From Christian Schaaf, Üni Heidelberg

Wie hoch beurteilen führende Wissenschaftler die Wahrscheinlichkeit, daß multipotente, adulte Stammzellen jemals werden reprogrammiert werden können zu pluripotenten Stammzellen?

Element of translation:
How high do researchers estimate the chance that multipotente, adult stem cells can possibly be reprogrammed to pluripotent stem cells?

Elements of answer:
Thank you very much for your contribution. Your question will be addressed during the conference.

From Alessandro Perillo

Several recent reports suggest that there is far more plasticity than previously believed in the developmental potential of many different adult stem cells (AS). Moreover, AS in vitro can be expanded up to 1x10⁹ cells in 8 weeks, regardless of the subject's age. On the other hand, different disadvantages have been described using embryonic stem cells (ES), such as:

• immunologic reactions with heterologous ES
• risk of teratome generation with murine ES
• high incidence of aneuploidies in human ES Why then, embryonic stem cells?

Elements of answer:
The specific issues regarding the possible disadvantage of using embryonic stem cells will be addressed during the conference.
The opinion of the European Group on Ethics on Stem Cell Research says in particular: "The Group notes that in some countries embryo research is forbidden. But when this research is allowed, with the purpose of improving treatment for infertility, it is hard to see any specific argument, which would prohibit extending the scope of such research in order to develop new treatments to cure severe diseases or injuries. As in the case of research on infertility, stem cell research aims to alleviate severe human suffering. In any case, the embryos that have been used for research are required to be destroyed. Consequently, there is no argument for excluding funding of this kind of research from the Framework Programme of research of the European Union if it complies with ethical and legal requirements as defined in this programme."

From Bert Joosten, University of Maastricht, The Netherland

The use of stem cells for implantation in various neurodegenerative diseaeses may be complicated by the fact that the implanted cells migrate into various, wanted as well as un-wanted directions. How do the experts think about the control of the migration of implanted stem cells and which technical approaches/modifications are required to minimize it?

From E.D.Carosella, Hôpital St Louis, France
(letter to Mr Hansen)

I would like to compliment you for the excellent symposium. It is, of course, a difficult task to cover all the subjects in two days and the effort that went into was very important. May I suggest that you form sub-groups that would meet at regular intervals to give thought to and adress one or two questions. The sub-groups would then submit to the Commission a global proposal issued from deep reflexion which could answer the concerns brought up by this meeting.

From Marla Pilato, Luxemburg

My mother has ALS. I have stem cells to donate. Who can help?

From Rick Dayes

I have a son who has a sports injury, he has brachial plexus damage, all 5 nerves have been pulled out of the spinal cord can stem cell help to grow these nerves again from the spinal cord ?

From Salvador Martinez, Instituto Neurosciencias, CSIC-UMH, Alicante

The use of embryonic/foetal stem cells for therapy in adult pathologies will imply heterocronic grafts. Thinking about CNS, fetal neurons will try to restore adult neuronal systems.
Are there any results about long-term regenerative effects of young neurons in the adult brain?
Has any research project suggested exploring possible short- and long-term effects of this temporal heterogity?

Elements of answer:
Thank you very much for your contribution. Your question will be addressed during the conference.

From Gisela Steinert, Parkinsongruppe

Ist es im Moment überhaupt möglich etwas darüber zu sagen, ob die Stammzellen überhaupt in der Lage sind, einem Parkinson-Erkrankten zu helfen. Bis jetzt kenne ich nur die Studie, bei der die Patienten eine Verschlechterung erlebt hatten, da keine Anhaltspunkte für die Menge der gegebenen Stammzellen vorhanden waren und es wahrscheinlich zu viele waren.

Element of translation:
Is it possible at this moment to say anything concrete on whether stem cells will actually help a person with Parkinson disease? Up to now I only know of a study where the patient conditions have worsened, since there was no clues on how to dose the stem cells, and probably the dose was too high.

Elements of answer:
Beside the one you refer to, there are some other studies.Based on the positive results of experimentation on rodents and primates, several clinical trials in patients with Parkinson's disease have been performed on around 200 patients over the last 10 years especially in Sweden (in particular by Prof. A. Bjorklund who will be present at the conference) and in the USA. They have shown that the transplantation of neural cells derived from the human foetus can have a therapeutic effect, with an important reduction of the symptoms of the disease in the treated patients. The clinical improvement among these patients have been observed for 6-24 months after transplantation and in some cases for 5-10 years. It has recently been shown that 10 years after the transplantation surgery, the transplanted neural cells were still alive and producing dopamine, the compound which is deficient in the brain of patients with Parkinson's disease. However, this therapeutic approach still remains experimental. In addition, the availability of neural foetal tissues is very limited. Five to six aborted foestuses are needed to provide enough neural tissue to treat one Parkinson's patient. That is why new sources of neural cells have been explored in some countries such as the US and Sweden. The aim is to derive neural stem cells from foetuses: these stem cells could be produced to proliferate in culture, providing much greater amounts of neural tissue for transplantation.

Parkinson disease seems to be on the top of the list of the deseases that are going to be hopefully treated by stem cells, however

1. what is the success rate for treatment of parkinson patients with stem cells transplant?
   
   
2. what will be the cost associated with such treatment?
   
   
3. last but not least what are the side-effects of such treatment?

Elements of answer:
See comments before

From Marla Pilato, Luxemburg

If I have left over stem cells from a operation, I chose, than is it not my right to do what I want with these cells, if they are to go to waste why not use them to save someone's life.

From Paul Woolley, CARE, United Kingdom

On the basis that embryos deserve protection and respect, a point readily recognised by the majority of participants, and the breathtaking speed of developments using adult stem cells, is it not our responsibility to invest all our energies into adult stem cell research, thereby avoiding all the ethical problems that therapeutic or experimental cloning entails?
I am opposed to reproductive cloning, but on the basis that the primary intent in reproductive cloning is to create a human life (like IVF treatment), is it not easier to justify reproductive cloning than therapeutic cloning on the basis that the latter necessarily leads to the destruction of embryos.
The only difference between therapeutic cloning (experimental cloning) and reproductive cloning is the outcome. The science for both is identical.
In the UK there are currently no regulations to protect cloned embryos, only IVF embryos. The UK has just passed a law that seeks to prohibit reproductive cloning. Unfortunately, it contains numerous loopholes. It prevents a cloned embryo being inserted into a 'uterus of a woman' but does not take into account the possibility of creating a human clone entirely in vitro (e.g. in an artificial womb) or in the womb of an animal.
Finally, not everyone thinks reproductive cloning is wrong. Professor Antinori has already selected two hundred couples in order to create the world's first cloned baby. It's important not to forget that the debate we are having is not taking place in a vacuum, ethical or scientific.

From Cuca Martìn Elvira Spain

Puede ser un avance cientifico muy importante pero sin traspasar los lìmites de la ètica ?

Element of translation:
It may be a very important scientific advance but without transferring the limits of Ethics?

Elements of answer:
Thank you very much for your contribution. The European Commission aims to promote debate and pluralistic dialogue in this sector, which must involve all stakeholders and society at large in order to ensure the responsible development and application of stem cell therapy.

From Francisco T. Baciero, Philosophy teacher, Spain

I think the most important thing about this issue is that there is no evidence about the superiority of embryo stem-cells in relation to adult stem-cells. The last studies (see Stephen Hall et al. in "Technology Review", MIT, November 2001) are saying that adult stem-cells are probably much more effective as a source of different human organs than embryo-cells, and, on the other hand, they are being used already in different therapies.It would take at least three or five years to the same with embryo-cells.
Therapeutic cloning should not be allowed, it would be the first step into reproductive cloning. In any case, we all were human embryos nine months before our birth. The question is: Why should we deny the same right to be borne we had to others human embryos already existent or to be "producted"?

In this very sensitive question (which is first of all an ethical issue), not only scientists and doctors and medical industries should (which are economically or scientific interested on the question) have a word about the question, but all members of the society.

Elements of answer:
From José María Villa Valverde, Afecto de Esclerosis Múltiple y autotrasplantado de progenitores hematopoyéticos procedentes de mi medula ósea en el 2001, Spain

Conclusiones personales de mi asistencia a la Conferencia "Sem. Cells: Therapies for the Future:

En primer lugar quiero resaltar la labor de la Organización de éste evento de tan elevado Nivel, Prestigio y Magnitud . Todos los mínimos detalles fueron cuidados al máximo por unos Profesionales que haciendo gala de su "savoir faire" superaron con creces el reunir con éxito a 500 personas de los mas diversas ideologías y posturas representativas de la Europa actual : políticos, científicos, religiosos, médicos, pacientes, medios de comunicación, universitarios etc... a los cuales se nos hizo "encontrarnos a gusto y cómodos" en todo momento y situación . Incluso fuera del recinto fue enriquecedor, dando pie a continuar intercambiando puntos de vista relacionados con la conferencia.

En segundo lugar quiero calificar de "Excelentes" las exposiciones realizadas por los Científicos e Investigadores los cuales y cada cual en su campo coincidieron en una misma Conclusión : La capacidad de unas células, de reparar de un modo casi inteligente un tejido lesionado, o incluso reconstruir a partir de cero un órgano enfermo de un ciudadano cualquiera. Hablamos de Células Madre o Progenitoras en Ingles "Stem Cells". Coincidieron igualmente en sus dos cualidades básicas: Pluripontencialidad y Diferenciación y que ambas son antagónicas es decir que cuanta mas pluripontecialidad posee una célula menor grado de diferenciación tiene y viceversa. La pluripontencialidad es propia de la célula inmadura o primitiva y tiene capacidad de convertirse en diversas células de muy diferentes tejidos (músculo, piel, hueso etc...)La diferenciación es la cualidad por la que una célula adquiere una especialización dentro de un tipo celular concreto y que no le permite cambiar a otro tipo.

