October 15 & 16, 2010, Princeton University - Open Hearts, Open Minds & Fair Minded Words - A Conference on Life & Choice in the Abortion Debate 

The conference is inspired by President Obama’s call for those on different sides of the abortion issue  to work together where we agree and engage in “vigorous debate” with “open hearts, open minds, and fair minded words”

Cosponsors:  University Center for Human Values & James Madison Program, Princeton University; Department of Theology, Fordham University; Center for Bioethics, University of Pennsylvania; Bioethics International

Cochairs:  Charles Camosy, Fordham University; Frances Kissling, University of Pennsylvania; Jennifer Miller, Bioethics International; Peter Singer, Princeton University

For more information and to register visit:  http://uchv.princeton.edu/Life_Choice/

Goals and Values of the Conference

1. Explore new ways to think and speak about abortion. Recognizing the divisive nature of the debate, and its larger effect on public discourse, we wish to explore new words, ideas, categories, arguments and approaches for engaging with each other
2. Approach issues related to abortion with open hearts and open minds. We wish to make a concerted effort to engage with each other with the kind of humility and quiet necessary to really listen and absorb the ideas of someone who thinks differently.
3. Define more precisely areas of disagreement and work together on areas of common ground. Some sessions are intended to cut through the confusion and fog of the public abortion debate, by clarifying more precisely areas of disagreement, potentially highlighting areas where we can move forward.
4. Get to know those on multiple sides of the issues more personally. In part because it is often easier to take seriously and listen to those one knows personally, we will self-consciously promote social interaction at this conference through lunches, cocktail hours and breaks.

[Nature] In the ethically fraught field of human-embryo research, Britain’s Human Fertilisation and Embryology Authority (HFEA) has long been regarded as a world leader in regulating and advising scientists.

But now the HFEA faces the axe, and researchers and politicians are chorusing their discontent. “I’m absolutely astonished at this,” says Ruth Deech, an independent member of the House of Lords and former chair of the HFEA. “I think our standing in the world will be reduced.”

Since it was created by the Human Fertilis­ation and Embryology Act in 1990, the HFEA has regulated fertility treatment and research involving human embryos in the United Kingdom (see ‘The development of an embryo agency’). Its work involves inspecting and licensing centres, as well as providing ethical and legal advice to scientists and the public. Scientists have generally applauded the HFEA for providing a clear set of boundaries for what research is permissible. “It’s looked upon as an organization that is often the first to make decisions that define scientific and clinical barriers,” says Justin St. John, director of the Centre for Reproduction and Development at the Monash Institute of Medical Research in Melbourne, Australia. Countries such as Australia and Canada have established similar agencies using the HFEA as a model. “It is the envy of American researchers and biotech companies,” adds Paul Wolpe, director of the Emory Centre for Ethics in Atlanta, Georgia.

The HFEA is threatened because Britain’s new coalition government has pledged itself to a “radical simplification” of the regulatory landscape for public health and medical research. Health secretary Andrew Lansley announced last week that the number of health agencies will be reduced from 18 to “between eight and ten”, to reduce overlap between the bodies and save £180 million (US$285 million). The move is part of a bigger push to make public spending cuts by closing ‘quangos’ — quasi-autonomous non-governmental organizations — many of which perform regulatory functions on behalf of the government.

The government says that the HFEA’s regulatation of fertility treatments will move to the Care Quality Commission, one of the health quangos to survive the cull. But its research licensing work will probably move to a new super-regulator that would also absorb the functions of the Human Tissue Authority (HTA), which oversees organ donation and the use of human tissues in research and teaching. The government says the HFEA and the HTA will be abolished by April 2013.

“I think amalgamation would be a loss,” says St. John, who held an HFEA licence for research using ‘cybrid’ embryos — created by putting human DNA into an empty animal egg — when he worked at the University of Warwick, UK. “You might lose expertise and considerable knowledge.”

If the clinical and research aspects of embryology were divided, “it would risk spreading the available expert advice thinly across two bodies”, says Martin Bobrow, emeritus professor of medical genetics at the University of Cambridge, UK.

After Britain’s previous government mooted similar reforms in 2004, research charities and academics queued up to decry plans to merge the HFEA, the HTA and parts of the Medicines and Healthcare Products Regulatory Agency into a new Regulatory Authority for Tissue and Embryos. Some said the bodies’ functions were too different for a merger to work; others feared the loss of specialist expertise that might result.

