From stem cell research to HPV vaccinations,
healthcare policy to genetic modification, bioethics
increasingly provides the framework for weighing the
costs and benefits of scientific progress. Long a leader
in the field, the University is moving to make Penn
the place where such work happens, and where the
next generation of bioethicists will be minted.
BY TREY POPP
Whether it goes down in history books as a chapter heading or a footnote, the Republican presidential debate of September 12, 2011 was a remarkable event. The first such contest ever to be sponsored by the Tea Party addressed issues ranging from Herman Cain’s “9-9-9” tax-reform plan to whether Federal Reserve chairman Ben Bernanke should be strung up for treason. But the most memorable exchange turned out to be a dust-up over cancer prevention.
It pitted two candidates widely considered by pundits to be the political equivalent of twins: Texas Governor Rick Perry and Minnesota Congressswoman Michele Bachmann. Both candidates were courting social conservatives and Tea Party voters. Following some debate over the appropriate use of executive orders, Perry was asked to answer for one he had signed in 2007, requiring that 11- and 12-year-old girls in Texas be vaccinated against human papillomavirus, or HPV, a sexually transmitted infection known to cause cervical cancer.
Perry professed regret about using an executive order to enact the policy, but defended the HPV-vaccine mandate as a life-saving measure. “Cervical cancer is a horrible way to die,” he said. “What we were trying to do was to clearly send a message that we’re going to give moms and dads the opportunity to make that decision, with parental opt-out.”
Bachmann pounced on her competitor. “I’m a mom of three children,” she declared. “And to have innocent little 12-year-old girls be forced to have a government injection through an executive order is just flat-out wrong … It’s a violation of a liberty interest.”
A few moments later, former Pennsylvania Senator Rick Santorum jumped into the fray. He declared executive orders to be beside the point; the HPV vaccine should not be administered, period. “There is no government purpose served for having little girls inoculated at the force and compulsion of the government,” he said.
For bioethicist Jonathan Moreno, a David and Lyn Silfen University Professor in the history and sociology of science, this tussle was emblematic of something deeper than the tactical imperative of likeminded candidates to distinguish themselves from one another. It was just the latest example of how “when the politics of biology rears its head, all bets are off.”
In the debate’s aftermath, Perry found his 2007 decision supported by women’s health advocates—a contingent more typically given to calling the governor “abysmal” or even “a Texas-sized threat” to women’s health. Yet that was cold comfort, for Bachmann and Santorum had clearly scored a rhetorical victory.
“The fact that Perry followed the medical advice of experts on public health provided him no shelter in this debate,” Moreno noted in a Huffington Post opinion piece at the time. Indeed, so powerfully did Bachmann disagree with those medical experts that for her the issue seemed to trump the business-friendly posture virtually all Republican politicians take pains to project; she accused Perry of mandating the vaccine to reward the drug company—and Perry campaign contributor—that markets it.
“We are in the midst of a new biopolitics,” Moreno wrote on the Huffington Post, “in which the power of science confounds the usual left-right spectrum of public policy, one that by no means favors one side or the other.”
The politicization of the HPV vaccine may be his favorite example from the current political season, but it is by no means the only one. Nor, of course, is it the first. Stem cell research has been a contentious issue for the last decade. So have the agricultural use of genetically modified organisms, the patenting of genes, and the creation of hybrid organisms or human/non-human chimera in laboratory research—to mention just a few that Moreno discusses in his new book, The Body Politic: The Battle Over Science in America. But Moreno senses that the bioethics debates of recent years are just the advance ripples of a wave system that has the potential to disturb our politics more profoundly.
“After the economy, biopolitics might just be the item that most challenges the 2012 candidates’ policy prescriptions,” he predicted in another of his frequent essays on the Huffington Post. Yet even that formulation misses the full thrust of Moreno’s argument (as he would grant), because biopolitics is increasingly inextricable from economic policy.
By way of example, Moreno pointed toward a less-commented-upon issue from the campaign trail during a January conversation in his Cohen Hall office.
“Santorum presents himself as somebody who wants to invest in reindustrializing America,” he observed. “So what do you do about biotechnology?”
Which is to say: Do you leave any techniques that involve, say, creating pigs whose arteries pump human blood (as Mayo Clinic researchers have done to study the transmission of viruses from animals to humans) to pharmaceutical companies in Singapore and universities in Denmark? Or do you permit that, but bar scientists from injecting human-brain stem cells into the brains of mice—as has been done to study neurodegenerative diseases? Judging from the trends of the last 20 or 30 years, the industrial infrastructure of tomorrow is likely to look more and more like the cutting-edge labs of today. As Moreno remarked to a business publication some years ago, in a story about a patent lawsuit over a four-color automated DNA sequencer in which hundreds of millions of dollars were at stake: “These machines are the ancestors of the kind of equipment that will be available for your children in doctors’ offices and pharmacies to design drugs for you … Once the machine is more understood, it’s going to be one of the 21st century’s equivalents of the light bulb or the Model T.”
