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DOI: 10.1177/136345930200600304
2002 6: 305Health (London)
Catherine Waldby
Stem Cells, Tissue Cultures and the Production of Biovalue
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Stem cells, tissue cultures
and the production of
biovalue
Catherine Waldby
Brunel University, Uxbridge, UK
ABSTRACT This article examines some of the social and philosophical implications
of stem cell technologies. Stem cell technologies promise to transform
the way that healthy tissues for transplant are sourced and circulated; from
a social economy in which citizens donate whole organs to others, to one in
which embryos are a major source of therapeutic tissues. This article considers
the transformations in concepts of health, bodily relationships and
social indebtedness that such a shift might entail. Using the concept of biovalue,
this article describes the ways embryos are biologically engineered to
act as tissue sources, and considers the relationship between biovalue, health
and capital value. It discusses the effects stem cell technologies may have on
concepts of the healthy body, particularly on the temporality of ageing, and
on understandings of the human more generally.
KEYWORDS bioethics; cultural studies; embryos; health; organ donation;
stem cells
ADDRESS Dr Catherine Waldby, Reader in Sociology and Communications,
Department of Human Sciences, Brunel University, Uxbridge,
UB83PH, UK. [Tel: +44 (0)1895 274000 ext. 3531; fax: +44 (0)1895 203018;
e-mail: catherine.waldby@brunel.ac.uk]
ACKNOWLEDGEMENTS Versions of this article have been given at the
National Centre for HIV Social Research, University of New South Wales,
Sydney; the Sociology Department, Plymouth University; the BIOS seminar,
Goldsmith’s College, London; and the Sociology Program, Lancaster University.
I would like to thank the participants in each of these venues for their
attention and ideas. In particular this article has benefited from discussions
with Nikolas Rose, Marsha Rosengarten and Brett Neilson. I would also like
to thank Dr Peter Mills at the Human Fertilization and Embryology Authority
for his suggestions and insights.
The gift is not inert. It is alive and often personified. (Mauss, 1967: 10)
Genes were among the most privileged biotechnical actors of the 20th
century, attributed with qualities of biological causality and vital essence,
the repositories of life itself (Keller, 2000). Certainly since the inauguration
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Illness and Medicine
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of the Human Genome Projects genes have commanded centre stage in the
theatres of popular science and big science alike. Nevertheless, commentators
like Keller (2000) and Rose (2001) suggest that the gene is on the
verge of displacement by new biological entities and models. In a postgenomic
biology, genes will appear as simply one point in what Franklin
describes as ‘protein events in much longer sequential chains’ (2001b: 19),
components in complex networks of biological interaction rather than alldetermining
points of morphological origin.
Stem cells are one of these new biological actors, recently taking their
place alongside genes as potent icons of promised control over our biology
and health. The term ‘stem cell’ refers to any cell that can renew tissue in
the body. The type most prominent in the media at present is ‘pluripotent’
stem cells, undifferentiated cells that have the capacity to develop into
almost all of the body’s tissue types. Some recent biomedical developments
suggest that it may be possible to produce large numbers of undifferentiated
stem cells that could then be induced to differentiate on demand, providing
an unlimited supply of transplantable tissue. It is thought that stem
cells may be very useful in treating currently intransigent medical conditions
– Parkinson’s disease, Alzheimer’s disease, stroke, spinal cord
injuries, arthritis – through the introduction of tissue into damaged or
degenerated sites. Stem cells might also provide alternative therapies for
common conditions like diabetes (NIH, 2000), promoting the growth of
insulin producing tissue to replace pharmaceutical insulin regimes. Moreover,
it may be possible to produce stem cell lines that are genetically and
immunologically compatible with particular hosts, avoiding the problem of
tissue typing found in whole organ transplants.
Stem cell research has been the subject of public controversy in the USA,
Canada, Australia, the UK and Europe over the last couple of years, as
various administrations try to work out regulatory frameworks for these
promising, yet problematic, biological agents. They present certain kinds
of political problems, for two reasons. First, the most viable source of stem
cell lines is human embryos. Stem cells can be found in blood from the
umbilical cord at the time of birth and from some adult tissues such as bone
marrow, but these other sources do not appear to be as flexible or active
as tissue derived from embryos. Hence stem cell technology brings with it
all the familiar controversies that circulate around the embryo, the foetus,
the right to life, and so forth.
Second, stem cell technologies are somewhat contaminated by their
association with the new cloning technologies made famous by the birth of
Dolly the sheep. If stem cell technologies succeed in engineering immunologically
compatible tissues for human use they will do so by drawing on
elements in the repertoire of techniques used for mammalian cloning,
notably cell nuclear replacement (CNR).1 Advocates of stem cell technologies
make careful distinctions between therapeutic cloning for stem
cell production and reproductive cloning for the production of whole new
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creatures. Nevertheless, as Franklin (2001c) notes, the distinction is highly
volatile and potentially controversial, and the association with the pejorative
term ‘cloning’2 has generated further political heat in some cases.3
At time of writing these controversies are taking up the time and attention
of the policy makers and politicians. A fairly pragmatic position has
been struck in the UK, although not without some, muted, controversy. An
existing piece of legislation, the Human Fertilization and Embryology Act
(1990) that governs research on human embryos for reproductive health
has been extended, after public and parliamentary debate, to allow for
embryonic stem cell research as well.4 Currently this research is limited to
applications for neurological conditions like Parkinson’s and Alzheimer’s
disease, although it seems likely that other conditions, like diabetes, will
be added in the future. Medical researchers may now apply to the Human
Fertilization and Embryology Authority (HFEA) for a licence to conduct
stem cell research, using ‘spare’ embryos, left over from IVF procedures.