The plans were abandoned after a cross-party parliamentary inquiry held in 2007 concluded that the case against a merger was “overwhelming and convincing”. The inquiry heard evidence that the HFEA’s remit was fundamentally different from, and more ethically complex than, the HTA’s. Many of those consulted warned that losing the HFEA as a discrete body could undermine public confidence in the regulations it enforced; and that even as part of a larger organization, it would still need the same resources to operate effectively, limiting any cost savings. Deech, who was on that inquiry committee, says that the merger plan “was comprehensively demolished three years ago for very good reasons, which are just as good today”.

Health hazard

A more immediate casualty of the ‘bonfire of the quangos’ is likely to be the Health Protection Agency (HPA), which provides advice and guidance on infectious diseases and environ­mental hazards. The government says that the HPA’s work will migrate into the Department of Health by April 2012. This has raised alarm bells with some scientists. “Will the new service be able to give advice that is in the best interests of public health, whether or not it conflicts with policy and interests of whatever government is in power?” asks Paul Hunter, a professor of health protection at the University of East Anglia in Norwich, UK. “The HPA currently does a lot of good research that ultimately benefits the public health,” he adds. “Will this still continue in the new service, or if not, how will the gap be filled?” Further details on the reforms are expected after a wide-ranging review of medical-­research regulation by the Academy of Medical Sciences, commissioned by the previous government, is completed this autumn.

Terry understood that focusing on abortion providers was possible because they had become increasingly isolated from mainstream medicine. That was not what physicians themselves anticipated after the Supreme Court’s 1973 decision in Roe v. Wade. An open letter signed by 100 professors of obstetrics and gynecology predicted that free-standing clinics would be unnecessary if half of the 20,000 obstetricians in the country would do abortions for their patients, and if hospitals would handle “their proportionate share.” OB-GYNs at the time emphasized that abortion was a surgical procedure and fell under their purview.

But then most of the OB-GYNs left the stage. After Roe, the shadow of the greedy, butchering “abortionist” continued to hover, and many doctors didn’t want to stand in it. As mainstream medicine backed away, feminist activists stepped in. They set up stand-alone clinics to care for women in their moments of crisis. In many ways, the clinics were a rebel-sister success story. Instead of a sterile and expensive hospital operating room, patients could go to a low-cost clinic with pastel walls and sympathetic staff members. At a Planned Parenthood I visited recently in Rochester, while women were having abortions, they could look at photos of a Caribbean beach, taped above them on the ceiling.

But the clinics also truly came to stand alone. In 1973, hospitals made up 80 percent of the country’s abortion facilities. By 1981, however, clinics outnumbered hospitals, and 15 years later, 90 percent of the abortions in the U.S. were performed at clinics. The American Medical Association did not maintain standards of care for the procedure. Hospitals didn’t shelter them in their wings. Being a pro-choice doctor came to mean referring your patients to a clinic rather than doing abortions in your own office.

This was never the feminist plan. “The clinics’ founders didn’t intend them to become virtually the only settings for abortion services in many communities,” says Carole Joffe, a sociologist and author of a history of the era, “Doctors of Conscience,” and a new book, “Dispatches From the Abortion Wars.” When the clinics became the only place in town to have an abortion, they became an easy mark for extremists. As Joffe told me, “The violence was possible because the relationship of medicine to abortion was already tenuous.” The medical profession reinforced the outsider status of the clinics by not speaking out strongly after the first attacks. As abortion moved to the margins of medical practice, it also disappeared from residency programs that produced new doctors. In 1995, the number of OB-GYN residencies offering abortion training fell to a low of 12 percent.

“Under pressure and stigma, more doctors shun abortion,” wrote David Grimes, a leading researcher and abortion provider of 38 years, in a widely cited 1992 medical journal article called “Clinicians Who Provide Abortions: The Thinning Ranks.” In a 1992 survey of OB-GYNs, 59 percent of those age 65 and older said that they performed abortions, compared with 28 percent of those age 50 and younger. The National Abortion Federation started warning about “the graying of the abortion provider.” In the decade after Roe, the number of sites providing abortion across the country almost doubled from about 1,500 to more than 2,900, according to the Gutt­macher Institute. But by 2000 the number shrank back to about 1,800 — a decline of 37 percent from 1982.

There’s another side of the story, however — a deliberate and concerted counteroffensive that has gone largely unremarked. Over the last decade, abortion-rights advocates have quietly worked to reverse the marginalization encouraged by activists like Randall Terry. Abortion-rights proponents are fighting back on precisely the same turf that Terry demarcated: the place of abortion within mainstream medicine. This abortion-rights campaign, led by physicians themselves, is trying to recast doctors, changing them from a weak link of abortion to a strong one. Its leaders have built residency programs and fellowships at university hospitals, with the hope that, eventually, more and more doctors will use their training to bring abortion into their practices. The bold idea at the heart of this effort is to integrate abortion so that it’s a seamless part of health care for women — embraced rather than shunned.

