has a number of layers to it. In the first place, we need to understand the value of stem cell research in purely scientific terms; what claims are being made of it, and why it is considered important. We also need to understand what the barriers are to achieving from it what our researchers want to achieve. We also need to place stem cell research in its broader context: global competition; public opinion in this country; and the ethical considerations that bear upon it, not least the ethical questions posed by those forms of research that have yet to receive parliamentary approval. All those aspects have been richly dealt with by those who have spoken.
I mentioned public opinion, as have others. When, earlier this year, the HFEA declined to give a ruling one way or the other on the applications of two academic institutions to produce cytoplasmic hybrid embryos, it came in for a fair degree of criticism. For my part, I congratulate the HFEA on realising that this was not an issue that fitted into the normal run of decision-making. If there is one thing that we have learnt in this country over the past 20 years—and learnt the hard way—it is that wherever science has a tendency to gallop ahead at speed, there is always a serious risk of its leaving public opinion behind it. As and when that happens, the situation becomes dangerous, because it is no longer the scientists who are in the driving seat but the tabloid press. We have only to think of the debacles over irradiated food, GM foods and the MMR vaccine to realise how ill-founded beliefs among the public can endanger or indeed scupper worthwhile scientific advances.
Those who bemoan what they see as an over-regulated environment for reproductive and stem cell research in this country need to reflect on something that is very easy to take for granted: the fact that this country has a regulator that reaches its decisions independently of government but within a framework of rules set by Parliament, which gives the public confidence that clearly delineated ethical boundaries are not being crossed and that agreed principles are being adhered to. That may sound obvious, but it is exactly the point at which, in the eyes of many, progress in the United States has been severely hampered. In that country, opposition to stem cell research among certain segments of the public has led to hard-line opposition on the part of government, to the extent that, ironically, the entire field of research remains unregulated and hence lacking in practical boundaries—a fact that in turn foments opposition all the more. The result is that, despite all that the noble Lord, Lord Winston, said, stem cell research in the United States receives nothing like the financial support that it would otherwise do in that entrepreneurial country, and that some of the best brains in the field migrate to this side of the Atlantic to pursue their work.
In the United Kingdom, public opinion on stem cell research has been generally positive, largely because the scientific community has been successful in keeping control of the debate and explaining why such research is important and necessary. One difficulty ensuing from that is the tricky business of managing public expectations. Embryonic stem cell research is a long-term enterprise. No one should imagine that it is going to produce treatment or cures for anyone or anything inside a decade. Indeed the scaled-up results of such research may not be evident for a good deal longer than that. There will almost certainly be failure and disappointment along the way. The noble Lord, Lord Patel, and the noble Baroness, Lady Finlay, sounded a warning about the risk of undue hype fuelling unrealistic expectations, and they are right. In the battle for public acceptance, hype is almost as dangerous as an information vacuum.
The HFEA was therefore right to defer a decision on cytoplasmic hybrid embryos, and a public consultation on the issue is now under way. We need theologians and philosophers to contribute to that. Once again, though, it is for the scientific community to make its case to the public. It needs to show convincingly that transferring human genetic material into an animal egg for research purposes can be fully justified by the scientific benefits that may ensue and is necessary to secure those benefits.
Many people instinctively recoil at the thought of mixing human and animal genetic material. Others believe sincerely that it is morally unacceptable. We cannot get away from that fact, nor should we seek to. Nor should we duck the concern expressed by, for example, the Scottish Council on Bioethics, that work of this nature carries with it the risk of disease transmission across the species barrier. During the course of this debate, we have heard the research case made very powerfully, and it was a case which convinced the Science and Technology Committee in another place to say that in its view the Government's current stance on the matter was prohibitive.
It is equally for those who object to such research to say precisely why they do so. The Select Committee did not find arguments centring on the notion of human dignity convincing, mainly because the notion of human dignity is simply too vague. Reverence for human life can co-exist in its fullest sense alongside scientific inquiry. Humanity as a whole is not self-evidently debased by a process that intermingles with human DNA tiny quantities of animal material at microscopic levels.
In any case, it is not always clear whether the opponents of such research object only to the mixing of human and animal genetic material or to embryonic stem cell research in general. If it is simply the former, we need to understand from them why the notion of cytoplasmic hybrid embryos is inherently more objectionable than other techniques, which are already legal, for inserting human chromosomes into animal embryos or implanting human neural cells into the brain of a mouse. As I read the White Paper, the creation of animal chimera embryos, which the Home Office may currently license, would be made illegal under the proposals. We have not heard an explanation of why that should be. I, for one, find that concerning.
