On a summer Thursday in 2000, Curt Civin was plying his craft as a physician-scientist when a caller rang his office in the Cancer Research Building and lured him into a fight. On the phone was an official from a national medical association with an urgent need: The future of federal funding for embryonic stem cell research was scheduled for a pivotal vote in the U.S. Senate, and a key senator was leaning against it. The official thought the senator might be swayed by a prominent scientist intimately familiar with the cell technology's formidable prospects for alleviating human suffering.
“Dr. Civin,” the official explained apologetically, “I'm calling at this late date because I need someone like you who's close to Washington . And I need somebody tomorrow.”
Civin had to think fast. By that point, he'd spent more than 25 years as a rising star in medicine. He'd been one of the early scientists to recognize the possibilities for embryonic stem cells, with their tantalizing ability to become almost any other human cell type. But he'd never imagined approaching politicians on bended knee to continue his research.
The request gnawed at him. Civin was exquisitely well acquainted with the conservative arguments against his kind of research. Experimenting with embryonic stem cells, or ESCs, means destroying an embryo, which throws open the floodgates regarding the chronically divisive question of when human life begins. Conservatives maintain that life starts with conception; most scientists believe newly fertilized embryos don't qualify as “humans.”
Civin was also beginning to understand that conservatives had targeted ESCs as the next front in their campaign against abortion. To them, creating human embryos with the intention of destroying them for research constituted a brand new threat against early human life. Medical science, they believed, would have to solve the riddles of disease with cells from umbilical cords or adult stem cells.
Like it or not, Civin knew, this was a values clash. It was personal, emotional, even theological. And choosing a side meant grappling with faith, discussions that have long been anathema to scientists. But Civin's ethics are also grounded in faith, and to him the proper course seemed every bit as clear. As a hematologist who'd committed early to waging war against the horrors of childhood leukemia, he'd been drawn into the world of ESCs because of their potential to repair the genetically flawed blood of the children he treated. If he didn't advocate for ESCs in the clutch, then who would?
“I remember thinking,” he says, “if I don't do this, then I don't have a conscience.”
Civin's decision to make the 50-mile pilgrimage to Washington the next day launched him into the world of politics—and into the thick of one of the most wrenching contests of modern science.
No polls exist regarding the scientific community's political leanings on using ESCs in search of new therapies, but the laws of self-selection for the field would suggest that the overwhelming majority support it. Indeed, a brief search among the Hopkins faculty found precious few who would argue against harvesting ESCs in the quest to cure people of debilitating diseases and injuries. One med school alum prompted rumbling in the Hopkins community by protesting ESC research in a letter to this magazine.
“We have to deal with the conflict of when life begins,” says James Sherley, who received his M.D. and Ph.D. from the School of Medicine in 1988 and now works with adult stem cells at MIT. “The first question is whether the embryo is alive. All scientists agree that it is alive. The next question is whether it's human. Well, what else could it be?” In Sherley's view, “the moment an embryo is created it's a member of the human community.”
Though many conservatives say scientists typically duck the question of when human life begins, Civin has emerged as a fearless exception. In a May symposium held here on the topic of spirituality and medicine, Civin took the stage in front of nearly 800 and put it in plain English: Two weeks. After the moment of fertilization, he said, there lies a brief window wherein no reasonable person could argue that human life existed in any moral sense.
Civin briskly outlined his case in a slide show peppered with the purportedly untouchable question—in bold black lettering, highlighted in yellow—“When does human life begin?” This was shortly followed by “Should the embryo have all the rights of a human being?” His argument against this last point centers on the scientific fact that, prior to the two-week threshold, no structure at all exists inside the embryo, until the tiny thread of a “primitive streak” forms. That primal structure, says Civin, is the first hint of human nervous tissue, the microscopic foundation of the brain, the primitive seat of that more ephemeral thing known as the mind, from where a being might eventually experience the distinctive human sensation of self-awareness. Without the primitive streak, says Civin, “all we have is a clump of cells.”
And it is from this pre-human clump of cells, Civin declared to the gathered hundreds, that scientists can obtain all the embryonic stem cells they'll need for research purposes.
Civin's slide show directly implored the holdouts on ESCs—many of them in the audience—to support the scientific case for a two-week window. “Can we unlink the debate on stem cell research to irreconcilable differences?” he asked
|> Civin with political partner Sandy Rosenberg
“Oh, everybody knows when human life begins,” says Paul McHugh, a card-carrying member for the opposition. McHugh, the vaunted University Professor of Psychiatry here who also professes a dear friendship with Civin, cut short his recent convalescence from heart surgery to hold up his end of this discussion. Pressing his hands into the shape of a tent at the fingertips and rolling his eyes at the suggestion that it's still up for debate, McHugh offers his scientific conclusion.
