Embryos, stem cell research, and the promise of health: comment on Gurmankin, Sisti, and Caplan.

In this issue of Politics and the Life Sciences, Gurmankin, Sisti, and Caplan report useful original data on the embryo-disposal practices of a good sample of in vitro fertilization (IVF) clinics in the United States. Their paper has important implications for the broadening debate about potential uses of cryopreserved embryos. Since a large proportion of these embryos will never be used for reproductive purposes, the primary choice becomes one of disposal as biological waste material or use in medical, primarily stem-cell, research. Although the authors rightly do not discuss these issues in this short research article, the question of the advisability and acceptability of such directed uses is most timely. Another set of issues raised by the authors relates to consent for disposal and, indirectly, to ownership of "extra" embryos. Clearly, the authors' suggestion for full disclosure of disposal options at time of enrollment is long-since overdue. However, while the majority of clinics include donation-to-research as an option, these data do not clarify the context within which this and other options are presented to patients. What information, if any, is given to patients to help or influence their decisions? I imagine that most patients would choose to "donate" their embryos to research rather than having them destroyed as biological waste after a certain period, if presented with such a choice clearly expressed. Not addressed is why we have so many spare embryos in the first place, given the risks now associated with hyper-stimulating ovaries to increase egg production prior to laparoscopie harvest. This question takes us to another: should American IVF clinics adopt standards and accept regulations similar to those developed by the Human Fertilisation and Embryology Authority in the United Kingdom? Although the advantages would likely be many, as the HFEA appears to be a success in the UK,1 American professional practices will undoubtedly remain disparate and patient experiences inconsistent, making studies of the type published in this issue ever more critical. The authors' contribution ? published onlinebefore-print 9 August 2004 for the third anniversary of George W. Bush's announcement of a federal stemcell research policy ? is especially timely in light of a front-burner debate now heating up American electoral politics. Despite little public understanding of terms or underlying science, distinctions among embryonic and other types of stem cells (i.e., adultderived and umbilical-cord stem cells), differences between therapeutic and reproductive cloning, and distortions of the reality (if not the promise) of stemcell research have become startlingly emotive fixtures of the 2004 presidential campaign, widely referenced by John Kerry, Ron Reagan, and others at the Democratic Convention. As usual when an issue becomes political, rhetoric on all sides tends to blur the facts. While I believe they are mistaken regarding the use of spare embryos, opponents of embryonic stem-cell use are wise to fear the creation of embryos expressly for research purposes, particularly if the more optimistic forecasts of proponents do in fact eventuate. Demand for stem cell sources would then expand rapidly because of huge commercial stakes in research and an ineluctable drive for rapid diffusion of clinical applications. Of two options to meet a burgeoning demand for cell lines, the first, permitting production of human embryos specifically for research, remains highly improbable in the current US political climate. Thus,