This is the future. Or rather, one possible future. There’s a long way to go from here to there. Between 2000 and 2005, the last year that statistics are available, the number of abortion facilities in the U.S. dropped 2 percent — a smaller dip than those in the preceding five-year periods, but a decline nonetheless. “The ’90s were about getting abortion back into residency training and medical schools,” says Jody Steinauer, an OB-GYN professor at the University of California at San Francisco, the hub of the abortion-rights countermovement in medicine. “Now it’s about getting abortion into our practices.”

THE INITIAL PUSH TO lift the status of abortion in medicine came from the profession’s most junior members. In 1992, Steinauer started medical school at U.C.S.F. In the spring of her first year, she and thousands of other students received a mailing at home called “Bottom Feeder.” It made racist jokes and included this exchange: “Q: What would you do if you found yourself in a room with Hitler, Mussolini and an abortionist, and you had a gun with only two bullets? A: Shoot the abortionist twice.”

Distressed by the mailing, Steinauer started talking to students at other schools about how abortion wasn’t the topic of a single class. She took a year off and started the group Medical Students for Choice. Soon chapters throughout the country began pushing to add lectures about abortion to the medical-school curriculum. “Not everyone has to do abortion, but everyone has to think about it,” Steinauer says today of M.S.F.C.’s philosophy. The point is to recruit not only future abortion providers but also the supporters they’ll need inside medicine later in their professional lives. M.S.F.C. now has 10,000 members. “You know, all these students going into dermatology or radiology — if you’re an OB who wants to provide and your hospital won’t let you, they’re the ones you want as your allies on the hospital board,” Steinauer says.

The next important moment came in 1995. With new studies showing how low the training rates for residents had fallen, the National Abortion Federation, with M.S.F.C. as an ally, began pushing for change. The Accreditation Council for Graduate Medical Education — which represents the medical establishment — decided, for the first time, to make abortion training a requirement for all OB-GYN residency programs seeking its accreditation. The anti-abortion movement tried to smother the new mandate. The following year, Congress passed the Coats Amendment, which declared that any residency program that failed to obey the Accreditation Council’s mandate could still be deemed accredited by the federal government. But the council had spoken, and medical schools and teaching hospitals listened. Today, about half of the more than 200 OB-GYN residency programs integrate abortion into their residents’ regular rotations. Another 40 percent of them offer only elective training.

To establish a secure foothold in academic medicine, abortion-rights supporters knew that along with residency programs they needed the kind of advanced training that attracts the best doctors and those who want to join medical-school faculties. A physician at the U.C.S.F. medical school set up the Family Planning Fellowship, a two-year stint following residency that pays doctors to sharpen their skills in abortion and contraception, to venture into research and to do international work. In recent years, the fellowship has expanded to 21 universities, including the usual liberal-turf suspects — Harvard, Columbia, Johns Hopkins, Stanford, U.C.L.A. — but also schools in more conservative states, like the University of Utah, the University of Colorado and Emory University in Georgia.

When Salt Lake City and Atlanta are home to programs that train doctors to be expert in abortion and contraception, the profession sends a signal that family-planning practices are an accepted, not just tolerated, part of what doctors do. That helps draw young physicians. The first generation of providers after Roe took on abortion as a crusade, driven by the urgent memory of seeing women become sick or die because they tried to induce an abortion on their own, in the days before legalization. Out of necessity, the doctors pushed ahead with little training or support. “We did it by the seat of our pants,” says Philip Ferro, an 82-year-old OB-GYN at the S.U.N.Y Upstate Medical University in Syracuse. “There was no formal source of knowledge.”

As Ferro wryly puts it, “That would not stand today.” Abortion and contraception have become the subjects of rigorous, evidence-based research. The younger doctors who are coming through the residency training programs and the Family Planning Fellowship “have invigorated this field beyond my greatest expectations,” Grimes, the researcher and abortion provider, says. “We are cranking out highly qualified, dedicated physicians who are doing world-class research. There is a whole cadre of people. I helped train some of them, and I’m very proud of that. In the 1980s, I wasn’t sure who would fill in behind me when I retired. I’m much more optimistic now.”

Many of the protégées Grimes is talking about are women. In the first generation after Roe, abortion providers were mostly men because doctors were mostly men. Since then, women have streamed into the ranks of OB-GYN and family medicine. They are now the main force behind providing abortion.