Having said that the HFEA was sensible to defer a decision on hybrid embryos, it would be very unfortunate if the delay was unduly prolonged. I do not know what the outcome of the current consultation will be, but let us suppose that at the end of it the Government say that they are receptive in principle to legalising that process. If we are to await the arrival of primary legislation, the coming into force of that legislation 18 months or two years later, and then, perhaps, the laying of regulations under that legislation even later, we are looking at an interval of many months before effective and meaningful research of the kind proposed can proceed. Such delay would surely serve no one's interests. I hope that the Government will bear in mind the need for reasonable expedition.
I also hope that they will take on board some of the other concerns expressed in this debate. The absence of any official means to accredit facilities for generating and maintaining embryonic stem cell lines presents a serious situation. The Government must resolve it. They must examine the concerns of the noble Lord, Lord Winston, about damaging delays in the ethical approval process. They need to reiterate their support for the recommendations of Sir John Pattison. They need to clarify what funding has been committed to basic stem cell research from public sources; and what their response is to the concern that there is a gap to be bridged if the UK-based programmes envisaged by Pattison are not to be short-changed.
Ministers also need to clarify to Parliament whether in the draft legislation that emerges from the White Paper, we will be dealing with government policy or a set of proposals to be presented to Parliament and determined on the basis of a free vote. I very much hope that, in line with the view of these Benches, they will follow precedent on issues of this nature and declare this to be free-vote territory. Indeed, I speak today on my own behalf, not that of my party. Above all, I hope that Ministers will bear constantly in mind the words of exhortation that we have heard repeated today from so many noble Lords for a sense of national effort and public commitment. I do not accuse the Government of being half-hearted on stem cell research, but if backing from the public is there, as I trust that it will be, the price that we would pay as a nation for any inaction or lack of urgency in this vital field would be lasting and heavy.
My Lords, I am extremely grateful to the noble Lord, Lord Patel, for raising this important matter today. I pay tribute to him as chair of the UK Stem Cell Bank Oversight Committee and of the newly launched UK National Stem Cell Network. In his excellent opening speech, he referred both to achievements and to some of his concerns about the direction of the approach to stem cell research. I will of course respond to him as well as I can.
I start by saying that I very much agree with the noble Earl, Lord Howe, about the outstanding quality of this debate in your Lordships' House. As the right reverend Prelate the Bishop of Newcastle explored some of the ethical considerations, I, and many noble Lords, I am sure, recalled the extraordinary seven-hour debate that we had in 2001 on the regulations. I pay tribute to the noble and right reverend Lord, Lord Harries, for his subsequent work on the Select Committee established as a result of the amendment moved by the noble Lord, Lord Walton, to those regulations.
The noble Baroness, Lady Carnegy, took us back further than that to the original Act and to the outstanding work of the noble Baroness, Lady Warnock. She modestly described herself as a lay person today, but it was surely her clear understanding nearly two decades ago of the wide-ranging ramifications of potential advances in science which paved the way for legislation that anticipated some future developments and has stood this country in such good stead. I echo the remarks of the noble and right reverend Lord, Lord Harries, about the robustness of that legislation.
Although I disagree with the noble Lord, Lord Alton, I have always respected his views. As ever, he made a powerful contribution to our debate.
Like the noble Lords, Lord Patel and Lord Soulsby, and the noble Baroness, Lady Neuberger, I am convinced that stem cell research offers us an unrivalled prospect for the treatment of a whole host of illnesses, such as degenerative diseases that have been mentioned today—Parkinson’s, certain forms of diabetes and strokes. Looking at the debates that we have had on health issues during the past few months, whether about funding, research or specialty nursing, it is remarkable that so much of that debate has focused on the degenerative diseases on which we are so keen to enhance our knowledge, the devastating consequences of which are lived and experienced by so many people in our country today. The noble Baroness, Lady Greenfield, eloquently described the potential of the research on stem cells. I was struck by her reasonable confidence, as she described it, and that of the noble Baroness, Lady Finlay, who outlined some of the potential extensions of research to, for instance, heart disease.
The noble Lord, Lord, Crisp, emphasised the importance of the impact of the research on services and, more particularly, on the National Health Service. That is an important consideration not only for the services to be provided but for the architecture of services which need to be planned and developed over the next 10 to 20 years; indeed, there could be an enormous impact on workforce considerations. In visioning out where healthcare needs to be over the next 20 years, we need to take into account this and other kinds of research. In the past, we have not been able to do that as effectively as we might have. We must also ensure that the intelligence that we can get from the pharmaceutical industry is made available to the NHS as quickly as possible. It is important that we see how the current pipeline, which I am glad to report looks encouraging in an enormous number of areas, might impact on the way in which we run services in the future.