Quedó muy claro que es en el embrión donde existen grandes cantidades de células pluripontenciales, cuya función es multiplicarse para ir construyendo los diferentes órganos del individúo. Cuando éstas células se asientan y se van diferenciando con el fin de construir un órgano, pulmón, páncreas, corazón etc.. llega un momento que no proliferan mas y se especializan para ser así el tipo de célula preciso en esa ubicación y con sus funciones propias.Prácticamente todos los tejidos (piel, mucosas, músculos, médula ósea) conservan una cantidad pequeña y variable de células pluriponteciales capaces de multiplicarse y poder así proporcionar células que se diferencien con el fin de renovar y reparar los tejidos dónde residen.
Respecto a la obtención de las Células Madre, (cualquier embrión, placenta, cordón umbilical) contienen una importante cantidad de éstas y de ahí que los últimos trabajos que se llevan a cabo, han visto en los tejidos embrionarios una fuente predilecta por poseer cantidades suficientes. No obstante pueden obtenerse de tejidos del ser humano adulto como por ejemplo, la médula ósea (como fue en mi caso).
Estas células tienen igualmente la capacidad de adaptarse cuando son emplazadas a un tejido distinto del que proceden y además atender las necesidades de regeneración del mismo, dotándolos de células específicas y adecuadas precisas.

Todos los investigadores coincidieron en que este tipo de estudios nos han abierto las puertas del fascinante reto de poder tratar en un futuro muy próximo enfermedades como el Parkinson, Diabetes, Infartos Cardiaco y Cerebral, Traumáticas, Dermatológicas o La gran lista de Enfermedades Degenerativas.

Respecto al debate Ético surgido en ésta conferencia he de confesar que por un momento creí estar en plena Edad Media, viendo como se planteaban cuestiones como ¿en que momento se crea el alma? ¿una pelota de células tiene alma? Etc. Etc- las cuales parecían sonsacadas de otros tiempos y en las que Yo personalmente no entré ni entro, por considerar que los avances científicos orientados a salvar la vida de millones de personas o recuperar su deteriorada salud no pueden verse sometidos por las ideas religiosas, morales o de una u otra índole, que no hacen sino retrasar algo imparable como es la investigación en pro de la humanidad.

Seríamos unos cínicos si pusiéramos "puertas a éste campo " o permitiéramos que un sector se las pusiera.
La libertad de la persona está por encima de todo y en ésta sociedad el respeto ha de ser el móvil de toda actuación. Si hasta ahora no había soluciones, quizá ya estamos en puertas de ofrecerlas en diferentes procedencias, células madre de embriones, medula ósea, cordón umbilical, etc y que cada cual y con sus principios elija el mas adecuado.

Trabajar e Investigar a espaldas a 370 millones de Europeos sería un error histórico, pues de algún modo todos tenemos relación con alguien que padece una grave enfermedad.

Si el curso de las investigaciones allí mencionadas continúan como hasta ahora, todo parece apuntar a que el uso Terapéutico de las Células Madre cambiará la medicina ofreciendo soluciones a problemas de salud hasta ahora incurables y este cambio desde mi humilde punto de vista ya ha empezado y lo ha hecho gracias a ésta Conferencia.

Aprovecho la ocasión para darles las gracias por haberme permitido aportar mi pequeño granito de arena y por todas las atenciones recibidas.

Element of translation:
First of all I would like to thanks the organisation to invite me to this Conference.
I found extraordinary all the interventions, even in the different fields of their scientific experiences, all of them arrived at the same conclusion: The Stem Cells have the capacity to build the new tissue or even a part of a organ.In my opinion, the speakers expressed very well the difference between pluripotential (is the capacity that a cell has to create other types of organ cells) and Differentiation (is the capacity that a cell has to create just a specific kind of organ cell) and is in the embryo where there are a lot of pluripotencial cells.
In general all organs tissues like skin, muscles, marrow etc have a bit quantity of this stem cells.
I don't want to expressed my opinion about the moral debate raised from the floor arguing the moment when the foetus or a quantity of cells need an individual to have a soul, it is to much important for me to save millions of lives using this kind of cells and the new technology.

From Christian Schaaf, Uni Heidelberg

Warum fällt es so schwer, die emotionale Barriere in der Öffentlichkeit zu durchbrechen, die bezüglich der Nutzung embryonaler Stammzellen besteht?Ch. Nüsslein-Volhard hat neulich einen exzellenten Artikel für die F.A.Z. geschrieben - damit erreicht man einen kleinen, intellektuellen Kreis. Wie erreicht man die "breite Masse" - ohne wissenschaftlich ungenau und oberflächlich zu werden?

Element of translation:
Why is it so tedious to break down the emotional barrier in the public related to the use of embryonic stem cells? C. Nüsslein-Volhard has recently written an article for the F.A.Z. (Frankfurter Allgemeine Zeitung - a german newspaper) - with which you reach a small, intellectual group. But how do you reach the broad public - without being scientifically incorrect or superficial?

Elements of answer:
The difficulty has two main origins: First, the definition of a legal status for the embryo is value-laden, and varies from culture to culture; second, such definition is not just science-based.§ Nonetheless, scientists have a role to play in structuring the debate and sorting out the issues. This has led Commissioner Busquin to organise the 18-19 December event. One objective is to spread knowledge into wider circles, but knowledge-sharing goes two-ways between experts and stakeholders. Since the means required to achieve this will be great, the Commissioner is putting forward an Action Plan on science-society. Ch. Nüsslein-Volhard is one of the 11 members of his High Level Group for Life Sciences, guiding this exercise and the 18-19 December Conference.

From Fernando Pérez Garijo, Spain

¿Porqué es posible manipular y matar a un nasciturus y sin embargo no sepuede hacer lo mismo con una persona nacida?.
Inicialmente se me ocurren algunas respuestas.
Aquellos no votan.
Tampoco pueden gritar ni "enternecernos" o "concienciarnos" con su presencia; son apenas unas pocas células dentro de un contenedor, humano o no, y nadie las ve -ojos que no ven, corazón que no siente-.

Su desmembración y muerte no proporcionan imágenes espectaculares que puedan subir índices de ventas o de audiencia, o despertar conciencias embotadas por el egoismo.
No pueden hacer manifestaciones masivas revindicando derechos y por lo tanto no ponen a ningún político en ningún compromiso.
Todas indicarían lo mismo: estamos desembocando en una cultura de la hipocresía donde todo son derechos humanos, pero en la práctica sólo se les reconocen a los que de una u otra forma se pueden defender. ¿Me equivoco?.¿
Los cultos europeos estamos dispuestos a retroceder hasta el nivel de inhumanidad e inmoralidad de la Roma Imperial?; pues ya sabemos cómo siguió la cosa. ¿Debemos reandar lo andado?.

Element of translation:
Why is it possible to manipulate and kill a " nasciturus " but not a human being?
Initially I think about some possible answers:

• Those (nasciturus) do not vote.
  
  
• Those cannot shout, neither provoke tenderness or consciousness with its presence. They are hardly a few cells within a container, human or not. Nobody can see them Eyes that cannot see, heart that cannot feel.
  
  
• Their dismemberment and death do not provide spectacular images that may go up indices of sales or audience or to wake up bring back to consciousness dulled by the egoism.

They cannot make massive demonstrations asking for rights and so do not put to any politician in any commitment.
All of them would indicate the same: we are ending in a culture of the hypocrisy where all are human right, but in practice they are only recognised to the ones that can be defended. Am I mistaken?
Are we, the European cults, ready to back down until we reach the level of inhumanity and immorality of the Roman Empire? Then we already know the consequences. Must we walk again what is already walked?

Elements of answer:
Thanks for this position. It is hoped that many other participants at the conference will be sensitive to these observations and react. A diversity of arguments might be invoked in one way or another. This concern here refers to the status of the embryo, one of the most complex and unsolved issues in national laws.

From Miguel Julian, Spain

Los embriones son seres humanos y destruirlos para obtener celulas madre va en contra del respeto que merece cualquier persona. Pueden utilizarse para la investigación células madre de organismos adultos, con igulaes o mayores garantias y sin ningun problema etico.

Elements of answer:
Despite the promising results obtained recently with adult stem cells there is a need for more basic research to understand how stem cells can be isolated, propagated, differentiated etc. and all possible sources of stem cells (adults, aborted foetuses, umbilical cord blood, early embryos) should be explored.However, this research raises many questions that will be addressed at the conference.The European Commission aims to promote debate and pluralistic dialogue in this sector, which must involve all stakeholders and society at large in order to ensure the responsible development and application of stem cell therapy.

From Íñigo Val Eguren Universidad de La Rioja Spain

Es un deber ético evitar la utilización de embriones humanos para la investigación, sobre todo cuando existen otros métodos más acordes y respetuosos con la dignidad del ser humano. No puede ser que "el poderoso caballero don dinero" prevalezca sobre la vida de miles de inocentes. Creo firmemente en la idea de una Europa abierta, moderna pero sobre todo fiel a su tradición, fiel al ser humano y su dignidad que ha sido y tiene que ser su principal razón de ser. Creo que si De Gasperi, Adenauer, Schumann y compañía regresaran al viejo continente no estarían muy de acuerdo con muchas de las cosas que están sucediendo.