When you start drilling down, What do you do? is a question that pops up anew with every twist of the bit into the next layer of bedrock. What do you do when some novel technique seems promising enough to test on human subjects? That’s a question with a ready answer: informed consent. But what constitutes informed consent for someone who’d be getting an experimental treatment for a traumatic injury that has rendered him comatose? And does informed consent look the same in Boston as it does in Botswana, should a drug company based in the former find it advantageous to run clinical trials in the latter?
Or suppose the Boston company’s research hinges on the donation of human eggs for stem cells, and it’s having trouble finding donors. Can it offer them financial compensation? Not if it plans to use federal funding, at the present time. But it could consider moving to New York, where a state advisory board on stem cell bioethics decided in 2009 to permit financial compensation of donors out of state research funds. (Moral quandaries aside, score a victory for job creation—and tax receipts—in the Empire State.)
Many of these questions deal with small-bore issues. Some broach policy dilemmas provocative enough to attract demagogues. But all of them require answers—or at least a framework for working toward answers: gathering evidence, comprehending fine-grained technical distinctions, squaring policy proposals with legislation and case-law precedents, and even subjecting conventional wisdom to experimental scrutiny.
“The complexity of modern technology means that these advances [in science, medicine, and technology] cannot be well understood or fully considered by a single field or just a few fields,” says Penn President Amy Gutmann, who earlier this year was reappointed as chair of President Obama’s Commission for the Study of Bioethical Issues. “Bioethics joins the perspectives of multiple disciplines—medicine, nursing, law, ethics, philosophy, religion, engineering, and beyond—to consider the opportunities and challenges raised by scientific progress.”
It happens that all of the examples above are issues faculty or alumni of Penn’s bioethics program have tackled, in professional capacities ranging from the design of clinical trials in emergency-medicine settings to advising the state of New York’s commissioner of health on stem cell research ethics.
Lately, University administrators have moved to make Penn the place where such work happens, and where the next generation of bioethicists will be minted.
The story of bioethics at the University begins with Art Caplan, who recently announced he would depart in July to head a new medical ethics division at New York University, but for 18 years has been the highly visible face of bioethics at Penn as the Emmanuel and Robert Hart Director of the Center for Bioethics and the Sydney D. Caplan Professor of Bioethics. Caplan played a pivotal role in building bioethics into an area of conspicuous strength at the University, and leaves behind an important legacy.
But in recent years Penn has added more heavy hitters to its bioethics lineup. Moreno, who came here as one of the first PIK professors in 2006 [“Proof of Concept,” Sept|Oct 2008] and was recently named to UNESCO’s International Bioethics Committee, is one key player in the University’s push to become a world-premier hub of bioethics scholarship and training. And with the recent hiring of Ezekiel Emanuel [“Gazetteer,” Nov|Dec 2011], who ran the bioethics department at the Clinical Center of the National Institutes of Health before becoming a special advisor on health policy to the Obama administration, the University has a new general manager, so to speak, in the clubhouse.
And one bent on acquisition. Emanuel plans to “double” the faculty in his department—the Perelman School of Medicine’s recently formed Department of Medical Ethics and Health Policy—over the next three years. (He also has a faculty appointment in the Wharton-based Department of Health Care Management, and is the Diane v.S. Levy and Robert M. Levy University Professor and vice provost of global initiatives.*) Additionally, he is spearheading the creation of a second bioethics master’s program at Penn—one designed to groom the Caplans, Morenos, and Emanuels of tomorrow.
As is the case whenever a university pushes a large pile of chips into a new pot, it bears asking what exactly lies behind Penn’s aims. How many bioethicists does the world need, anyway? What has the field accomplished so far, and what has it left to achieve? Is politics warping bioethics, or the other way around? What can people actually do with a bioethics degree? And how does Penn hope to impact the world by minting more of them?
Caplan, Moreno, and Emanuel have differing perspectives on the trajectory of bioethics at Penn, and in the world more generally. But those perspectives overlap with the experiences of alumni of the University’s 15-year-old master’s of bioethics program to paint a picture of a field in transition, and one that promises to have a growing influence on society and its management.
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Illustration by The Heads of State
Photography by Candace diCarlo
“We are in the midst of a new biopolitics,”
Moreno wrote on the Huffington Post,
“in which the power of science confounds
the usual left-right spectrum of public policy,
one that by no means favors one side or the other.”