THE PROVIDERS THAT make up the new vanguard don’t define themselves as “abortion doctors.” They often try to make the procedure part of their broader medical practice — by spending much of their week seeing patients for general gynecology or primary-care visits, and by being on call on the labor and delivery floor. If the young doctors succeed at making abortion mainstream and respected within medicine, abortion could move from clinics to doctor’s offices and hospitals. And if that happened, would the politics surrounding it finally change? Would protesters stand outside a hospital or a primary-care clinic or a group practice that treats all kinds of patients?

By taking jobs on university faculties, the young doctors avoid walking to work through a scrum of screaming demonstrators. “Some people like to live on the edge — I don’t,” said Emily Godfrey, a 40-year-old doctor who practices at a primary-care clinic at the University of Illinois at Chicago, where she also does abortions. “I’m a Catholic girl from the suburbs. I’m a yoga student. I like calm and serenity.”

Godfrey is tall and graceful, with auburn hair and freckles. She decided as a child she wanted to be a doctor. In her favorite course as an undergraduate at the University of Wisconsin, on the history of women in medicine, she read rejection letters that Harvard Medical School once wrote to women applicants who were turned down because they would someday marry. Godfrey started at the Medical College of Wisconsin in 1993, the same year that Jody Steinauer founded Medical Students for Choice. Godfrey put most of her extracurricular energy into working with domestic-violence victims. But as a third-year student, she went to an M.S.F.C. meeting at which an internist who did abortions suggested a book called “The Story of Jane.” It was about a few women in Chicago, in the years before Roe, who were furtively trying to help other women in their desperate search for illegal but safe abortions. Godfrey still has her copy. “Women had to meet strange men who were supposedly doctors in a hotel room or in somebody’s kitchen,” she recalled. “To ask a woman to show up secretly like that and hope some guy won’t take advantage of you — to me, it was horrible. I started thinking that I wanted to be the one to make sure that women in that situation could be dignified.”

After graduation, Godfrey started her family-medicine residency in a hospital on Chicago’s West Side. It bordered gang territory. On her obstetrics rotation, Godfrey delivered baby after baby to poor women who seemed overwhelmed. Some were drug addicts. “Bringing so many unwanted children into the world, or children who wouldn’t be readily provided for because their mothers were on drugs or who were taken away at birth — well, that just solidified my feeling that I wanted to provide abortions,” she told me. Godfrey read up on contraception and learned that IUDs can be safely inserted right after delivery. But Medicaid refused to pay for a delivery and this second procedure in one day. “Many of my patients were getting pregnant again, without intending to, and it was extremely frustrating,” she says.

When a friend gave her a flier about the Family Planning Fellowship, Godfrey saw it as a way to learn a skill she wanted to have, try her hand at research and travel abroad. Most Family Planning fellows are OB-GYNs; Godfrey was one of the first family-medicine doctors in the program. Family physicians deliver babies, set broken arms, remove precancerous moles. Because they’re more likely than specialists to work in rural areas, they are for abortion-rights advocates the best hope of bringing more providers to the parts of the country where hundreds of miles roll by without one.

Godfrey spent the two years of her Family Planning Fellowship at the University of Rochester, where she did enough abortions to “train to competency,” the term for doing a sufficient number of supervised abortions to be fully qualified to do the procedure alone. The rate of complication for first-trimester abortions that require hospitalization is so low (fewer than 1 in 100) that doctors often have to do the procedure scores of times to learn what to do when something goes wrong.

Godfrey also went to Nicaragua and Mexico to learn about those countries’ reproductive-health services and to the World Health Organization in Geneva to do research. Now she’s publishing W.H.O. data on using the IUD, inserted after unprotected sex, as emergency contraception. (It works surprisingly well, though it’s not yet entirely clear how.) The fellowship’s international component means that young doctors see the kind of suffering that their predecessors saw in the U.S. before Roe. “In Kenya, a woman came with a stick hanging out of her,” says one doctor whose fellowship took her to Africa so she could train nurses to treat complications from illegal abortions. “You bring in this inexpensive, reusable equipment to places without electricity or running water, and you teach nurses to use it, and you save women’s lives.”

The first fellowship-trained doctors mostly took jobs in cities that were already flush with abortion providers — San Francisco, New York, Boston. Now positions in those places are filled, and the fellowship alums, who number more than 20 per year, are spreading out. In Chicago and even Rochester, there isn’t one lone fellowship-trained physician. There are clusters. They go out for drinks together. Nationally, the fellows have annual meetings and an e-mail list on which they ask one another’s advice. “More than anything, what’s hard about this work is that there aren’t a lot of people you can talk to about it,” says Sunni, a colleague of Godfrey’s and a 40-year-old OB-GYN whose parents immigrated to the United States from South Asia. “That’s probably the most important thing we do for each other.”