Atentamente. Íñigo Val (Universidad de La Rioja)

Element of translation:
It is an ethical duty to avoid the use of human embryos for research, especially when there are other methods more in agreement with dignity towards human beings. It may not be that "the powerful gentleman Mr. Money" prevails on the life of thousands of innocents. I firmly believe in the idea of an open Europe, modern but above all faithful to its tradition, towards human beings, their dignity and reason for existing. I believe that if Gasperi, Adenauer, Schumann and company would return to the old continent they would not be in agreement with many of the things happening.

Elements of answer:
You would appear to justify in retrospect the European Charter of Fundamental Rights, adopted in 2000. The Charter stipulates, among other things:

Aticle 1 Human dignity
Human dignity is inviolable. It must be respected and protected.

Article 2 Right to life

1. Everyone has the right to life
   
   
2. No one shall be condamned to the death penalty, or executed.

Article 3 Right to the integrity of the person

1. Everyone has the right to respect for his or her physical and mental integrity.
   
   
2. In the field of medicine and biology, the following must be respected in particular:

• the free and informed consent of the person concerned, according to the procedures laid down by law,
  
  
• the prohibition of eugenic practices, in particular those aiming at the selection of persons,
  
  
• the prohibition on making the human body and its parts such as a source of financial gain,
  
  
• the prohibition of the reproductive cloning of human beings.

Article 4 Prohibition of torture and inhuman or degrading treatment or punishment
No one shall be subjected to torture or to inhuman or degrading treatment or punishment.

Article 5 Prohibition of slavery and forced labour

1. No one shall be held in slavery or servitude
   
   
2. No one shall be required to perform forced or compulsory labour.
   
   
3. Trafficking in human beings is prohibited.

The new Framework Programme for research in (2002-2006) draws upon the Charter. In addition, the European research Area launched last year by Commissioner Busquin includes a platform of shared values to unite researchers in Europe on a set of agreed principles and good ethical practice. These very recent measures should reassure you that an ethical dimension is now becoming integral part of the European agenda.
At the same time, researchers would not be satisfied with a research area in which ethical vigilance is exclusively based on raising barriers. There is a dynamic aspect in ethics, which requires dialogue, sharing of experiences and the enlightment of principles as knowledge grows and become more accessible. Establishment of firm principles should not mark the end of dialogue. There should be a willingness to include more points of view as Europe moves towards enlargement and inclusiveness.

From Cuca Martìn Elvira Spain

puede ser un avance cientifico muy importante pero sin traspasar los lìmitesde la ètica ?

Element of translation:
It may be a very important scientific advance but without transferring the limits of Ethics?

Elements of answer:
Thank you very much for your contribution. The European Commission aims to promote debate and pluralistic dialogue in this sector, which must involve all stakeholders and society at large in order to ensure the responsible development and application of stem cell therapy.

From Javier López, University. Law School, Spain

The debate on the stem cells is framed in a dilemma: What is better: to use human beings in project like sources of scientific material, or to respect the integrity of the human life from its conception? But, who guarantees that investigation with stem cels will suppose an advance in the fight against the diseases? This debate is the one that will reveal the hierarchy of values we have: if in order to save a life we destroy another one, the Right to the Life does not comprise of our values.

El debate sobre las células-madre se enmarca en un dilema: ¿Qué es mejor: utilizar a seres humanos en potencia como fuentes de material científico, o respetar la integridad de la vida humana desde su concepción? Pero, ¿quién garantiza que la investigación con células-madre supondrá un avance en la lucha contra las enfermedades? Éste debate es el que revelará la jerarquía de valores que tenemos: si para salvar una vida destruímos otra, el derecho a la vida no forma parte de nuestros valores.

Elements of answer:
From Monty Gatehouse, Basingstoke Branch of PDS, United Kingdom

I believe that research into Stem Cell Therapy should go forward to help alleviate the human suffering caused by these terrible neurological diseases.

I have already scanned the comments on this Web site, and I note the strong anti stem cell research position taken by many of the participants who represent the largely Catholic pro-life lobby.

However I hope that these anti stem cell research pro-lifers have little or no knowledge of the gradual debilitating effects of these diseases that stem cell therapy aims to cure. Nor I hope do they any experience of the distress and very poor quality of life and slow death awaiting those with these diseases.

Unfortunately the pro-life lobby also take an anti euthanasia stance which results human beings suffering the indignity and quality of life that one would not allow to happen to a dog.
If I stick to my original statement, that our goal should be to ALLEVIATE HUMAN SUFFERING and in this context we should also consider the difficult position of the carers, family friends.

So in blunt terms I ask that the pro-life lobby not become the no-(quality of) life lobby. Politially Philosphically our Society should decide to "Kill or Cure!"

Finally I would plead with our Scientific Community not to expend all their energy on this aspect of the debate but struggle to find uses for stem cell therapies and a cure for these diseases. I ask this not for myself but for the younger people with diseases who have not yet experienced and live with quality of life to the full. I note and accept that this Research is way into the future beyond my life span.

I also believe that the complexity sophistication and cost of such therapies requires a European dimension of investment for funding knowledge and skills that our individual nations cannot sustain alone.

I speak with some knowledge being a Parkinsons Disease Sufferer myself living in the UK currently under the care of a German doctor, with friends and fellow sufferers who have sought and received treatment in Sweden and France.

So good luck and my best wishes for a positive and successful outcome(s) to your conference I wish I could be there to engage in your debates

From Ramon Soley, Spain

Mi comentario se refiere a la posibilidad de utilizar células madre de embriones humanos. En este sentido, muestro mi total rechazo al considerar que la ciencia tiene que estar al servicio del hombre y no al revés. Si seguimos en esta senda puede que consigamos hacer santo a Hitler y compañía.

Element of translation:
My observation refers to the possibility of using stem cells from human embryos. I express my total rejection because science has to be to the service of man. If we continue in this path perhaps we arrive to make saint to Hitler and company.

Elements of answer:
This sounds like a reference to eugenics, an issue worth debating in this context. But is there enough research based on social sciences and humanities to draw relationships between cell therapies and the risks associated with eugenic ? The conference of 18-19 December will bring together many specialists from these frontier areas at the junction of "hard" and "soft" sciences.

From Josefina Eugui Hospital Txagorritxu, Spain

I think human life should be protected. Besides, there is a succesfull research on adult stem cells going on

Elements of answer:
Despite the promising results obtained recently with adult stem cells there is a need for more basic research to understand how stem cells can be isolated, propagated, differentiated etc. and all possible sources of stem cells (adults, aborted foetuses, umbilical cord blood, early embryos) should be explored.

From David Ashby (26 years old), Organisation: Life, United Kingdom

In as far as embryonic stem cell research involves the killing of embryos to take the stem cells, it is as evil as abortion. The ends may be good but they do not justify the means.

Scientists can do as much research on anything they like so long as the research does not entail killing anybody in the process. Many people think that the embryo is just a ball of cells, a blob of jelly. It does in fact contain all of the DNA required to make a fully grown adult. I believe that it may well have an immortal soul, that God loves him or her and that he or she may go on to do great things given the chance.

I believe that it is immoral to create a human being simply to destroy them for research purposes. Animal experimentation, I can live with but please, not humans. Thankyou to science for improving our lot, please don't become arrogant. I hope that I have made myself clear and that the outcome will be good. God bless you all.

Elements of answer:
Thank you very much for your contribution. The European Commission aims to promote debate and pluralistic dialogue in this sector, which must involve all stakeholders and society at large in order to ensure the responsible development and application of stem cell therapy.Your point will certainly be debated during the conference.

From Vanessa Palmer, United Kingdom

I and many like me believe that using embryonic stem cells, which destroy a human embryo, is destruction of human life and should not be allowed in the EU, or in the world. Use of adult stem cells has in fact proven successful and I think all monies should be put towards research in use of adult stem cells.

The consideration that a human embryo is a potential human being cannot lightly be dismissed. Everything we want our governments to be doing involves helping people to reach their full potential. We don't say, for example, that because a child does not know anything that we will not send him to school. No, we look at the potential the child has to learn and we do what we can to nurture his potential. We have special programs for the disabled so that they can reach their full potential in life, we have re-training programs for people going back to work. When a baby is born, we do not say, this is a completely helpless being, and therefore we will let it die. No, we nuture it. In the same way the POTENTIALITY of the human embryo is something that rightly should be recognized by our society.
Life, human life especially, should be cared for and nurtured, and it should be respected.

Elements of answer:
Form submitted by: Peter Hoogendoorn, Parkinson Patiënten Vereniging, The Netherland

The original deutch version is in annexe of this document.

Element of translation:
As chairman of the Dutch Parkinson Patients Association, I have been following, in and outside our Parliament, the ongoing discussion on the possible use of Stemcells.

When I look at the varied contributions to this discussion, there is a huge discrepancy between the opinion of the people who are directly concerned (patients, scientists) and let's say the other party, having a totally different outlook on this subject. Even in the ranks of our own association, the discussion continues.

As a spoken person for the association, I have always been and I am still defending the need for a continuing research in this matter because we have not yet find out whether or not a useful therapy might emerge from it as a result.