The embryos must be no more than 14 days old, a limit set by the original
legislation in order to mollify objections that research on embryos is unwarranted
interference in fully human life (Mulkay, 1993). The Authority has
stated that it will consider applications using CNR, and the recent (December
2001) production of a CNR embryo by the US biotechnology company
Advanced Cell Technology suggests that applications may be forthcoming
in the near future.
By contrast, President Bush has declared that US federal funding for
stem cell research will be made available only where existing stem cell lines
are used, ‘where life and death decisions have already been made’ (Bush,
2001: 10), rather than lines established by harvesting spare embryos.5 Other
administrations, like Canada and Germany, are exploring various compromises
between biotechnological development and bioethical conservatism.
The Canadian Federal House of Commons committee on health, for
example, has just (December 2001) recommended a regulatory system
similar to that now accepted in Britain, using ‘spare’ IVF embryos and
licensed through a specific regulatory body. Unlike Britain, the report
recommends that it be illegal to create embryos solely for research.
With these various regulatory frameworks in place, it seems likely that
stem cell technologies will continue to garner considerable public interest,
and to be objects of hope for the medical charities and advocacy groups,
like the Parkinson’s Disease Society, that form the natural constituency for
these technologies. In the UK at least one biotechnology company,
ReNeuron, has announced that it is gearing up for a clinical trial of stem
cell transplantation for stroke victims. Many clinical researchers consider
such plans premature, given equivocal results in related trials elsewhere
(Meek, 2001). For example, a recent US clinical trial using foetal neural
tissue to treat Parkinson’s disease produced improvement in some patients,
and exacerbated symptoms in others, pointing to the difficulty of calibrating
and controlling a biotechnology that becomes fully internalized in the
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body (Freed et al., 2001). Other research groups are focusing on animal
model research, in the hope of more controllable clinical applications in
five to 10 years time. Hence it seems possible that stem cell technologies
could become an important component of biomedical therapeutics over the
next decade or so.
Biotechnology and biovalue
My interest in these new stem cell technologies arises out of a more general
interest in biotechnology, and its relations to sociality and subjectivity.6 I
am particularly interested in ways that developments in biotechnology frequently
destabilize and reconstitute naturalized relations between bodies,
bodily fragments, human identities and social systems. Biotechnological
change effectively produces new material conditions of possibility for these
relationships, challenging existing ethical, legal, ontological and sociological
frameworks for their understanding and organization. So, for example, new
reproductive technologies have exercised profound effects on structures of
parenting and kinship, creating new relational categories like surrogate
mother and sperm donor. New genetic tests, that identify a person’s risk
for contracting conditions like Huntington’s disease, can reconstitute a
tested person’s identity, family and social world in complex ways. As Novas
and Rose comment:
When an illness or a pathology is thought of as genetic, it is no longer an individual
matter. It has become familial, a matter both of family histories and
potential family futures. In this way genetic thought induces ‘genetic responsibility’
– it reshapes prudence and obligation, in relation to getting married,
having children, pursuing a career and organising one’s financial affairs. Hence
. . . these descriptions do not merely inform the judgements, calculations and
actions of agencies of control – they shape the self-descriptions and possible
forms of action of the genetically risky individual. (2000: 487)
Like new reproductive technologies and genetic tests, stem cell technologies
involve a reorganization of the boundaries and elements of the human
body, the development of new kinds of ‘separable, exchangeable and reincorporable
body parts’ (Rabinow, 1999: 95). Rapid changes in the relationship
between human bodies and bodily fragments have characterized
developments in medical biotechnology over the last 40 years or so. Organ
transplants have been succeeded by IVF, by genetic tissue sampling, by the
creation of human cell lines and now by stem cell technologies. Each of
these developments has created new possibilities for health, and produced
new kinds of medical knowledge. They also involve often unpredictable
implications for identity and embodiment. What does it mean when the
human body can be disaggregated into fragments that are derived from a
particular person, but are no longer constitutive of human identity
(Rabinow, 1999)? What is the status of such fragments, and how is the status
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of the individual (strictly speaking the in-dividual, he who cannot be subdivided)
altered to accommodate these possibilities for fragmentation?
At the level of social relations, how might the exchange of such fragments
between persons, their donation or sale, their receipt and reincorporation,
constitute relationships between them? Here I am working with
the proposition that the circulation of biological ‘gifts’ create forms of social
reciprocity and imagined community in much the same way as the circulation
of others kinds of material goods in both traditional and market
economies (Mauss, 1967; Frow, 1997). This proposition forms the basis for
Titmuss’ (1997) classic study of the social effects of tissue economies The
gift relationship: From blood to social policy, which analyses the different
social effects generated by different methods of tissue (blood) donation and
management. For Titmuss, giving blood as an act of altruistic donation
establishes social ties of indebtedness between fellow citizens, and creates
the condition for the maintenance of community between strangers. Selling
blood, on the other hand, creates instrumental, non-binding commodity
relations between producers and consumers. The first economy creates
social relationships based on generosity and indebtedness, an acknowledgement
that the blood recipient’s health is now owed to another. The
second severs ties between the bodily fragment and the person from whom
it is derived, so that it circulates as a commodity and is incorporated as an
object of possession and consumption, without the creation of a tie between
vendor and purchaser.