Godfrey and Sunni (who asked to be identified by a nickname to protect her privacy) have known each other since they met eight years ago when they were both fellows. The three of us had lunch together in April. Godfrey talked about the first job she took after she finished her fellowship and went back to Chicago. While she looked for a position on a medical-school faculty, she worked one day a week at an abortion clinic 90 miles away in the northern Illinois town of Rockford. The doctors there were the only providers within miles.

The owner of the Rockford clinic was Richard Ragsdale, a Vietnam veteran who’d opened his doors the day after Roe v. Wade was decided. The first time Godfrey came to work, Ragsdale wasn’t there. A nurse showed Godfrey old-fashioned metal instruments that she’d never seen before. Godfrey made do as best she could. Before she could come back to meet Ragsdale the following week, he died. “They called me and asked, ‘Are you our doctor now?’ ” she remembered over lunch.

For the next two years, Godfrey drove to Rockford one day a week. Once she prescribed birth control for her first patient, everyone in town knew her as the new abortion doctor. Protesters surrounded her when she walked into the clinic. One day, a clinic resident left his lunch in the car and said he’d rather be hungry than go back to get it.

Godfrey tried to act tougher than she felt, but the work wore on her. Meanwhile, an OB-GYN in his 60s started working at the clinic, and his unruffled calm seemed like a rebuke. “The older docs — those guys knew how to stand on their own two feet,” she said. “He was immune to everything. But emotionally, for me, it was too hard.”

And then one snowy day in 2007, Godfrey had a patient with a serious complication who needed to go to the hospital. She called the OB-GYN who was supposed to be on call. He was out of town. She called Sunni, who told her to get the patient to the local hospital. But Godfrey had no admitting privileges there, and the doctor on call seemed unwilling to admit the patient. “She said, ‘How dare you come here,’ ” Godfrey remembered. She looked down at her salad, her face flushed.

“You were really out there all alone,” Sunni said.

Godfrey nodded. “Yeah, I remember you said that,” Godfrey said. “And I was like, God, you’re right.” Godfrey called George Tiller, the veteran abortion provider who was later killed at his Kansas church in 2009, to ask his advice. He told her to call an ambulance and send the patient to the hospital.

Godfrey did, and the woman was admitted; she got the care she needed, and in the end she was fine. But Godfrey was shaken. So was Sunni, who told us about a dream she had after that tense day about Godfrey going back to Rockford. “The clinic got destroyed somehow. I saw you in the rubble, still working. And I said: ‘This is ridiculous! Come home!’ ”

A year later, Godfrey stopped going to Rockford. By then she had started at the University of Illinois as an assistant professor of family medicine. This is the job that allows her to be an abortion provider with “a normal life,” as she puts it. “You know what, I’m a single woman who still wants to get married,” she says. “I will not be flying and driving around rural Midwest America. I’m not willing to be out on that frontier.”

IN 1999, UTA LANDY, a former director of the National Abortion Federation, and Philip Darney, her husband and an OB-GYN professor at U.C.S.F., created the Kenneth J. Ryan Residency Training Program. The program gives medical schools two or three years of seed money for abortion training for OB-GYN residents. Through it, 58 campuses in the U.S. and Canada have received financing. Landy also directs the Family Planning Fellowship, with Jody Steinauer as the associate director.

When I e-mailed Landy in January to set up an interview, she wrote back that her policy is not to speak to the press. Steinauer explained that the organization fears that the publicity might scare away a university considering a Ryan or fellowship grant. Or it might spook the donor, other doctors told me.

The money for the Ryan and the Family Planning Fellowship comes from one foundation and from one family. The donor has chosen to remain anonymous, which helps to explain why there’s been so little publicity about the pro-choice strategy of bringing abortion into academic medicine. It has been covered by a veil of semisecrecy.

At the same time, as the Ryan and the fellowship have expanded to dozens of institutions, many people have come to know about the source of funding. In the course of my reporting, two doctors who had not done the fellowship themselves, but who work in universities, volunteered to me that the money for the programs comes from the Buffett Foundation. They meant the Susan Thompson Buffett Foundation.

Susan Thompson Buffett was married to Warren Buffett and served as president of the foundation that bears her name. She died in 2004. Two years later, Warren Buffett gave the foundation about $3 billion. He said that he expected the gift to increase the foundation’s annual expenditures by $150 million. And in fact, total giving by the foundation, where two of the Buffetts’ children sit on the board, increased from $202 million in 2007 to $347 million in 2008, according to tax returns.