For the time being it is still a matter of experimenting and tracing the right stemcells to be put to our use. In the case of Parkinson's disease that would be to produce dopamine in the Substantia Nigra. Should this be succesful, it would drastically improve the quality of life of a hundredthousand people suffering from this illness.

It goes without saying that it is preferable to use but those particular stemcells that are of an adult nature or can be produced from the blood of the umbilical cord. Although these are, to my knowledge, rather hard to find.

If the remaining embryos of IVF are to be destroyed, why not check first if the research doesn't reveal any positive or productive possibilities ? Maybe there aren't any at all and then we would have been fighting over nothing.

From Carsten Riegart, Familienbund der Katholiken

Summary of position paper of the "Family association of catholics" ("Familienbund der Katholiken"), the whole text is in annexes.

• Biotechnology and genetic engineering is a key technology that will have fundamental consequences for society.
  
  
• The principle of the protection of human life in all stages must be the basis of all regulations
  
  
• The "family association of catholics" rejects therapeutic cloning.
  
  
• Instead of research on embryonic stem cells, research on adult stem cells and stem cells from umbilical blood cord should be intensified.
  
  
• The association calls upon responsible persons in politics, industry and society to reject the ideals of "perfect human being".

Elements of answer:
We are happy to welcome to this European Commission web-site the detailed position spelled out by the German association of families belonging to the catholic communities. We would like to receive from other interest groups concerned with science or in the applications of science, throughout Europe, their views on the potential of stem cells for research and therapy. For this debate to be as balanced and complete as possible, we need the whole diversity of points of view to be represented.
Thanks to all them, including Familienbund der Katholiken, who let us benefit from their experience and conclusions. For those of us having feeling responsibility for dialogue between science and society, the debate can never be concluded. It will move and evolve continously as new knowledge is revealed and new standards are established for our ways of living, eating, and curing ourselves.
Associations defending citizens' interests have been actively involved on several occasions:
Discussion Platform with Commissioner Busquin, on Genetics and the Future of Europe, 6-7 November 2000.
Hearings by the European Parliament in the framework of their Human Genetics report, Brussels, 9 and 10 July 2001.
Stakeholders Conference on the Strategic Vision for Life Sciences and Biotechnology in Europe, Brussels 27-28 September 2001.
Discussion Platform on Stem Cells - Therapies for the Future, by invitation from Commissioner Busquin, Brussels 18-19 December 2001.
The role of these associations, as part of a wider circle of stakeholders, will become more visible as principles of modern governance (Commission White Paper on the European Governance, 25 July 2001) come into force through more transparent and accountable procedures for the provision of scientific advice or the support to policy decisions.

The entire position paper of Carsten Riegart

From Pilar Calva, Organisation: Asociación Panamericana de Bioética, Outside EC
The whole text is in annexes.

El uso de las células estaminales embrionarias

Autor: Academia Pontificia para la Vida

Resumé : the complete text is available on our web site www…

Este documento tiene la finalidad de ofrecer una aportación al debate que se está desarrollando y extendiendo, tanto en la literatura científica y ética como en la opinión pública, sobre la producción y utilización de las células estaminales embrionales. En efecto, ante el creciente relieve que va tomando el debate sobre sus límites y licitud. Es necesaria una reflexión que ponga de manifiesto las implicaciones éticas.

En la primera parte se expondrán muy brevemente los datos más recientes aportados por la ciencia sobre las células estaminales y de la biotecnología por lo que se refiere a su producción y uso. En la segunda, se llamará la atención sobre los problemas éticos más destacados que estos nuevos descubrimientos y aplicaciones suscitan.

Element of translation:
This document has the purpose to contribute to the current debate on the production and use of the embryonic stem cells, which is being developed in scientific and ethical literature as in public opinion. Indeed, in view of the increasing degree of the debate that is dealing with limits and legality. A reflection on ethical implications is necessary.

The most recent scientific data on stem cells and biotechnology with regard to its production and use are briefly presented. In the second, it is important to draw attention to the ethical implications of these new discoveries and applications.

Elements of answer:
Thank you very much for your contribution. The European Commission aims to promote debate and pluralistic dialogue in this sector, which must involve all stakeholders and society at large in order to ensure the responsible development and application of stem cell therapy.
This is precisely the objective of this conference.

The entire position paper of Pilar Calva

From Pierre Goube de Laforest , Organisation: CERPH, France

Main topics of the text submitted by P. Goube de Laforest, the whole text is in annexes.

A PROPOS DES CELLULES SOUCHES EMBRYONNAIRES HUMAINES

1. L'utilisation d'embryons humains à des fins de recherche n'a d'autre raison d'être que la reconnaissance implicite de leur qualité biologique d'êtres humains.
   
   
2. L'utilisation d'embryons humains à des fins de recherche implique donc l'existence d'êtres humain inférieurs en dignité.

Elements of answer:
Thank you very much for your contribution. The European Commission aims to promote debate and pluralistic dialogue in this sector, which must involve all stakeholders and society at large in order to ensure the responsible development and application of stem cell therapy.
This is precisely the objective of this conference.
The European Group of Ethics also gives is opinion in the report n°12 "Ethical aspects of research involving the use of human embryo in the context of the 5th framework programme" and n°15 "Ethical aspects of human stem cell research and use" that you can find on internet: http://ec.europa.eu/european_group_ethics/avis_old_en.htm

The entire position paper of Pierre Goube de Laforest

From Ignacio Monreal, Spain

Se debe respetar la vida del que luego será una persona como usted y como yo.
Hay alternativas para la terapia, como el uso de células madre obtenidas de sangre periférica o de cordón. Aquí hay que ahondar.

Elements of answer:
Thank you very much for your contribution. The European Commission aims to promote debate and pluralistic dialogue in this sector, which must involve all stakeholders and society at large in order to ensure the responsible development and application of stem cell therapy.

From Manuel Cruz, Fundación Vida, Spain

Los marcadores que distinguen las celulas madre en la médula ósea necesarios para poder separarlas y trabajar con ellas en su multiplicación y diferenciación son el cuello de botella para que las de los embriones no sean necesarias y quede a salvo la dignidad del ser humano en su estado embrionario. ¿Vamos a aumentar el presupuesto para terminar esta investigación o vamos a ser complices de una aberración más?

Elements of answer:
Thank you very much for your contribution. The European Commission aims to promote debate and pluralistic dialogue in this sector, which must involve all stakeholders and society at large in order to ensure the responsible development and application of stem cell therapy.

From Alex Arino, Spain

From my point of view this one of the advances in the medicine field, it can help to cure many of the cronical diseases that affect our parents, sons, mates, neighbours... I'm afraid about those people who are scared about these possible improvements, our scientist development is growing much faster than our social one, I want to encourage all the doctors and scientists that are working hard and I want to ask them a question ¿when can we start seeing all the positive effects of this technology? I know that there is a difficult question but I am worried about those who are trying to stop this advance; I am sure once we can show them the good results of the research they will stop moaning. Thank you very much.

Elements of answer:
For Europeans, the principle of freedom of research is to be respected. It is prominently referred to in of the European Charter of Fundamental Rights (article 13).
With applications growing in number and diversity, the responsible behaviour of researchers and practitioners is essential. And that of legislators is critical to guide scientific progress for the benefit of citizens now and in generations to come. Hence the value of debates, like this one of 18-19 December, which allow scientists and society to broaden their views and adjust their interests in a consensual way.

From Rut Cazorla, Youth for life, Spain

The whole text is in annexes.

My prolife group opposes all forms of human cloning. In particular therapeutic cloning, which involves the destruction of the human embryo, is opposed for the following reasons;

You can find the reasons on the web (or at this end of this document … ?)

Elements of answer:
Thank you very much for your contribution. The European Commission aims to promote debate and pluralistic dialogue in this sector, which must involve all stakeholders and society at large in order to ensure the responsible development and application of stem cell therapy.

The entire position paper of Rut Cazorla

From Dunkelberg Hartmut, Abt. Hygiene and Environm. Medicine, Germany

The central question in the discussion on the research with embryonic stem cells is the necissity to protect the human embryo. The decision has to be made between two competitive health objectives:

the necissity to protect the human embryo, on the one hand, and the gaining of scientific knowledge with a therapeutic option, on the other hand. In this connection it has to be observed that not only the integrity of embryonic life is affected and endangered but also the improved state of patients' health through medical action must be justifiable with regard to the methods used.

Therapeutic procedures always have to be evaluated also under the ethical aspect. The question "At what cost and offering is therapeutic succes achieved" can basically be answered at least in the following ways:

- It is a service which is based on a contract (e.g. insurance benefit)

- It is a donation or a free supportive service (e.g. donation of blood,
organs, first aid)

- It is an unacceptable and irrespondsible appropriation (e.g. forced or
involuntary removal of organs)

If the use of embryonic stem cells is permitted, many physicians and a great part of mankind will probably not be able to give their consent an will reject this procedure as an unacceptable appropriation to the detriment of the life of others. The trust in an intact health system on a highly ethical level is therefore shaken. Well-being and health will then be generally impaired.

Elements of answer:
Thank you very much for your contribution. The European Commission aims to promote debate and pluralistic dialogue in this sector, which must involve all stakeholders and society at large in order to ensure the responsible development and application of stem cell therapy.

From Crespillo Antonio, FOMENTO COLLEGE, Spain

NO HAY DERECHO AL USO DE EMBRIONES HUMANOS CUANDO NO HAY NINGÚN PROBLEMA PARA EL USO DE CÉLULAS ADULTAS. usar embriones humanos es matar, es un homicidio, nos cargamos los derechos de los no nacidos, seguimos siendo la única especie sobre la tierra que realiza la autodestruccción. HITLER HIZO LO MISMO CON LOS JUDÍOS: en vez de embriones, usó adultos.