While Titmuss’ work has been criticized for its idealism and its posing of
an absolute and unsustainable opposition between gift and commodity
(Frow, 1997) it nevertheless recognizes a constitutive relationship between
the distribution of biological tissues and formation of social relationships
more generally. On this model the exchange of biological substance is
simultaneously a technical/material and a social act. Bodies that are
materially implicated in each other through tissue donation and transplantation
are also socially implicated, and medical systems that exchange and
circulate tissues are also social systems.
Since Titmuss’ study in the early 1970s, rapid developments in biotechnology
have produced more and more kinds of bodily fragments, that can
be alienated, altered, redistributed and reincorporated in increasingly
complex economies. Nevertheless, if my analysis of the implications of
Titmuss’ model is correct, each such shift requires a reconsideration of the
kind of social and corporal economy the new technology might imply, and
what kinds of economies it might be situated within. In particular, the ideal
gift economy set out by Titmuss is becoming more difficult to reconcile with
the recent, ever-growing capital value of the biological fragment, and the
ability of biotechnology to make cells, tissues, genes and the like ever more
productive.
At this point I want to introduce the idea of ‘biovalue’, developed in
some of my earlier work, (Waldby, 2000) to elucidate this biotechnical
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trajectory. Biovalue refers to the yield of vitality produced by the biotechnical
reformulation of living processes. Biotechnology tries to gain traction
in living processes, to induce them to increase or change their productivity
along specified lines, intensify their self-reproducing and self-maintaining
capacities. This intensification or leveraging of living process typically takes
place not at the level of the body as a macro-anatomical system but at the
level of the cellular or molecular fragment, the mRNA, the bacterium, the
oöcyte, the stem cell. Moreover it takes place not in vivo but in vitro, a
vitality engineered in the laboratory, where, as Rabinow puts it, the biological
fragment is constituted as a ‘potentially discrete, knowable, and
exploitable reservoir of molecular and biochemical products and events’
(Rabinow, 1996b: 149). Here a repertoire of biotechnical procedures can
be developed that induce the fragment to expand, to accelerate or slow
down, to unfurl or recapacitate, to produce new substances or develop
along new pathways, to recombine with other fragments and swap properties.
In short biotechnology finds insertion points between living and nonliving
systems (Mackenzie, 2002) where new and contingent forms of
vitality can be created, capitalizing on life.
Cast in these terms, biotechnology produces a margin of biovalue, a
surplus of fragmentary vitality. There are, generally speaking, two incentives
for the production of biovalue. The public incentive, foregrounded by
the technology’s advocates, is the hope of creating a use value,7 some viable
contribution to human health. Scientists, funding bodies and patient groups
hope that, one day, the vitality of the stem cell will be transformed into a
lessening of debility, an improvement in functioning and well-being. As
Rabinow notes, the legitimacy of biological research, its right to funding
and experimentation, depend more and more on the claim to produce some
therapeutic or clinical application, rather than simply the production of new
biological knowledge. While the modernist biology of the cold war could
legitimate itself with reference to the need to understand the basic organization
of the natural world and living organisms,8 contemporary life sciences
are increasingly involved in the production of health.
More than ever before, the legitimacy of the life sciences now rests on claims to
produce health . . . the bioscience community now runs the risk that merely
producing truth will be insufficient to move the venture capitalists, patent offices,
and science writers on whom the biosciences are increasingly dependent for their
new found wealth. (Rabinow, 1996: 137)
The second incentive, as Rabinow’s words clearly imply, is the production
of exchange value, of biological commodities that can be bought and sold.
The production of biovalue is caught up with the production of capital
value. The process of producing biovalue is also the process of technical
innovation that enables the patenting of cell lines, genes and transgenic
organisms as inventions, securing their status as intellectual property and
possible sources of profit for their inventors. However the process of
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translating the activity of the biovaluable fragment into vitality at the level
of the bodily system or profit at the level of the biotechnology company is
highly uncertain. The end result may not at all resemble the scenario presented
by the advocates for the technology, and science publics are increasingly
critical of the rhetorics of hope (Mulkay, 1993) that are routinely
deployed in the launching of a new biotechnology.
Currently, advocates for stem cell technology are producing optimistic
promises of a new biology, a regenerative body that can repair and renew
itself in the face of trauma, ageing and deficiency. This regenerative biology
will, they claim, replace or substantially supplement current economies of
tissue production and circulation, organized through anonymous blood and
whole organ donation and characterized by risk and scarcity. Stem cell technologies
promise to turn scarcity into plenty, and to develop new ways for
the living body to utilize tissue resources in the production of a renewable
health, less vulnerable to the predations of time and ageing.