Like the noble Lord, Lord Rees, I am proud of our achievements in this country, for which quite a few noble Lords who have spoken today can take a great deal of credit. I say to my noble friend Lord Winston that I am not at all complacent. I take note of what he has to say about our research effort and the efforts of other countries to invest properly in research. The Government are not at all complacent about where we stand. I agree with the noble Baronesses, Lady Finlay and Lady O’Cathain, and with the noble and right reverend Lord, Lord Harries, that we wish to support all types of stem cell activity and research. I have not moved one jot from the position that I expressed in 2001. We see these approaches as being complementary, and it is important that we say that again and again. If research in adult stem cells shows promise, I rejoice as much as the noble Lord, Lord Alton.
I agree with the noble Lord, Lord Sutherland, that we have to get the balance right with regulation. We have heard criticisms today of the way in which the regulator performs its functions but, as the noble Baroness, Lady D’Souza, said so well, the principles underpinning the UK legislation have stood us in good stead; indeed, they have been replicated in one form or another by many other countries. We are, of course, proposing to overhaul the legislation on the Human Fertilisation and Embryology Authority. I will come back to that in a minute, but I should first respond to my noble friend Lord Winston on the performance of the HFEA.
The target performance indicator for dealing with research licence applications is three months, excluding the time taken for peer review of applications. I understand that the HFEA hits the target rate for 75 per cent of applications and is seeking to improve that performance further. I will come on to deal with the Regulatory Authority for Tissue and Embryos, but my hope is that the arrangements that we will introduce to create that body may enable decisions to be arrived at more quickly, albeit as rigorously as the noble Earl, Lord Howe, suggested.
I say to the noble Baroness, Lady Warnock, that I understand the tensions that sometimes arise with local research ethics committees. However, they have expertise in dealing with wider research ethical issues and I believe that many of them have raised their game considerably in the past few years. I accept the challenge of the need to streamline the process so as to remove or reduce any duplication between the HFEA and the local committees. I understand that discussions are under way between my department, the HFEA and the Central Office for Research Ethics Committees to see how we can do that. My department is also planning to consult on the future role of LRECs generally.
The noble and right reverend Lord, Lord Harries, as a member of the HFEA, made a reassuring point on this. I echo what the noble Earl, Lord Howe, and the noble Baroness, Lady Neuberger, said about ensuring that the regulatory framework provides reassurance to the public. The regulatory framework and the way in which the HFEA conducted its role were highly important in persuading noble Lords in 2001 to support the amendment of the noble Lord, Lord Alton, which allowed the regulation to go through but also established a Select Committee further to advise the House; those factors were a telling point in those debates.
I know that there are concerns about the nature of the proposals in the new human tissue and embryo Bill that we will bring before Parliament. First, let me deal with the Regulatory Authority for Tissue and Embryos. I say to those noble Lords who have expressed concerns that we want the best of the HTA and the HFEA to be brought together in the new regulatory body. That will provide a more cost-effective system of regulation. It will ensure that common principles and standards can be applied wherever appropriate. It will also ensure that the risk of overlap between sectors is minimised and that there is continuity at the interface between related areas, such as embryo research and cell therapies.
I fully take into account the issues that have been raised today about the importance of regulation, which we will ensure are carefully considered. We will publish a draft Bill, which will allow pre-legislative scrutiny. That will surely enable a lot of these issues to be teased out in a reasonable time further to inform the Government in bringing forward the Bill. I understand what the noble Earl, Lord Howe, said. In fact, he said two things. He said that we should be cautious, as we should, and that the science should not march way ahead of public opinion, but he also worried about delays and blight in relation to legislation. He expresses the dilemma in getting the balance right. I cannot give him a legislative timetable, but I assure him that, as far as my department is concerned, we want to get on with this and we understand the need for certainty and stability. Equally, the pre-legislative scrutiny will be enormously important in helping us to understand so many of the issues that have been explored today and to find the best way forward.
Your Lordships always rightly enjoy the contributions of the noble Baroness, Lady O’Neill. She made some profound remarks about the status of human cells. She suggested reasons why such research should be sanctioned and spoke of the ethics around egg donation. I know that a number of noble Lords agree with what she said.
That brings us to the question of public engagement. My noble friend Lady Kennedy, as chair of the Human Genetics Commission, made a telling point about the need to engage the public. She was right to say that the public have differing views; it is important that they are able to express those views, and that they are taken into account. They should not just be dismissed as oppositionist. We have to take those views into account and give them the respect they deserve.
That is why I noted with interest the remarks of the noble Baroness, Lady Carnegy, and indeed the noble Baroness, Lady O’Cathain, about public opinion and confidence. We heard from the noble Lord, Lord Sutherland, who reported on the Alzheimer’s Scotland survey that put forward such a positive view of the impact of research. He made the point, as did the noble Lord, Lord Crisp, that in order for the public to have trust, it is vital that we engage with them and that they fully understand the issue, and I am delighted that the noble Lord, Lord Rees, said that the Royal Society has produced a document to help them do so.