Elements of answer:
Thank you very much for your contribution. The European Commission aims to promote debate and pluralistic dialogue in this sector, which must involve all stakeholders and society at large in order to ensure the responsible development and application of stem cell therapy.

From Rosa María Arin-Lakidain, University of the Basque Country, Spain

Soy médico y profesora de Fisiología en la Universidad del País Vasco.
Quisiera hacer llegar a todas las personas en cuya mano está el futuro de la investigación en Europa mi firme convencimiento de que un verdadero avance en el campo de la Ciencia, sólo puede ser considerado como tal cuando nos acerca cada vez más a una vida más digna a todos y cada uno de los que formamos parte de la sociedad; nunca será un avance lo que conlleve favorecer a unos en prejuicio de otros. En el caso de admitirse como válida la investigación con células madre de embriones,daríamos por bueno el dominio de unos seres humanos sobre otros permitiendo acabar con la vida de los más débiles e indefensos en beneficio de los más poderosos ya que ello conllevaría la muerte de embriones,seres humanos usados como fuente de material de laboratorio. Pienso que deben dedicarse todos los recursos y esfuerzos posibles a investigar con células madre de adultos, aunque ello suponga mayor esfuerzo, menores éxitos a corto, que no a largo,plazo (suponiendo que pueda llamarse éxito matar a unos en beneficio de otros)y la oposición de algunos. Dentro de unos años se habrán conseguido no pocosavances y habremos evitado abrir el camino a experimentos con seres humanos que pueden convertirse (lo digo conscientemente y sin ánimo de exagerar) en auténticas carnicerías y en una total falta de respeto y sensibilidad hacia el valor de cada vida humana. Si trabajamos con células madre de adultos,estoy absolutamente convencida,trabajaremos por un mundo más justo para todos y los europeos del futuro nos lo agradecerán.

Elements of answer:
Thank you very much for your contribution. The European Commission aims to promote debate and pluralistic dialogue in this sector, which must involve all stakeholders and society at large in order to ensure the responsible development and application of stem cell therapy.

From Dra. María Dolores Vila-Coro, Directora de la Cátedra de Bioética y Biojurídica de UNESCO, Spain

Creo que se debe fomentar la investigación la investigación en células madre a partir de células somáticas-nunca de embriones. La destrucción de embriones va en contra del derecho a la vida de todo ser humano. Ya que el cigoto inicia su desarrollo continuando hasta alcanzar su plenitud como persona sin que haya ningún cambio cualitativo que justifique la denominación de preembrión.

Se deben crear bancos para guardar las células del cordón umbilical con objeto de que estén disponibles para investigación.

Elements of answer:
Thank you very much for your contribution. The European Commission aims to promote debate and pluralistic dialogue in this sector, which must involve all stakeholders and society at large in order to ensure the responsible development and application of stem cell therapy.

From Javier Martín, Spain

Espero que a la hora decidir sobre esta ley piensen en el mundo en el que estamos y el mundo que quieren crear, y piensen en la Vida, con mayúsculas, en el amplio sentido de la palabra. Queda mucho por hacer en muchos campos, Educación, sanidad, hambre como para desaprovechar el dinero de todos en investigaciones que sabemos son perjudiciales para el Hombre...con Mayúsculas. Soy de los que creen que la VIDA empieza en el momento sagrado de la gestación en el útero de la Madre, no puede ser de otra manera. Muchas gracias.

From Spain

No estoy de acuerdo con la manipulación de embriones humanos. Pienso que hay que respetarlos.

From Ignacio Arsuaga, Phoenix Institute, Spain

We oppose use of cloning to produce human embryos, whether for live birth or for experimentation that will harm or destroy them.

The entire position paper of Ignacio Arsuaga

From Josef Wisser , Dept. Obstetrics, University of Zurich, Outside EC

The original text in German is in the Annexes of this document.

Elements of translation:
Before a society takes a decision on research on embryos and with embryonic stem cells, there needs to be clarity on the moral status of embryos. The arguments that have been put forward in the last decades on this question have received different weightings at different times. In the discussion on abortion it was the beginning of brain activity or the capability of surviving outside the uterus and now it is the implantation as the distinct incision point brought forward to define at what point embryonic life should be protected. Scientists motivate this incision point through the communication that starts between the embryo and the pregnant women, not taking into account the biochemical communication that makes the nidation possible. On the other hand, one speaks of a completion of the development process through the process of nidation, not being able to identify the specific differences of the development before and after the nidation.
The discussion in the last decades on the point in time where human life is worthy to be protected has shown that we have arbitrarily tried to define a borderline, depending on the social or science policy environment, in order to allow science the freedom to act. Science may not be misused to provide arguments for such arbitrary borderlines. Shouldn't we apply the principle of in dubio pro reo also to the earliest stages of human development.

The discussions on research with embryonic stem cells has been very emotional in the EU and in particular in the German speaking countries and in a way that the public was not able to understand the merits of embryonic stem cells in comparison with adult stem cells demonstrated in animal experiments. In the meantime, the number of scientific publications is increasing that report on production of stem cells from foetal or postnatal tissue. A selection of recent publications is the following:

• Orlic D. et al. Bone marrow cells regenerate infarcted myocardium.
  Nature 2001; 410:701-705
  
  
• Krause DS. et al. Multi-organ, multi-lineage engraftment by a single bone marrow-derived stem cell. Cell 2001;105:369-377
  
  
• Reyes M. et al. Purification and ex vivo expansion of postnatal human marrow mesodermal progenator cells. Blood 2001;98:2615-2625

I would like to ask the experts to discuss the clinical significance of this research and based on the outcome, to demonstrate the advantages of embryonic stem cells.

From Prof. Dr. med. Schmid-Tannwald Ingolf, Ärzte für das Leben, Germany

gegen den Import von und die Forschung an embryonalen Stammzellen

The entire position paper of Prof. Dr. med. Schmid-Tannwald Ingolf

From: No Name

Creo que la utilización de celulas embrionarias para la investigación "científica" supone un paso atrás para el progreso de la humanidad. Supone la utilización del más débil para lograr unos objetivos que pueden serlogrados por otras vías. Supone un insulto a la inteligencia humana y por tanto a la razón.

From Alberto Tarifa, Spain

Mi opinión es la siguiente:

• Es inaceptable manipular embriones con fines distintos de su propio bien, pues desde la concepción existe un ser humano, cuya vida se ha de proteger. Esta me parece la base de nuestra civilización de libertad y verdad.
  
  
• Es innecesario acudir a las células procedentes de embriones, cuando las células madre adultas y las que proceden de cordones umbilicales pueden servir para nuestras investigaciones y tienen muchas ventajas (identidad donante-beneficiario, por ejemplo).
  
  
• Es vergonzoso que se presente la investigación con células madre (o la clonación) como la panacea para curar muchas enfermedades y a muchas personas, cuando eso científicamente no es más que un deseo, muy alejado de la mera posibilidad, y cuando lo sofisticsdo de las técnicas hace impensable que puedan aplicarse generalizadamente
  
  
• Es necesario denunciar la campaña de márketing e ideológica que hay detrás de la presión para investigar con células madre, que persiguen en realidad dinero, deshumanizar el embrión (para hacer definitivamente aceptable el aborto) y poder (la sensación prometéica de manipular la vida).

Conclusión:

1. Deberíamos prohibir absolutamente la investigación con células madre embrionarias que haga inviable el desarrollo del embrión.
   
   
2. Deberíamos fomentar la investigación con células madre adultas o que procedande técnicas que no provoquen la destrucción de una vida.
   
   
3. Deberíamos obligar a los científicos y a las empresas de biotecnologíaa ser resposables al informar sobre sus investigaciones, y no "vender humo" para conseguir financiación y/o notoriedad.

Elements of answer:
Thank you very much for your contribution. The European Commission aims to promote debate and pluralistic dialogue in this sector, which must involve all stakeholders and society at large in order to ensure the responsible development and application of stem cell therapy.

From Naomi Young, United Kingdom

It is incorrect to say that scientists can best further their medical research by using embryonic stem cells. There is increasing and significant evidence from trials to show that the use of adult stem cells are an adequate alternative. Even Professor Donaldson, who issued a report last year which argued in favour of extending embryo research, has admitted that the promise of adult stem cells for treatment of diseases and other disabilities could equal or surpass that of embryonic stem cells. In addition it has been found that the development of adult stem cells has been easier to direct and control when attempting to produce various kinds of human tissue.
The use of adult stem cells would avoid the cannibalisation of human embryos which is morally unacceptable to asignificant proportion of the population. It is unreasonable to expect profit-making organisations to regulate themselves, as the recent scandal of the price of AIDS drugs makes clear. Pharmaceutical companies already have enormous vested interests in human experimentation. The only answer given to the question Why do scientists prefer embryonic stem cells? in the UK government briefing produced by the Wellcome Trust in December 2000 is that it is cheaper and more convenient. This is not an acceptable argument. I hope that the EU and the member states will take strong action to ensure that biotechnology is put at the service of human life and not human life at the service of biotechnology.