In what follows, I want to consider the various tissue economies that are
involved in stem cell technologies, and speculate about the implications
they may have for biopolitics more generally. What kind of biovalue is being
engineered from stem cells, and what health use values and exchange values
are suggested by this engineering? What effects might stem cell technologies
have on existing systems for the management and exchange of tissues,
particularly on organ donation and transplantation? What idea of the
healthy body is being projected by stem cell technologies? What modes of
social relationship and imagined community will be constituted by the
donation, engineering, distribution and transplantation of embryonic stem
cells? To use John Frow’s (1997) phrase, what kinds of indebtedness will
be set in motion? Stem cell technologies are very new, and their sociotechnical
consequences cannot be known at this stage. Here I want to raise
questions and develop some theoretical approaches to these new entities,
rather than provide definitive answers.
Tissue economies
Medical and political interest in stem cell research arises, it seems to me,
at the intersection of two biopolitical problems. One of these is the ageing
of the population in first world nations. With a decline in mortality, and
increase in longevity, more and more people develop chronic and degenerative
conditions associated with ageing – stroke, Parkinson’s disease,
Alzheimer’s disease, heart disease and the like. Health systems devote an
increasing proportion of their budgets to the long-term management of such
conditions (CMOEG, 2000), as people live longer with more disease.
The second problem is the increasing difficulty of mobilizing tissues
under current technical and social conditions, in the face of an ever-growing
demand. Since the Second World War in the UK, Canada, Australia and
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Europe blood donation has been nominally organized according to the
principle of anonymous donation to strangers, the model celebrated by
Titmuss. Organ transplantation first became viable in the 1950s, and whole
organ donation has been largely modelled on blood donation. Organ donation
is sometimes from a live donor, particularly in the case of kidneys, but
more often from a legally dead body. These gift economies have been the
primary source of living tissues for therapeutic transplantation and transfusion
over the last 50 years.
As numerous commentators have observed (Frow, 1997; Rabinow, 1999;
Franklin and Tutton, 2001) these gift economies have never worked without
commercial supplementation, the illicit or official buying and selling of
blood and organs.9 A number of recent developments have further reduced
the viability of donation economies for the production and circulation of
living tissues. Blood transfusion systems have increasingly been associated
with the spread of viral diseases like HIV and Hepatitis C, producing a
growing mistrust of the public health management of such enterprises
(Rabinow, 1999). Willingness to donate whole organs has been reduced in
the face of hospital scandals like the recent discovery of organ banks, harvested
from dead children without their parents’ consent, at the Alder Hey
Hospital and Bristol Infirmary in the UK (Legge, 2000). As Franklin and
Tutton note, the decline in the legitimacy of organ donation suggests that
‘the value given to body parts has grown as trust in the medical profession
has possibly been eroded’ (2001: 8). This suggests that the network of
anonymous social trust and bodily indebtedness created by tissue donation
economies are becoming less workable as declining medical legitimacy and
increased commercialization take hold in first world health systems.
In contrast, Renée Fox (Stafford, 1999) locates the problem for organ
donation not on the side of supply but on that of demand. She argues that,
in addition to the recurrent problem of tissue typing, the difficulty of finding
an immunologically compatible donor, the primary reason for organ shortages
is a dramatic expansion in the constituency for organ transplantation.
More and more conditions are defined as amenable to treatment through
transplant, hence eligibility lists grow longer and longer. The practice of
retransplantation also increases demand, as the immunological rejection
that inevitably accompanies any organ transplant propels the organ
recipient back onto the waiting list. Hence the organ shortage is not so
much a problem with donation but more a problem, as Fox puts it, of
‘aspiration to transplant’ and ‘to replace every worn out part of the human
body’ (Stafford, 1999: 243–4).
These recent refigurations of tissue economies, the expansion of demand
alongside the problems of supply, means that, more than ever, healthy living
tissue has the status of a scarce and precious substance, distributed according
to carefully controlled systems of triage. In general, organs go to the
sickest, the youngest and those in need of a second transplant (Stafford,
1999). The ever-growing constituencies for organ donation who are not
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privileged by these hierarchies form a ready market and source of capital
value for other sources of tissue.
Stem cell technologies identify a new and highly flexible source of tissue
to augment the scarcity of existing tissue economies. Rather than living
tissue donated by fellow-citizens, stem cell technologies source tissues from
the very margins of (pre-) human life, the embryo. Stem cell research in
the UK uses ‘spare’ embryos, those produced as part of the IVF process.
IVF treatment routinely produces more embryos than can be used in actual
reproduction, and couples may consent to their use for research. If spare
embryos are not donated, they are usually disposed of. Hence stem cell
technologies shift the source of tissue from a whole organ to a tiny collection
of cells, and from an unarguably human person to an entity whose
status regarding the human community is the subject of bitter contestation.
For opponents of embryo research the embryo is not a biological fragment
of another’s body, but an autonomous being, a proto-child who cannot legitimately
be given away.10 For advocates, the embryo is a legitimate gift. The
fact that the IVF couple can donate the embryo implies that it is a biological
fragment of their two bodies, not unlike other bodily fragments that
they may donate under other circumstances. It is not a member of the
human community. Nevertheless its potential membership, its status as
human embryo rather than the embryo of another species is the thing that
makes it such a valuable source of transplantable tissue. Advocates of stem
cell research generally portray the spare embryo as a precious substance.