In echoing the remarks about the need for public engagement, we have to have sympathy for the way the HFEA handled the two applications that noble Lords have mentioned. The noble Earl, Lord Howe, importantly congratulated the HFEA on the judgment it exercised. It would be all too easy simply to dismiss the authority as putting off a decision, but it has had to exercise a very difficult judgment. Even if we disagree with it, it would be right to acknowledge the difficult role the HFEA has to play, and I hope the noble and right reverend Lord, Lord Harries, will take that back to the board, alongside what I am sure are legitimate criticisms of some aspects of its performance.
The noble Lord, Lord Alton, questioned whether the Government and the bodies responsible for allocating research were being unfair to adult stem cell researchers. He is right—we do not list the different types of stem cell research. My understanding is that the research councils do not do that; they base their funding on the quality of science. I assure the noble Lord that that is right; whenever I have had debates here and noble Lords have argued for funding in a particular area, I have gone back to those funding organisations and suggested that they jolly well ought to fund that area, and that is the response I have always received. I understand the issues the noble Lord raises, and I will pursue with the funding bodies the question of whether there is some more knowledge about this that I can send to him and other noble Lords. I say again that I do not see these various avenues of research as being in conflict. Surely they are complementary; surely we all, unless one is ethically opposed to embryonic stem cell research, wish to see the best possible research that can have the most positive impact on patients in dealing with these appalling degenerative diseases.
The noble Lord, Lord St John of Bletso, made an interesting point, asking where adult stem cell research has gone and what the delays are in translating that research into treatment. It would be fair to say that stem cells have in effect been used in bone marrow treatments and skin grafts for many years, but perhaps we are only now understanding which stem cells in these sources are important. I understand his frustration about the number of trials and the time it takes for trials to take place, but they are necessary to give us a better understanding of what is happening inside the patient’s body, the best way to treat and, of course, the safety and efficacy issues.
I ought to come to funding before my time is up. I understand the issues noble Lords have raised about resources. The Pattison report was very important here. It costed the total amount required over a 10-year period. My understanding is that the projected investment this year is around £45 million, which takes total funding since 2003 to approximately £109 million. Noble Lords have asked me to go on and state what the Government will do in the future, but they know I cannot do that; it depends on the CSR. I fully understand that noble Lords want to make sure that we invest as much as possible in this area, but it has to be seen in the context of overall funding. Recalling the past six or eight health debates in your Lordships’ House in which I have taken part, I remind noble Lords that if I were to total up the amount of money that noble Lords collectively wish to spend, it would be a huge figure indeed—and I would add our debates on the Mental Health Bill to the total bill. This is not easy. We understand the priority and the need. The Government have produced a lot of additional resources, but there are other issues that require investment.
I pay enormous tribute to the charities under the umbrella of the Association of Medical Research Charities, mentioned by my noble friend Lord Turnberg. The work they have done has been very important in maintaining and encouraging public confidence in this kind of research. I hope the intention is that we work strongly together with those organisations to ensure that collectively the research amount is as high as possible.
On funding, I must remind noble Lords that the Chancellor, in his Budget, reinforced his commitment to science by announcing an annual average rate of 2.5 per cent in real terms over the CSR period. I would also say that, on a visit to the US to encourage more investment by its pharmaceutical industry in this country, I found that the quality of our science base is strongly recognised, and we need to do everything we can to enhance that in the future.
This has been a remarkable debate that has been extremely helpful to the Government in making the important decisions that must be made on the way forward. I am most grateful to the noble Lord, Lord Patel, for his initiative and for the fine quality of his opening speech.
My Lords, on behalf of us all I thank the Minister for his reply. It was not too convincing in all aspects, but we will have other opportunities to come back to this. I also thank all noble Lords who have spoken. The debate has been good; it has been of the highest quality and informative.
I take note of the need for public engagement. I know not of a single scientist working in stem cell science in the United Kingdom who would not agree with that statement. The scientists wish to be involved in this public dialogue and to make it clear to the public in the simplest possible terms why they want to pursue certain kinds of science.
The holy grail for all stem cell scientists, if I might use that term, would be one day to be able to take a somatic cell from a patient suffering a disease, to deregulate it and be able to differentiate it again to behave like a pluripotent stem cell and differentiate it to the cell type required, and then to be able to treat that patient with healthy cells and replace the diseased cells. They are not wedded to embryonic stem cell research; it is the promise of that research to be able one day to use that technique of mass production of stem cells, using adult stem cells. I believe that cord blood stem cells will be the next advance before the embryonic stem cells, as some of the adult stem cells are today. That is the utopian dream, that is what the stem cell scientists want to work towards, and that is why we need to back them. I beg leave to withdraw the Motion for Papers.
Motion for Papers, by leave, withdrawn.