Elements of answer:
The European Commission, invited by the European Summit in Stockholm this spring, will put forward a communication to Council and Parliament spelling out policy options to support a strategic vision for Life Sciences and biotechnology up to the year 2010. In conformity with the consultation document of 4 September 2001, and echoing interests debated on 27-28 September at the Stakeholders Conference in Brussels, European biotechnology will focus on growth and prosperity, keeping citizens interests at the centre of the policy agenda. Although no research is currently funded on embryonic stem cells with the support of the Quality of Life Programme, it would only be fair to say that research pursued in Europe with embryonic stem cells does not primarily obey economic requirements. Despite the promising results obtained recently with adult stem cells there is a need for more basic research to understand how stem cells can be isolated, propagated, differentiated etc. and all possible sources of stem cells (adults, aborted foetuses, umbilical cord blood, early embryos) should be explored.

From André La Prairie, Government of Canada, Dept of Health

What should the role (if any) of governments be in the overseeing research involving stem cells?

Elements of answer:

• In Europe, scientific research is free (charter of the fundamental rights of the European Union http://europa.eu/charter/)
  
  
• But governments must place boundaries where e.g. human dignity is threatened
  
  
• Under the perspective of modern governance, governments must also assist researchers in the establishment of good ethical practices, comprising review by ethical committees, ethical surveillance by funding organisations, etc.

The European Group of Ethics (http://ec.europa.eu/european_group_ethics/index_en.htm) invites governments to establish a "central authority" to clear research employing human embryos.

From Christian Schaaf, Uni Heidelberg

Warum sollte die DFG mit ihrer Entscheidung über den Import embryonaler Stammzellen noch über Dezember hinaus warten?
Akzeptieren involvierte Wissenschaftler den Wunsch des Dt. Bundestages?

Element of translation:
Why should the DFG wait until after December for a decision to be taken on the import of embryonic stem cells? Do involved scientists accept the wish of the German Bundestag (to postpone the decision)?

Elements of answer:
Thank you very much for your contribution. This question specifically concerns a national regulator, which may eventually be addressed at the conference.

From Miguel Palomero, Spain

Mi opinión sobre el uso de celulas madre es a favor siempre que se respete al Hombre como humano en sí y desde un punto de vista deontológico. La investigación con células madre, tanto de embriones humanos, como de tejodos adultos, estoy también a favor. Otra cosa es que se pase de la mera investigación a la aplicación en los Hombres, para ello creo que tienen que estar (y cuanto antes) regulados y tipificados todos los supuestos posibles para que no haya posibilidad de intervención o/y abuso por los los de estas técnicas por los gobiernos, empresas, laboratorios...

Element of translation:
I am in favour of the use of stem cells provided, Man is respected as human, and from a deontological point of view. It includes research with stem cells from adult organisms and human embryos also. However, when it passes from mere research to the implementation. I believe that all the possible assumptions have to be regulated and typified as soon as possible so that there is no possibility of abuse of these techniques by the governments, companies, laboratories...

Elements of answer:
From Dr Robert A. Brown, Director of research, Tissue Repair & Engineering Centre, University College London, United Kingdom

I participated in the 2 day debate on the futures for stem cell research and therapies. It was a broad and excellent discussion, representing a welcome example of democratic scrutiny of a controversial issue. I am director of a major research centre specialising in research into cell control for therapeutic cell and tissue engineering (participating in 2 EU consortia).

1. The discussion about adult versus embryonic (and other) derived 'stem' or progenitor cells is indeed in its early stages and quite unresolved. Indeed we are at the stage where formulation of questions is more important than concluding and excluding. The intention below is to try to provide a useful-clarifying framework based on rational chronology.
   
   
2. I have a recurrent point which I feel is most important that we refine and direct a number of the sections of this discussion. This is relevant to the staging/timing of scientific research, development and clinical application. There is an understandable tendency (particularly outside the scientific community) to mix and compress these or to confuse their limits. [This can be fuelled by scientists who themselves fudge and exaggerate the stage we are at, - under pressure for funding]. My recommendation (1) for future discussion, then is to focus on one defined segment or stage at a time. Complete segregation of stages is neither possible nor desirable but a clear concept of the different needs, threats, strengths and opportunities at each stage is essential if the discussion is to make FURTHER progress.
   
   
3. This point of distinguishing temporal stages of (a) basic research (b) applied research, (c) development & commercialisation, (d) clinical application is perhaps most critical in the area of regulating stem cell research. I assume the central concept of minimum necessary regulation and for this it is clearly most important to control the later applied stages (e) and (d). Equally it is clear that more basic the research [(a) and (b)] more importantly its direction is neither pre-determined nor censored. This is axiomatic since the best research innovation is not predictable.Clearly its techniques and source materials must fall within what is accepted by the society of the day but this is absolutely not the same as predicting, pre-supposing or making value judgements on its possible outcomes. The dynamic entrepreneurial, mercurial nature of research innovation means that such regulation will either kill it or move its best talents elsewhere. Hence 'Regulation' needs to (i) define its limits, (ii) demonstrate that it is the minimum necessary ('harmonised' is not the same as minimised) (iii) operate at the point in the process where it is appropriate [(iii) refers back to point (2) and offers a framework for rational progress].
   
   
4. (Positive observation) - taking an overview of the debate I was persuaded that (perhaps to our surprise) we should consider that our situation in the EU may be ideal for this issue. We have a diversity ofapproach (on embryonic stem cell research) from outright banning in some states to regulated/enabling in others. This has stimulated familiar efforts to harmonise our approach across Europe (with the difficulties highlighted in the debate). However, perhaps we should reconsider the nature of the problem we are tackling - it too is diverse with highly uncertain outcomes. Could it be that we should make a VIRTUE of state-level diversity in this instance since 'selection' of a simple single approach (i.e. harmonised) would be the most dangerous option. Rather, consider that a diverse approach will allow us to facilitate say, adult stem cell research by one group of states and embryonic in others, depending on their national strengths, leanings and moral alignments. Surely, this will generate a healthy tension across the Union, fostering competition. When we know more we can draw on both expertise and (most likely) synthesis ideal solutions AHEAD of our competitors by virtue of our diversity of approach.

I would suggest that the Commission in this case enjoy the good fortune of its position and resolve to foster the present situation of 'facilitative diversity'.

We have a diversity of more research is needed to confirm this point and most of the scientists working in the field consider that today there is a need for more basic research to understand how stem cells can be isolated, propagated, differentiated etc. and all possible sources of stem cells (adults, aborted foetuses, umbilical cord blood, early embryos) should be explored.

Indeed, therapeutic cloning is excluded from Community research (see European Group of Ethics's opinion, and the ethical provisions of the Framework programme of RTD for the EU 1998-2002)

Yes, this is the reason why the Life Sciences High Level Group invited this debate, to the benefit of responsible policy-making on EU level.

From Marios Tannousis, Cyprus Parkinson's Disease Association, Cyprus

First I would like to congratulate you, personally on behalf of the Cyprus Parkinson's Disease Association, on the vital debate on 'Stem Cells: therapies for the future?' which I attended, after your kind invite. From the debate I learned more about stem cells and I realised that the potential for treating degenerative diseases such as, 'Parkinson', 'Alzheimer', 'Multiple sclerosis', as well as many other diseases is really feasible and must not be delayed.

It seems that more than 300 Million patients' worldwide will have the opportunity to be cured. Therefore I strongly believe that research on stem cells must continue. Conflicting parties will always be present, but when the benefits are immense, I do not see the reason of delaying a law to be passed to make stem cell research legal and permissible.

It is my opinion that the E.C. Commission must:

1. Launch a campaign in every E.U. Member State and prospective Countries for accession to explain and make the people aware of the prospective benefits of stem cell research.
   
   
2. Assist all Countries to set up a National Ethics Committee, which will be a watchdog for all research done on stem cells. This Committee should include members from all levels of society.
   
   
3. Each Country must set up a stem cell line register and bank, which will be centralised and under the umbrella of a European Central Stem Cell Line Register and Bank.
   
   
4. In any debate there are always the pros and cons but we should always look at what is good for society.

We at Cyprus Parkinson's Disease Association are firm believers in research, and we would like to see stem cell research continued and we are confident that through research we will ease the pain of millions of our fellow citizens that suffer from degenerative diseases.

From Luis Laredo, HazteOir.org, Spain

Main topics of the text submitted by L. Laredo, the whole text is in annexes.

Una campaña agresiva
Clonación terapéutica: un procedimiento elitista
Origen de los más de 30.000 embriones congelados
Beneficiarios de la investigación a costa de los embriones congelados
La alternativa a la destrucción de embriones humanos
Los derechos del embrión
Ética y ciencia vs. dinero y política

Element of translation:
An aggressive campaign
Therapeutic cloning: an elitist procedure
Origin of over 30.000 frozen embryos
Beneficiaries of research at the cost of frozen embryos
The alternative to the destruction of human embryos
The rights of embryo
Ethics and science Vs money and policy

Elements of answer:
It is with great interest that we receive this position, under.First, we have to note the crucial role played by IVF, and the fact that this is regulated by national laws.
The abundance of spare embryos from IVF reflects the state of the art in assisted procreation, and the standards, recognised by national laws, which permit parents with fertility problems to bring to birth a wanted baby safely for mother and child. These standards vary from country to country. Hence the resulting problem of excess embryos. Decisions made on IVF are coming into focus, not that much on stem cell research.The fear expressed in this message, according to which therapeutic cloning might become an elitist intervention for the benefit of highly selected patients with compatibility criteria, needs some qualification :

1. It must be remembered that neither the European Group of Ethics (whose opinion considers therapeutic cloning as "premature") nor the European Commission (whose research programme excludes therapeutic cloning) have ever suggested that therapeutic cloning might be developed under the present state of the art.
   