The tax records also show that most of the foundation’s spending goes to abortion and contraception advocacy and research. According to Access Philanthropy, a research institute that focuses on the giving preferences of foundations and corporate donors, family planning is one of the Susan Thompson Buffett Foundation’s main purposes. The foundation’s nonprofit 990 tax form shows that in 2008, Planned Parenthood and its affiliates in the U.S. received about $45 million; the international arm of the organization got about $8 million. There is no line item for the Ryan program or the Family Planning Fellowship. But the foundation paid out around $50 million to universities with one or both of the programs.

Warren Buffett has never spoken publicly about his views on abortion. But in the 1990s, according to The Wall Street Journal, the Buffett Foundation helped finance the research and development of the pills that induce abortion. The foundation also helped finance a lawsuit to overturn the ban on so-called partial-birth abortion in Nebraska, Buffett’s home state and the headquarters of his company, Berkshire Hathaway. (Susan Thompson Buffett moved from Omaha to San Francisco in 1977 but remained close to her husband. She took credit for introducing him to the woman he has lived with since 1978; the three sent out Christmas cards together.) In Thompson Buffett’s only television interview, which was broadcast after her death, she told Charlie Rose: “Warren feels that women all over the world get shortchanged. That’s why he’s so pro-choice.”

Buffett hasn’t been a target of heated protest — his plainspoken Midwestern persona and his enormous wealth may make him the wrong enemy for anti-abortion advocates. But in 2001, a right-wing activist named Thomas Strobhar showed up at Berkshire Hathaway’s annual meeting with a shareholder resolution objecting to donations to Planned Parenthood, via a program that allowed shareholders to make gifts through the company to charitable organizations of their choice. Buffett ended the giving program two years later.

In 2006, Buffett announced his $3 billion gift to the foundation in a letter that’s written in a kind of code. He and his late wife had established the foundation, he wrote, “to focus intensely on important societal problems that had very limited funding constituencies.”

“You mean you didn’t know Warren Buffett’s foundation has been funding abortion-rights organizations?” NPR reported at the time. “Well, that’s just the way the Buffetts wanted it.” The Web sites for the Family Planning Fellowship and the Ryan program are also discreet. A private log-in is required to read more than basic information.

The foundation could have been straightforward about its work from the start. Instead, according to some doctors involved with the programs, a low profile eased the way for universities to sign on for the fellowship and the Ryan. Landy and others administrating the grant programs continue to express concerns about the implications of publicity (including this article). Buffett and Allen Greenberg, the director of the foundation, and Buffett’s former son-in-law, declined to speak to me on the record.

And yet for all the anxiety about being in the spotlight, the surprising truth is that however embattled abortion remains in America at large, at the top of academic medicine, the structure built to support it looks secure. David Grimes, the researcher, is on the committee that chooses the Family Planning fellow at his university, and this year, he said, there were so many well-qualified candidates that they turned some down. Grimes surveys the terrain — the annual meetings with presentations of top-flight research, the schools where Medical Students for Choice and residency training and the Family Planning Fellowship are flourishing — and says with satisfaction: “A few things have happened to turn it all around. Thanks to the donor, I think it’s all here to stay.”

Medical schools that host the Ryan and the fellowship have, however, experienced the occasional protest. Last fall, an anti-abortion newsletter reported that the Family Planning Fellowship had come to Washington University in St. Louis. (In fact, the fellowship began there in 2007.) The author, Joe Ortwerth, posted the names and mailing addresses of key “decision makers,” including the chancellor and chairman of the board of Washington University. “You may wish to contact them to urge that they put an end to this shameful and insidious relationship with Planned Parenthood,” Ortwerth wrote. “Please pray for them as you send such messages that they will receive your communication with an open heart.” The newsletter later reported that the Family Planning Fellowship had posted on its Web site that Wash. U. was running the fellowship in collaboration with St. Louis University, a Catholic school.

In The St. Louis Post-Dispatch, St. Louis University denied any involvement. Washington University apologized for the mention of St. Louis University on the fellowship Web site. In a letter to the editor published in The Post-Dispatch, Ortwerth wrote, “It is shameful for Washington University to attempt to dignify the dirty business of abortion by awarding academic fellowships to future abortionists.”

The flap ended there, and Washington stuck with the fellowship. Still, such controversy isn’t welcome at most universities. The doctors who run the Ryan and fellowship programs aren’t trying to hide, they say. But they don’t want to be singled out. When I asked to visit medical schools where doctors like Godfrey are performing abortions, some of them asked not to be the only university I mentioned. “We want to fight the battle, but not all of us are martyrs,” said Leo B. Twiggs, chair of the OB-GYN department at the University of Miami in Florida, where two fellowship-trained doctors perform first- and second-trimester abortions as part of their gynecology practice. “Everyone was nervous when you asked to come. We basically said that if we really believe in what we’re doing, we should be able to talk about it. But we don’t want to be especially known for pregnancy termination.”