If it is not freely donated it will be simply wasted, a recklessly squandered
resource. So, for example, the Chief Medical Officer’s report into stem cell
technologies argues:
The vast majority of embryos used in research are embryos created in the course
of infertility treatment and which, for whatever reason, are no longer required
for treatment. The only options at this stage are to let the embryos perish or to
use them, with the express consent of the individuals whose eggs or sperm have
been used to create the embryo, in licensed and controlled research as part of
the effort to enhance . . . human lives. (CMOEG, 2000: 38)
Stem cell technologies are, in these terms, particularly productive sources
of biovalue precisely because they can rehabilitate what would otherwise
be needless waste and transform it into a spectacularly active, flexible and
manageable tissue resource. Here we can discern two conflicting ideas
about the life of the embryo, and about the idea of ‘life’ more generally.
For opponents of stem cell research, the life of the embryo is biographical,
the beginning point of a human narrative that should be allowed to run its
social course.11 For advocates of stem cell research the life of the embryo
is a form of raw biological vitality. From this point of view the embryo is
not killed. Rather its vitality is technically diverted and reorganized.
Embryonic stem cells have particular cell capacities and qualities that are
quite different from those of adult, differentiated tissues and organs. The
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hope of stem cell advocates is that these qualities can be isolated and made
available for the augmentation of the adult body, the production of new
forms of health. The healthy body proffered by stem cell research is not
the immunocompromised, medicated and indebted12 body of the organ
recipient, but rather an immunocompetent, self-renewing body where stem
cell biotechnology is fully incorporated as part of itself. In what follows I
want to consider in some detail the ways that stem cell technologies engineer
embryonic matter to mobilize and leverage these capacities and
qualities, reorganizing them in ways that suggest this utopic, unencumbered
health.
Capitalizing organism time
The biovalue produced by stem cell technologies depends on complex temporal
reconfigurations, the engineering of cellular, embryonic and ultimately
ontological time. I would argue that the manipulation of the time
scales and trajectories of biological fragments is one of the major biotechnological
strategies for the production of biovalue. As Rose (2001) comments,
intervention in the temporality of biological pathways is a crucial
part of the new biotechnological repertoire, across a number of different
biological fields.
All life processes now seem to consist of intelligible chains of events that can be
reverse engineered and then reconstructed in the lab, and modified so that they
unfold in different ways . . . Life now appears to be open to shaping and
reshaping . . . by precisely calculated interventions that prevent something
happening, alter the way something happens, make something new happen in
the cellular processes themselves. (Rose, 2001: 15)
Stem cell technologies clearly alter the trajectory of biological development,
at numerous points. As Franklin (2001c) notes, CNR and its cognates
involve the reversal of genetic temporality. CNR involves the creating
of an embryo not by the usual process of in vivo conception, fusion of egg
and sperm, but through the in vitro insertion of the nucleus of a cell from
an adult body’s organs or tissues into an oöcyte, an unfertilized egg. The
oöcyte has in turn been enucleated, that is, had its own nucleus removed
to make way for the introduced nucleus. This creates an embryo with the
genome of the adult from whom the nucleus was taken. Prior to the cloning
of Dolly, it was assumed that the nuclei of adult cells had lost their totipotency.
That is, once programmed to produce a particular kind of cell they
lost their ability to produce different kinds of cells (Keller, 2000). Cloning
based on CNR demonstrated that adult cell nuclei could, in fact, be induced
to revert to or reactivate their embryonic potential.
The version of cloning by nuclear transfer used for Dolly succeeded by reprogramming
the nuclear DNA of an adult, differentiated, body cell to make it
behave like an embryo: a cell that could produce every kind of tissue – that is,
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a cell that could become a viable offspring. It was the ability to reprogram the
adult DNA to go back in time, which was the astounding accomplishment of
Wilmut’s team . . . In sum, [they] have devised means of reversing cellular
processes by resetting the cellular clock. (Franklin, 2001c: 345, original emphasis)
Stem cell therapies using CNR would involve the same kind of reprogramming,
inducing the DNA in the adult cell of a patient to reactivate the
potential it had at the point of conception. The embryonic tissue would be
histocompatible with those of the donor, and could be used to repair organs
or degenerate tissues. Such tissues would carry no risk of immunological
rejection and the person would not need to take immunosuppressive drugs.
The establishment of immortalized stem cell lines13 also reconfigures biological
time, rerouting and reharnessing the temporal processes of ontogenesis.
Pluripotent stem cells are embryonic cells at the first stage of
differentiation, after the cells that form the placenta and supporting tissues
for the foetus have divided off. They are pluripotent in the sense that they
are capable of giving rise to most of the tissues that comprise an organism,
although they cannot, at present, be induced to give rise to blood. In uninterrupted
embryonic development in the uterus the stem cells that form
the embryonic tissue cluster, the blastocyst, eventually divide and differentiate
into the cells, tissues and organs that constitute the infant human
body. To create a stem cell line the blastocyst is disaggregated into individual
stem cells. These cells are then immortalized; that is they are induced
continuously to clone themselves in their undifferentiated state. Cells that
are immortalized will continue to divide and multiply indefinitely.
Hence immortalization involves not a reversal of biological temporality
but its arrest; cells are maintained and expanded at a particular point in
their developmental trajectory, the moment of pluripotency. In the
Thomson (1998) study that established the first human embryonic stem cell
lines, cells were cultured for four to five months without differentiation.