   
2. It is hard to follow the reasoning on elitist methods. First, because so much stem cell research remains at a very basic level it would be hard to foresee the range of its long term applications and spin-offs (hence the meeting held on 18-19 December in Brussels); second, because one can easily see a parallel between the provision of typed cell lines for specific tissue repair and the provision of organs for transplantation. Clinicians will draw lessons from current transplantation practices. Studies are required in this area as well. The conference will probably reveal more of these issues.

The entire position paper of Luis Laredo

From Alessandro Perillo, Catholic University of Rome-Dep. Ob/Gyn, Italy

As far as I know, there is no specific course in the european faculties of medicine on the issue of stem cells.
I think that such relevant scientific, ethical and regulatory aspects should be more in-depth discussed during the universitary course of studies for medical doctors.
My suggestion is that medical students, clinicians and surgeons should be more involved in the recent advances with stem cells, for the potential therapeutic applications.

For example, the following areas of study could be defined in the ob/gyn field:

• stem cells in high-dose chemotherapy treatments for gynecological tumors and breast cancer- umbilical cord blood as source of stem cells
  
  
• stem cells for prenatal transplantation and in-utero gene-therapy
  
  
• fetal stem cells in maternal blood circulation for prenatal diagnosis

From Christian Schaaf, Uni Heidelberg

Warum fällt es so schwer, die emotionale Barriere in der Öffentlichkeit zu durchbrechen, die bezüglich der Nutzung embryonaler Stammzellen besteht?
Ch. Nüsslein-Volhard hat neulich einen exzellenten Artikel für die F.A.Z. geschrieben - damit erreicht man einen kleinen, intellektuellen Kreis. Wie erreicht man die "breite Masse" - ohne wissenschaftlich ungenau und oberflächlich zu werden?

Element of translation:
Why is it so tedious to break down the emotional barrier in the public related to the use of embryonic stem cells? C. Nüsslein-Volhard has recently written an article for the F.A.Z. (Frankfurter Allgemeine Zeitung - a german newspaper) - with which you reach a small, intellectual group. But how do you reach the broad public - without being scientifically incorrect or superficial?

Elements of answer:

• The difficulty has two main origins: First, the definition of a legal status for the embryo is value-laden, and varies from culture to culture; second, such definition is not just science-based.

Nonetheless, scientists have a role to play in structuring the debate and sorting out the issues. This has led Commissioner Busquin to organise the 18-19 December event. One objective is to spread knowledge into wider circles, but knowledge-sharing goes two-ways between experts and stakeholders. Since the means required to achieve this will be great, the Commissioner is putting forward an Action Plan on science-society. Ch. Nüsslein-Volhard is one of the 11 members of his High Level Group for Life Sciences, guiding this exercise and the 18-19 December Conference.

Raik-Hiio Mikelsaar, Professor of pathology, Head of department, University of Tartu, Estonia

It was a very nice and useful conference "Stem cells: therapies for the future?" in Brussels on December 18-19, 2001. Our Estonian (Tartu University) group was the only one from Baltic countries: Raik-Hiio Mikelsaar - professor of pathology; Aivar Ehrenberg - head of obstetrics department; Kadri Simm - Ph D Student of ethics; Maria Malva and Liina Raskasov - medical students. We thank the conference organizers for invitation, registration and giving a grant to 3 from us.
We are convinced that stem cells investigations and their therapeutic use are the future of medicine. We think that a regenerative medicine is a suitable trend also for Baltic countries. The best perspective seems to have the stem cells from umbilical cord blood, which I call shortly "umbal blood" (UB): "umbo"="umbilicus". It would be reasonable to initiate here in Estonia a umbal program (project) (UP), using the UB for biological insurance, scientific investigations, medical diagnostics and therapy. The general purpose is to maximally effectively utilize this valuable biological material.
To realize the UP we need a suitable institution - may be "Esto-Cell". The first thing is to found a special Cryo-bank for UB and immunological, biochemical and haematological testing system and organize a social network for UB collecting. Unfortunately we have no experience in this field. So I ask you, especially the leaders of projects Eurocord and Netcord - professor Peter Wernet, Eliane Gluckman and Manuel Nicolas Fernándes Rodrigues - to help us. In turn we offer a collaboration. In Estonia there is about 13000 childbirths in year. Due the quickly developing internet and other good communications, we can in case of optimal Euro-help to collect during 1-2 years approximately the same number of UB samples or even more as is now in Düsseldorf's bank and interchange them with neighboring countries. This bank would contain sections for autologous, heterologous and mixed UB.
Estonian university-town Tartu is localized in a good geographical position. Thus the Cryo-bank of "Esto-Cell" may serve as a regional center for surrounding countries. In this case it is a joined "Balto-Cell", which will coordinate the activity of "Lat-Cell", "Lit-Cell", "Rus-Cell" and why not also "Fin-Cell" and "Schwed-Cell" (to be founded). Perhaps the general European UB and UP institution made on the base of projects Eurocord and Netcord should be called "Euro-Cell". As you remember, European Commission stem cell research 13-14 September 2001 meeting report (p. 4) concluded: "Europe needs to establish public stem cell banks in order to ensure standardization, quality and safety as well as easy and affordable access to the different cell lines".
An operative founding of effectively working Cryo-banks, would facilitate not only the medical therapeutics and diagnostics but also the fundamental cell stem research in the field of UB and UP, which should be included as thematic priority "Genomic and biotechnology for health" into the 6th Framework Programme 2002-2006 of the European Community for research and technological development (see the above-mentioned13-14 September meeting report p.13). A suitable basis for UP investigations is a new Biomedicum of Tartu University, which has been built in 1999 and is provided by modernist research equipment. Here already some scientific work on (mainly neuronal) stem cells is carried out. About 150 years ago Tartu University has been a central high school in Eastern Europe, where among other famous scientists Karl Ernst von Baer, a discoverer of mammalian egg cell and Alexander Schmidt, a constructor of blood coagulation theory, were working. It would be symbolically nice to create the "Balto-Cell" on the living and working place of discoverer of the most important stem cell - Human Egg. I invite you to participate in Tartu University 370/200 Jubilee celebrations. The festive meeting will be on May 3, 2002. On April 25-26 a Jubilee Meeting "Medicine, Ethics and Society" will be organized. Additional poster and oral presentations should be included into the program if they will be sent during a next week. On April 27 a teatralized open-air documental-performance "Tartu University 370/200" and on April 28 a football match "Medicine contra Society" will be organized. During the Jubilee-days we can discuss the problems of UB and UP. To get more information and a second circular of the conference you should write on address:

Conference secretariat:
Department of Public Health
University of Tartu
Ravila 19, 50411 Tartu, Estonia
Phone +372 7 374190; Fax +372 7 374 192
e-mail: conference.dph@ut.ee