“It begins with conception,” he says, chuckling as if the conundrum is child's-play simple and implying that the question's persistence can be explained as the mass denial of an entire culture unable to abide the grand inconvenience of having to believe otherwise. “Good grief, I mean I'm a psychiatrist. I know rationalization when I see it, OK?”
McHugh says biologists all agree that a mouse's life begins at conception, so why should they redefine the construct to accommodate the political druthers of a more advanced species?
Such a conviction would be academic if McHugh didn't also occupy an influential post on George Bush's Council on Bioethics. The 16-person group ultimately supported the president's decision to withhold federal research funding for all embryos created in fertility labs after Aug. 9, 2001 . The policy cut directly against the hopes of Civin—with whom McHugh has shared a robust debate.
“I love Curt,” McHugh says. “But we haven't cured a mouse of anything,” he says. “No mouse has been cured of his diabetes. No monkey has been cured of his parkinsonism. Show us what you can do with animal embryos before pressuring those of humans.”
McHugh is especially rankled at talk of creating incubation laboratories on Maryland 's Eastern Shore that would supply the volume and quality of ESCs desired for research. “Farms for making human beings like we have chicken farms,” snorts McHugh. “Repugnant.”
On the point of such so-called fetus farming, at least, Civin agrees with McHugh, going so far as to formally nix the idea in his latest effort with a new Maryland law. But Civin says he parts ways with McHugh on the most fundamental point. It's simply incorrect, Civin says, to equate the scientific accord over when an animal's life begins, in the biological sense, with that of a human being. “We're talking about ‘Life' with a capital L,” says Civin, citing, as an example, the uniquely human trait of cognition.
One of the more immediate effects of this trenchant standoff, according to MIT's Sherley, is that the dominant zeal of those in favor of ESC research has skewed the contest between ESCs and adult stem cells. Lost in all the heated rhetoric, he believes, is that the very property most prized in the embryonic stem cells—their “pluripotency,” or ability to turn into most any type of tissue in the human body—is also their biggest negative.
Pluripotency, Sherley points out, has consistently given rise to tumors when ESCs are introduced into adult animal tissues—no small obstacle to their healing prospects. Less noticed, he says, is that work with adult stem cells and cord blood has made strides without those complications, advances that have been conspicuously less glamorized.
But the potential risks associated with ESCs should not prohibit their study, Civin contends. If scientists can defeat the tumor mechanisms, a whole world of therapies could open up beyond those promised by other, more limited types of stem cells. One of the most desirable properties of ESCs, he points out, is that they can multiply in the lab for years. This also means that only a few new embryos would be required to establish additional cell lines beyond those that were spared before President Bush's funding cutoff in 2001.
Six years after entering the public arena, Curt Civin looks no worse for the wear. His default expression is a cherubic smile, even when gently fending off the opposition's never-ending challenges. His case-making skills for public funding of ESC research since that initial foray have become battle-tested, seasoned and polished.
Some lessons came the hard way. Civin can chuckle now about that first trip to Washington in 2000, when his attempt at making his case for federally funding ESCs fell on deaf ears. But Civin was just warming up. In the coming years, he would enjoy a succession of greater legislative successes, first by taking a personal role in educating Senator Orrin Hatch on the details of ESCs, ultimately converting him into a powerful ally in the cause. Crafting the Hatch presentation superbly prepared Civin for testifying before Senator Arlen Spector's committee in September 2002. There, Civin successfully made the case that the purported 70-some “presidential” ESC lines were largely flawed and deteriorating. Only about one or two were viable for scientific research. Progress would be impeded if the government refused to back new lines.
Today, with federal funding for ESC research remaining frozen, Civin has shifted his energies to the state level, where legislatures frustrated with the federal restrictions are stepping in to support the research within their own borders. Driven partly by states' competition to boost their biotech industries, the movement has been led by California Governor Arnold Schwarzenegger. But Maryland 's Robert Ehrlich is now following closely behind, influenced in no small part by Curt Civin, the Hopkins professor who has quietly toiled alongside Delegate Sandy Rosenberg to pave the way for state support.
Civin's and Rosenberg's campaign came to a head this past spring, as debates over the ESC bill escalated. So cogently did the duo present their case that, at one point, a news reporter even marveled aloud over the mastery of the subject demonstrated by both the house speaker and a committee chairman. Rosenberg turned to Civin and quipped, “That's because they're both Civin scholars.”
In April 2006, Ehrlich signed the Maryland Stem Cell Act into law. It allocates $15 million in start-up funding for ESC research in the state.
But Civin is not resting on his laurels. The opposition is still formidable, and their argument has cast a chilling effect across American ESC research. “Is it slowing down science?” Civin asks. “Yes. Is there a cure that isn't getting delivered because of it? No. We're at a very early stage for this research. But I can tell you that, as surely as night follows day, if you slow down research, it will slow down cures.”