That is, one stem cell multiplied to produce two stem cells, without differentiating
into more specialized tissues. These cell lines were later induced
to differentiate into the main groups of embryonic tissue layers. Subsequent
experiments have induced stem cell lines to differentiate into the precursors
of several mature tissue types, including neurons. Moreover, stem cell
lines can be frozen, stored and grown again once thawed (CMOEG, 2000).
So immortalization permits the arrest, immobilization and deployment of
undifferentiated cells at specific points in their development, and the reactivation
of differentiating activity on command. It also expands stem cell
biomass to usable levels, so that the single ‘spare’ embryo, with its 200 cells
and all its attendant political problems, forms the starting point for significant
amounts of stem cells that can be produced and banked, the perfect
self-renewing bio-commodity. As one medical article puts it, stem cells
could act as, ‘Universal donor cells . . . “off the shelf” reagent, prepared
and/or additionally engineered under good manufacturing practices readily
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available in limitless quantities for the acute phases of an injury or disease’
(Snyder and Vescovi, 2000: 828). This detailed control over the time of
ontogenesis will, if it is achieved, present a unique and uncanny temporal
resource for both health and subjectivity. It will, in effect, allow people to
revisit specific moments of their own ontogenesis, activating a technobiological
version of their own body’s formation. If CNR technologies are used
to produce therapeutic clones, with the same genome as the human donor,
the embryonic tissue resource is also a kind of delayed twin, a repetition
of the donor’s first moments of biological emergence.14 Certainly this is not
a perfect iteration; at the level of genetics, the embryo will inherit mitochondrial
DNA from the enucleated egg used in the replacement process,
an inheritance with currently unknown consequences for the utility of the
stem cells. Nevertheless CNR stem cell technologies suggest ways in which
the extreme margins of human technogenesis can, as I have argued elsewhere
(Waldby, 2000), form the most important kinds of material resources
for the production of human health and the preservation of subjectivity
against the predations of the body and illness.15 Following Braidotti (1994),
such biotechnological manipulations of organism time might also act as a
kind of psychic resource for shoring up a position of biological autonomy
or individualism. She argues, regarding reproductive technology, that it is
driven by a fantasy of parthenogenesis, the desire to be,
In total control of one’s origins, that is of being the father/mother of one’s self. . . .
This implies the blurring of generational time, of one’s position in time, in
relation to others. . . . The fantasy of being at the origin of oneself, [is] of not
having to recognise one’s beginnings in others – one’s parents. (Braidotti, 1994:
23)
This revisiting of ontogeny is pursued in order to intervene in the temporality
of yet another biological process, the process of ageing. Not surprisingly,
biology’s changing control over the temporality of the bodily
fragment has coincided with a shift in its understanding of the processes of
ageing. According to Sinden (2000), biology has recently abandoned a
model of the body as temporally homogeneous, involving a uniform growth,
renewal and ageing. Instead it has adopted a model in which the body’s
times are heterogeneous, sites of self-renewing vitality interspersed with
sites of irreversible loss and degeneration.
[Until recently] it has been generally believed that a human body builds up most
of its cells and tissues early in life, and then everything begins to fall apart, cell
by cell; the whole degenerative process accelerating as we get older. In fact, the
daughters of the same cells that were the totipotent originators within the first
weeks of our life . . . busily work away through our lives . . . repairing [damage]
. . . It is now believed that such rebuilding is going on constantly all over the
body: stem cells are making new cells continuously for bone, liver, heart, muscle
and even the brain . . . . While some cells and tissues seem to replenish themselves
constantly throughout life, . . . other tissues such as brain and heart seem
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to decline inexorably with age and suffer major irreparable functional loss with
damage or disease. (Sinden, 2000: 18–19)
Here we can see a rethinking of the human body as a complex ‘sheaf of
times’ as Serres (1982: 75) puts it, the co-existence of cellular proliferation,
mutation, growth and self-renewal with wearing, ageing, loss and decay. In
this complex temporal bioscape the regenerative activity of the stem cell
can reinvigorate ageing sites, and harmonize them with more vigorous kinds
of tissue. Sites prone to degeneration like the brain can be augmented, and
brought into line with self-renewing sites like the bone marrow. If ageing
is now defined as a clash of heterogeneous tissue temporalities, it can presumably
be adjusted so that tissues age in a homogeneous way.
Conclusion
The dream of stem cell technologies is then the dream of a regenerative
biology, where every loss can be repaired, and where treatments currently
available as pharmacology, like L-Dopa for Parkinson’s disease, are
replaced by the endogenous incorporation of tissues. The ageing body
would partake of the embryonic tissue vitality of the very young body, able
to reproduce itself indefinitely. This dream biology is, of course, unlikely
to be realized as such. It is based on the hope that the vitality, self-renewal
and immortality of the biovaluable fragment can be scaled up to become
the qualities of the macro-scale body. It ignores the risks, dangers and
uncertainties involved in translating biovalue into health. As some stem
cell researchers comment, the plasticity and immortality of stem cells are
qualities that present risks of inappropriate tissue development, as well as
therapeutic possibilities. ‘[Researchers] must create safeguards such that
cells with theoretical “totipotency” do not give rise to inappropriate cells
(e.g. muscle in the brain), transform to teratocarcinomas, or create autonomous
organs within the larger organ (e.g. neural tubes within the heart)’
(Snyder and Vescovi, 2000: 828). At the same time dream biologies can be
highly informative about the social relations involved in medical biotechnology.