Many of the two dozen young doctors I talked to for this article were similarly conflicted. They wanted to talk about their work. They see it as part of making abortion mainstream. But the murder of Dr. George Tiller last year scared them. One 33-year-old family-medicine doctor I met in Rochester drives 90 miles each week to perform abortions at a clinic in Syracuse. She is pregnant with her third child, and she asked me not to use her name after her father insisted that she’d be putting herself and her kids at risk. Still, at her Episcopal church, where she feels safe, she is open about what she does. “When people are surprised, I say, ‘Yes, a Christian can also be an abortion provider,’ ” she told me.

EMILY GODFREY, too, has reckoned with the sensitivity of her line of work. She was brought up in a casually Catholic home in which abortion wasn’t discussed. Her mother strongly supports her. Privately, her father does, too. But while he thanked her for telling him when she won a local award for her work, he didn’t come to the ceremony.

Godfrey has treaded carefully at the University of Illinois. When she joined the faculty, she got a grant to train residents to do abortions. (The money came from a sister program to the Ryan for family physicians, called the Center for Reproductive Health Education in Family Medicine.) But Godfrey started slowly: during her first year, in 2006, she handled only primary-care visits at the university-run clinic where she sees patients two days a week. She stressed contraception, increasing the number of patients getting IUDs — one of the most effective forms of birth control — from fewer than 15 to more than 90 a year.

As Godfrey came to know the nurses and front-desk staff at her primary-care clinic, she learned that some of them flatly opposed abortion. They’ve come around, she says, out of mutual professionalism. She doesn’t object when nurses don’t want to assist her, and she tries to meet them halfway by doing abortions only up to nine weeks of pregnancy. The early threshold means that no one on staff has to contend with recognizable fetal parts. “It was a way of being respectful, because I know that not everyone agrees with me and what I do,” she says. After I watched Godfrey coach one of the residents she trains through a surgical abortion for a 22-year-old college student who was six weeks pregnant, we went to the clinic’s utility room. The resident floated the pregnancy tissue in a glass dish of water, for a routine check. Amid the uterine tissue was a gestational sac about the size of a dime surrounded by millimeters-long white villi, the fronds that later help form the placenta.

In the clinic’s waiting room, it’s impossible to tell who has come because of a stuffy nose or chest pain, or for birth control. In this setting, Godfrey can take care of a pregnant woman whether she chooses to keep the baby, put it up for adoption or end the pregnancy. To her, this is the core of an integrated practice. “I have nothing to gain or lose whatever my patient decides,” she told me. “I’m just being her advocate and her family physician.”

A first-trimester abortion is low-risk, relatively simple and fast — a skilled doctor can do it in less than five minutes. It’s the traditional province of OB-GYNs, but it also fits easily within the scope of care of family-medicine doctors, who do other minor procedures, like endometrial biopsies, which screen for uterine cancer. So far, only a small number of the family-medicine residencies offer abortion training. But those programs are attracting applicants — they have higher match rates, which means greater success in recruiting the residents they want.

Technological advances have made it easier to shift abortion to the earlier stages of pregnancy. Tests have become sensitive enough to detect pregnancies two weeks after conception. The M.V.A., or manual vacuum aspirator, is gradually replacing the electric pump as the equipment of choice for first-trimester procedures. It’s about 10 inches long, costs only $30 and looks like the kind of appliance you might find in a kitchen drawer. Lawrence Leeman, a family physician at the University of New Mexico, describes how he convinced skeptical nurses that their primary-care clinic could handle abortion by coming to a meeting with his M.V.A. supplies in his coat pocket. Even smaller, of course, are the pills for a medical abortion.

Most facilities that offer surgical abortions now offer medical ones too. And in fact, Godfrey also does medical abortions up to nine weeks: she gives patients the pills misoprostol and mifepristone (formerly known as RU-486) and sends them home for an induced miscarriage, with a follow-up visit to make sure there are no complications. When the Food and Drug Administration approved medical abortion 10 years ago, abortion-rights advocates hoped that the method would move into the offices of doctors who don’t do surgical abortions. That shift hasn’t much happened. But medical abortion has helped to increase the number of very early abortions. It has long been an abortion-rights selling point that almost 90 percent of the abortions in the U.S. are performed before 12 weeks; in addition, four years ago, the proportion of procedures performed before 9 weeks reached 62 percent. The statistic points to a paradox: Anti-abortion advocates succeeded in focusing the country’s attention on graphic descriptions and bans of late-term abortion even as more and more women were ending their pregnancies earlier and earlier.