Stellungnahme des Familienbundes: Chancen und Grenzen der Biotechnologie zwischen Machbarkeit ... Die Bio- und Gentechnologie hat sich in den letzten Jahren nicht nur wegen der sich abzeichnenden Fortschritte in der Medizin, sondern auch aufgrund ihrer wirtschaftlichen Erwartungen zu einer entscheidenden Schlüsseltechnologie entwickelt, die für unser Leben fundamentale Folgen nach sich ziehen wird. Mit der Aussicht auf Erfolg versprechende Diagnoseverfahren zur Früherkennung von Krankheiten, auf Therapierbarkeit von Krankheiten, die bislang unheilbar erschienen sowie mit den Möglichkeiten der weitreichenden vorgeburtlichen Diagnostik und der modernen Fortpflanzungsmedizin verbinden viele Menschen hoffnungsvolle Perspektiven. Gleichzeitig lösen diese zahlreichen Möglichkeiten auch Verunsicherung und Ängste aus, wenn mit der Biotechnologie Vorstellungen einer generellen Vermeidung von Krankheit und Behinderung verknüpft sind oder Versicherungen und Arbeitgeber künftig Kenntnisse über Ergebnisse aus gentechnischen Tests von Arbeitnehmern oder Versicherungsnehmern erlangen könnten. Die technische Machbarkeit in der Bio- und Gentechnologie darf nicht zwangsläufig dazu führen, diese auch ethisch und rechtlich zuzulassen. Der Familienbund der Katholiken orientiert sich an dem christlichen Menschenbild und fordert daher von Verantwortlichen in Politik, Wirtschaft, Wissenschaft und Gesellschaft, dass das Primat der Unverletzlichkeit und Unantastbarkeit des Lebens eines Menschen allen gesetzlichen Regelungen zugrunde liegen muss. Dies setzt auch eine Begrenzung technischen und medizinischen Handelns voraus: Mit der Befürwortung der verbrauchenden Forschung an Embryonen und mit den Forderungen nach einer Aufweichung des seit 1991 geltenden Embryonenschutzgesetzes steht prinzipiell der Schutz des ungeborenen Lebens zur Disposition. Mit der Verschmelzung von Samen- und Eizelle beginnt neues Leben, dessen Würde unantastbar und vom Staat besonders zu schützen ist. Zahlreiche neue Fragen und Probleme, z.B. zum Embryonenschutzgesetz, zur vorgeburtlichen Diagnostik oder zur künstlichen Befruchtung in den letzten Jahren führten zu Überlegungen für ein neues Gesetz im Bereich der Fortpflanzungsmedizin. Der Familienbund der Katholiken lehnt das "therapeutische" Klonen ab, da bei der Gewinnung embryonaler Stammzellen ein im Prinzip lebensfähiger Embryo zerstört wird. Der Embryo wird damit als Rohstoff für die Menschen genutzt. Zudem eröffnet das "therapeutische" Klonen Tor und Tür für eine Technik, die geklonte Menschen ermöglicht. Die Einhaltung einer strengen deutschen Gesetzgebung ist schon deshalb erforderlich, da die verschiedenen internationalen Dokumente (Uno-Deklaration, Bioethik-Konvention des Europarates und Charta der Grundrechte der EU) kein Verbot des "therapeutischen" Klonens vorsehen. Statt der Forschung mit embryonalen Stammzellen, sollte die Forschung mit adulten Stammzellen einschließlich der Stammzellen aus Nabelschnurblut intensiviert werden.
Vorgeburtliche Untersuchungsmethoden gehören immer mehr zum festen Bestandteil einer allgemeinen Schwangerenvorsorge und werden angeboten, um festzustellen, ob der im Mutterleib heranwachsende Fötus mit einer Krankheit oder einer Behinderung behaftet ist. Entscheidend ist allerdings, dass diesen Untersuchungen eine ausführliche, nicht nur medizinische Beratung vorangeht und eine anschließende Begleitung erfolgt. Der Familienbund der Katholiken fordert Verantwortliche in Politik, Wirtschaft und Gesellschaft auf, Leitbildern entgegen zu treten, nach denen nur gewünschte und gesunde Kinder angenommen werden und damit dem sich abzeichnenden "Zwang zum perfekten Menschen" Vorschub geleistet wird. Prädikative Tests im Rahmen von medizinischen Eignungsuntersuchungen an Arbeitnehmern vor dem Abschluss eines Arbeitsvertrages sowie genetische Analysen als Bedingung für die Aufnahme in eine Kranken- oder Lebensversicherung lehnt der Familienbund ab. Gentests an Embryonen, die im Reagenzglas erzeugt wurden, sind von vorne herein auf die Selektion menschlicher Lebewesen ausgerichtet. Der Familienbund der Katholiken spricht sich gegen die Zulassung der Präimplantationsdiagnostik aus, da bei der Zulassung von genetischen Tests an außerhalb des Körpers erzeugten Embryonen die Gefahr besteht, dass die eigentlich für nur wenige, erblich stark belastete Paare gedachte Methode schnell auch auf weniger schwerwiegende Krankheiten und andere genetische Merkmale, z.B. Geschlecht, Haarfarbe eines Kindes, ausgeweitet werden kann und dass nicht eingesetzte Embryonen getötet oder anderweitig "verbraucht" würden. Diese sogenannte "Zeugung auf Probe" ist als weiterer Schritt hin zum "Menschen nach Maß" zu werten und abzulehnen. Es steht außer Zweifel, dass die Biotechnologie im Bereich der Medizin Chancen zur Heilung bisher unheilbarer Krankheiten und damit zur Linderung von Schmerz und Leid bietet. In der sich bislang abzeichnenden Debatte um medizinische Fortschritte zeigt sich jedoch, dass der Beginn des Lebens eines Menschen mit der Zeugung in Frage gestellt wird. Für den Familienbund der Katholiken sind die Menschenwürde und das Lebensrecht eines jeden Menschen nicht nur Grundrechte, sondern müssen zunehmend Ziele staatlichen Handelns sein. Es muss ein "Recht auf Unvollkommenheit" geben. Krankheit und Behinderung gehören zum Leben. Die neuen Erkenntnisse über das menschliche Erbgut müssen zum Wohl des Menschen, d.h.
zur Heilung von Krankheiten und zur Minderung menschlichen Leids, genutzt werden.
Dies darf aber nicht dazu führen, die Diskussion über Krankheit und Behinderung nur unter dem Blickwinkel ihrer Vermeidbarkeit zu führen. In der ethischen Debatte muss vielmehr die Aufmerksamkeit auch auf die Verbesserung der Lebensumstände der von Krankheit mittelbar Betroffenen wie der Eltern und anderer Angehöriger gelenkt werden. Nur so kann der Anspruch, menschliche Lebewesen von Anfang bis zum Ende schützen zu wollen, erfüllt werden.
Die Stellungnahme wurde beim Zentralen Familienrat des Familienbundes der Katholiken am 18.3.2001 in Mainz verabschiedet.

Position of the central family council of the "Familienbund der Katholiken" of Germany, which was adopted in Mainz on 18.3.2001. The full German text is available at: http://www.familienbund.org/2/showmeldung.php3?id=38

Form submitted by: Peter Hoogendoorn, Parkinson Patiënten Vereniging, The Netherland

Als voorzitter van de Nederlandse Parkinson Patiënten Vereniging heb ik de discussie in ons parlement en ook daarbuiten over het mogelijk gebruik van stamcellen op de voet gevolgd.

Als ik de verschillende bijdragen aan de discussie bekijk, dan valt op dat er een groot verschil is tussen de meningen van betrokkenen (patiënten, wetenschappers) en anderen die met een totaal andere optiek naar deze problematiek kijken. Ook binnen onze vereniging is die discussie nog steeds gaande.

Als standpunt van het bestuur, en dus van de vereniging, heb ik altijd naar buiten gebracht dat het onderzoek in ieder geval moet doorgaan, want we weten nog steeds niet of er een waardevolle therapie uit voort kan komen.

Het is nog steeds experimenteren en proberen de juiste stamcellen op te sporen en ze zodanig te trainen dat ze gaan doen wat we graag zouden zien: in het geval van Parkinson is dat dopamine maken in de substantia nigra. Zou dat lukken dan kan de kwaliteit van leven van honderdduizenden mensen belangrijk worden verbeterd.

Vanzelfsprekend heeft het de voorkeur stamcellen te gebruiken die geen of minder discussie oproepen, zoals volwassen stamcellen, of die welke uit navelstrengbloed te verkrijgen zijn. Die zijn, zo heb ik begrepen wat moeilijker te vinden.

Als rest-embryo's van IVF vernietigd zullen worden, ligt het toch voor de hand, te bezien of ze voor betere doeleinden dan vernietiging ingezet kunnen worden. Laten we eerst het onderzoek naar de mogelijkheden maar eens hebben. Misschien blijkt het uiteindelijk helemaal niet te werken en dan hebben we voor niets zitten bakkeleien.

From Josef Wisser , Dept. Obstetrics, University of Zurich, Outside EC

Bevor eine Gesellschaft eine Entscheidung über die Forschung an Embryonenund mit embryonalen Stammzellen trifft, muss Klarheit über den moralischenStatus des Embryos herrschen. Die Argumente, die in dieser Frage in denvergangenen Jahrzehnten vorgebracht wurden, haben immer wiederunterschiedliche Gewichtung erfahren. War es in der Diskussion um dieAbtreibung der Beginn des Gehirnlebens oder die extrauterineÜberlebensfähigkeit, so ist es derzeit die Implantation, welche alsentscheidender biologischer Einschnitt für den Beginn der Schutzwürdigkeitdes Embryos ins Feld geführt wird. Dieser Einschnitt wird von hochrangigenWissenschaftlern mit dem Beginn der Kommunikation zwischenEmbryo und Schwangerer begründet, wobei die biochemischeKommunikation, welche die Einnistung erst ermöglicht,unberücksichtigt bleibt. Andererseits wird von einer Vervollständigung desEntwicklungsprogramms durch den Vorgang der Einnistung gesprochen, wobei dieUnterschiede des Entwicklungsprogrammes vor und nach der Implantation nichtbenannt werden können.

Die Diskussion um den Beginn der Schutzwürdigkeit menschlichen Lebenswährend der vergangenen Jahrzehnte zeigt, dass wir je nach gesellschafts-oder wissenschaftspolitischem Umfeld willkürlich Grenzen zu begründenversuchen, die dazu dienen, Handlungsfreiheiten zu ermöglichen.Wissenschaft, darf sich zur Begründung solcher Grenzen nicht missbrauchenlassen. Sollten wir das Prinzip in dubio pro reo nicht auchauf die frühesten Phasen der menschlichen Entwicklung übertragen?

Die Diskussion um die Forschung mit embryonalen Stammzellen ist in der EU und besonders im deutschsprachigen Raum sehr emotional geführt worden, so dass die im Tierexperiment beobachteten Vorzüge der embryonalen Stammzellen im Vergleich mit adulten Stammzellen nicht für die Öffentlichkeit nachvollziehbar war. In der Zwischenzeit mehren sich wissenschaftliche Publikationen, die über die Stammzellgewinnung aus fetalen und postnatal verfügbaren Geweben berichten. Eine Auswahl von aktuellen Publikationen stellen folgende dar:

- Orlic D. et al. Bone marrow cells regenerate infarcted myocardium. Nature 2001;410:701-705

- Krause DS. et al. Multi-organ, multi-lineage engraftment by a single bone marrow-derived stem cell. Cell 2001;105:369-377

- Reyes M. et al. Purification and ex vivo expansion of postnatal human marrow mesodermal progenator cells. Blood 2001;98:2615-2625

Ich bitte die anwesenden Experten, die klinische Bedeutung dieser Untersuchungen zu diskutieren und in Kenntnis dieser Befunde die Vorteile embryonaler Stammzellen aufzuzeigen.