John Frow, commenting on whole organ transplantation, makes a
crucial observation about such dream biologies. He writes:
Transplantation constructs a culturally very powerful myth of the social body –
that is, of the limits and powers of all our bodies. This is the myth of the restoration
of wholeness and of the integrity of the body: a myth of resurrection. Yet
this wholeness can be achieved only by the incorporation of the other. The
restored body is prostheticised: no longer an organic unity but constructed out
of a supplement, an alien part which is the condition of that originary wholeness.
(Frow, 1997: 177)
Health involves supplementation, and in more and more biomedical technologies,
this supplementation is not pharmaceutical or mechanical but biovaluable.
It utilizes value added biological fragments whose vital qualities
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have been processed and engineered. The sources of such fragments seem
to be diversifying. While the ideal gift economy described by Titmuss
involved the exchange of body parts between consenting citizens, tissues
and bioactive substances are increasingly derived from ‘abandoned’ human
tissue, as in the Mo16 and HeLa cell lines; from animals, sometimes transgenic
animals, like the sheep cloned by PPL pharmaceuticals to produce
an enzyme in their milk useful for the treatment of Cystic Fibrosis
(Franklin, 2001c); and now from embryos.
At the same time, as Frow’s formulation implies, the production of this
kind of health expresses social relations of (sometimes unacknowledged)
indebtedness. The healthy owe their health to others, human and nonhuman,
and incorporate fragments of these others as a condition of their
well-being. Titmuss’ gift economy was one way of managing this indebtedness,
drawing on its productive effects in the creation of common interest
and relations of equality between embodied citizens. However the
complex, deferred temporalities involved in stem cell biovalue and the
ambiguous ontological status of the donated fragment may not lend this
form of tissue production and distribution to Titmuss’ proposals for a
humanist imagined community, for the following reasons.
First the ontological status of the stem cell and the embryo; part of the
difficulty of incorporating a transplanted organ for whole organ recipients
is their acute, often guilty sense that their renewed bodily vitality and sense
of a viable future is owed to the interrupted biography of another, the
posthumous organ donor (Fox and Swazey, 1992). In this current stage of
stem cell technology it is impossible to know empirically how embryonic
tissue recipients may experience their new-found health. Yet Fox and
Swazey’s study of organ recipients suggest that this will be strongly conditioned
by the recipient’s evaluation of the human sacrifice involved in the
donation. If the embryo from which tissue is derived is valued as an interrupted
human biography, then it seems possible that the recipients will
experience their health through media of guilt, indebtedness and shame. If
the embryo is evaluated as a precious, vital fragment given by the couple
to the recipient, then the relationship will be closer to that described by
Titmuss, a bond of generosity and gratitude between fellow citizens. It
seems possible that the tissue may also be interpreted in non-personified
ways, as, for example, something more akin to medicine, the product not
of human donation but medical ingenuity. Moreover the relationship of
embryos to human status will doubtless become more complex and fractured
if embryos prove to be such productive sources of tissue, so that the
humanist valuation of embryos as proto-human may intensify, weaken or
both. It seems inevitable that stem cell technologies will induce some difficult
to anticipate mutations in what the human means, if human health and
embodiment is enhanced through the technological manipulation of human
ontogeny.
Moreover, the biovaluable engineering of stem cell tissues complicates
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the play of gratitude and indebtedness celebrated by Titmuss in quite
unprecedented ways. In the case of whole blood and whole organ donation,
the gift is transferred more or less intact, more or less in a one-to-one
relationship between giver and receiver, although mediated by technical
systems that ensure the safe transfer and storage of the gift. In the case of
stem cell technologies the donation of a single embryo is simply the starting
point for a process of biovaluable amplification. A single cell disaggregated
from the embryo might form the basis for an incalculable amount of
therapeutic tissue, transplanted into innumerable recipients, for a diversity
of conditions, over an unspecified length of time. The tissue will perpetuate
the genetic legacy of the donor couple, quite possibly well beyond their
lifetimes. The biovaluable engineering of the stem cell multiplies its
biomass exponentially, so that the original donation is simply the starting
point for an infinitely branching and self-multiplying network of tissue
relations. The extent to which any tissue circulating in such a system is
invested with relations of identity is difficult to specify. However, the fact
that the tissues will perpetuate the genetic legacy of the donors suggests
that, for the donors at least, this may be the case, as the equation between
genetic material and identity becomes stronger and stronger in the popular
imagination (Keller, 2000).
These complex new tissue networks demand a rethinking of biopolitical
frameworks for the social management of tissue economies. Given the
incalculable provenance of donated embryonic tissue, donation may
become more and more problematic for IVF couples unless some means
of articulating relations between donor and recipient is developed.
Attempts to extract excessive exchange value from stem cells may also act
as a deterrent to donation, as couples feel uneasy about giving their
embryos to private companies intent on patent and the maximization of
profit. Tissue recipients may have difficulties living out a form of health
indebted to embryonic tissue.
At the same time these problems cannot, it seems to me, be addressed
simply through the reassertion of the categories and morality of a humanist
bioethics. Stem cell technologies, like many other contemporary biotechnologies,
make evident the fact that the human is not a natural, biological
category but rather a status and being emerging from a complex network
of technobiological production. Contemporary biotechnology demands a
bioethics that can understand the complex reciprocities and technical mediations
between human and non-human entities, and frame ways of living
that acknowledge this. The kinds of social relationships that may develop
around stem cell technologies must be understood as part of a broader
social negotiation over this network of production, and the kinds of humans
and non-humans, entities and hybrids, health and illness it should produce.
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Notes
1. CNR is discussed at length below.
2. Franklin (2001a) argues that the term ‘cloning’ now has only pejorative
connotations in popular discourse, and is used as a shorthand term for the
dangers of modern biology.
3. The HGAC (1998) report found that a number of those it consulted found the
distinction between therapeutic and reproductive cloning arbitrary and
meaningless.
4. A UK religious group, the ProLife Alliance, managed briefly to wrestle the
governance of embryonic stem cell research away from the HFEA during
November 2001, when they secured a bizarre ruling from the British High
Court. The Court declaring that embryos produced through CNR were not
embryos, as the term only applied to entities created through ‘natural’
fertilization. The Government was then forced to rush emergency legislation
through both houses of parliament to prevent an outbreak of unregulated
research.
5. Predictably the response to this rather weak compromise has been scathing. As
one Australian bioethical conservative puts it, ‘it enshrines the principle that it
is wrong to benefit from experiments on someone you have killed, but right if
someone else has done it for you’ (Cook, 2001: 13). American scientists are
concerned that the existing lines are too few to offer adequate genetic
diversity, while companies like Geron in the USA and ES Cell International, a
Singaporean/Australian consortium, are poised to negotiate profitable
commercial deals for the use of their product.
6. I am using the term ‘subjectivity’ in a broadly Foucauldian way, where the
subject is understood to be constituted through particular networks of
disciplinary and biopolitical power, materialized in historically specific modes
of embodiment. At the same time the term is intended to evoke the experience
of the self, identity and agency made available within these networks.
7. The terms ‘use value’ and ‘exchange value’ are taken directly from Marx, in his
elaboration of his theory of value in Capital Vol. 1. Use value describes the
usefulness of an object, its physical properties that allow it to be consumed or
do useful work for human beings. Exchange value pertains to the
standardization of value through which one kind of use value can be
exchanged for another. Hence the establishment of exchange value is intrinsic
to the formation of markets and money-based economies.
8. See Kay (2000) for an account of the post-war pure research effort in genetics,
for example.
9. For example, as Rabinow (1999) states, while whole blood was generally
donated through the voluntary gift system in France, blood products like
Factor VIII, a bioengineered clotting agent used to treat haemophilia, were
sourced from commercial, international suppliers.
10. For some examples of this view of the embryo see Mulkay’s article on the
Parliamentary debates around the introduction of the Human Fertilization and
Embryology Act. One opponent of the bill states:
If passed, [the law] will allow the in vitro embryo to be frozen, discarded,
donated, sold and used for destructive research . . . On that basis the
embryonic human being is a . . . another example of the throwaway society
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that says, if it is not useful or convenient, get rid of it. (Cited in Mulkay,
1993: 729)
11. Thanks to Simon Cohen for this point. This position, being one dictated by in
principle opposition to embryo research of any kind, tends to ignore the fact
that ‘spare’ IVF embryos have no possibility of a biography, as they are not
introduced into a uterus where they can become viable pregnancies.
12. Fox and Swazey’s (1992) work, and that of Rosengarten (2001) found that
organ recipients generally experienced powerful feelings of indebtedness,
gratitude, identification and often guilt towards the person whose organs they
receive.
13. Stable, pluripotent stem cell lines were first produced from human embryos
only in 1998 (Thomson, 1998), although they have been established for other
animals for much longer.
14. One of the dystopian scenarios associated with CNR technology is the
production of an anencephalic twin, an immunocompatible donor body
genetically engineered to develop without a brain, which could serve as a
source of whole organs for transplant. Such anencephalic donors are not
strictly dystopian fantasies. In the USA anencephalic neonates have been used
sporadically as sources of organs for infants in need of transplants, with
generally poor success rates and considerable strain for staff and families (Fox
and Swazey, 1992).
15. In The visible human project (Waldby, 2000) I argue that medicine’s privileged
place in humanism derived from the ability of medical biotechnology to
preserve and engineer the body in the service of subjectivity, at least up to a
point. That is, medicine protects the self from dealing with the waywardness of
the body’s materiality, and the impossibility of containing its life within the
confines of culture. Of course this protection is only ever partial, precisely
because illness and death cannot be escaped indefinitely, and because
medicine’s own practices involve subjective encounters with the body’s limits
and recalcitrance.
16. For discussion of human cell lines and their provenance, see Rabinow (1996)
and Erin (1994).
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Author biography
CATHERINE WALDBY is Reader in Sociology and Communications and the Director
of the Centre for Research in Innovation, Culture and Technology at Brunel
University, London. She is also Adjunct Assoc. Professor at the National Centre in
HIV Social Research, University of New South Wales, Sydney. She is the author
of AIDS and the body politic (Routledge, 1996), The visible human project: Informatic
bodies and posthuman medicine (Routledge, 2000) and numerous articles
about science, technology and the body. She is currently researching human stem
cell technologies.
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