DOCTORS WHO PERFORM abortions are startled by some poll numbers showing that for the first time, more Americans call themselves pro-life than pro-choice — a shift that includes young people. I saw hints of that discomfort. Medical residents with a moral or religious objection can always choose not to participate in abortion training, and in Godfrey’s program this year, four out of seven did not take part. When I visited the Planned Parenthood in Rochester, a 29-year-old pediatric resident came to watch the nurses counsel patients about their options but chose not to see an actual abortion. “I don’t know how I personally feel morally, and I’m never going to do one,” she said. “So if it could bother me if I saw one, then what’s the point?”

Godfrey trains her residents to do abortions up to 13 weeks by taking them one afternoon a week to a hospital where her colleague Sunni runs an abortion service as part of her OB-GYN practice. When the residents finish their training, Godfrey asks them how they feel about doing the procedure at 7 or 10 or 13 weeks. “Some will say, ‘I’m perfectly O.K. going up to 10 weeks, but after that I can see more of the fetus moving on an ultrasound, and I’m just not comfortable with that.’ ” She has set her own threshold at 14 weeks. “I’m not an OB-GYN, and I’m not a surgeon, and that’s as far as I can safely go,” she said. “But to be honest with you, I haven’t seen a lot of terminations past 19 weeks. There’s a part of me that’s almost grateful that it’s not even an option for me.”

These gradated choices are a delicate subject within the field. The abortion providers I talked to are intensely grateful to the doctors who are willing to handle difficult late-second-trimester cases. But they also see the moral complexities up close. Two years ago, a young professor at the University of Michigan named Lisa Harris wrote an academic article about performing an 18-week abortion while she was 18 weeks pregnant. Harris described grasping the fetus’s leg with her forceps, feeling a kick in her own uterus and starting to cry. “It was an overwhelming feeling — a brutally visceral response — heartfelt and unmediated by my training or my feminist pro-choice politics,” she wrote. “It was one of the more raw moments in my life.”

Other abortion providers have sorted through related issues. When Sunni was pregnant, some of her patients asked how she could perform an abortion while she was carrying a child. “I said: ‘There’s a time for everything. This is my time. Yours may come later.’ ” When Harris’s article was the subject of a workshop at one of the Family Planning Fellowship’s annual meetings, Sunni remembers the difficult emotions that came to the surface, and also the concern about how the article had been depicted in the anti-abortion press, it’s most graphic passages quoted as evidence of hypocrisy and folly. “We want to bring this discussion more to the forefront,” Sunni says. “But it’s a bit dangerous. Because people can misconstrue what we mean.”

SINCE BEFORE THE days of Roe v. Wade, a small number of doctors have quietly provided abortions in their offices (often only for patients with health insurance or who pay out of pocket). Their numbers have dwindled: in 2005, the Guttmacher Institute counted 367 abortion providers in doctors’ offices nationwide, down from more than 700 in 1982. Doctors’ offices now account for only 2 percent of the total number of procedures; hospitals account for barely 5 percent.

This highlights the challenge of making abortion truly mainstream — of moving beyond residency training and outside the haven of medical-school faculties, so that more doctors offer abortions when they join a regular OB-GYN or primary-care practice. As yet, all the success in training new doctors hasn’t translated into an increase in access. Abortion remains the most common surgical procedure for American women; one-third of them will have one by the age of 45. The number performed annually in the U.S. has largely held steady: 1.3 million in 1977 and 1.2 million three decades later. In metropolitan areas, women who want to go to their own doctor for an abortion can ask whether a practice offers abortion when they choose an OB-GYN or family physician. But in 87 percent of the counties in the U.S., where a third of women live, there is no known abortion provider.

OB-GYNs who learn to do abortions during residency are more likely to offer the procedure when they go off to practice, according to a 2008 study that Jody Steinauer helped write. And yet a study published this month, which she helped conduct (along with Darney, Landy and Lori Freedman of U.C.S.F.) offers an explanation for why the numbers of providers have continued to fall: the shift to group medical practice. The authors interviewed 30 OB-GYNs with abortion training. Eighteen said they wanted to provide abortions after residency. But 15 of them weren’t actually doing so. One doctor from a midsize city in the Midwest described her job interview at a group practice: “The one partner who’s very senior in the group and very pro-life, basically his only job is to sit with you and just tell you . . . ‘If you join this group, you will not be performing abortion procedures. And if that’s a problem for you, then you will work elsewhere. O.K.?’ ” Another doctor from the suburbs of a big Western city said that she refers her patients to Planned Parenthood. “Actually, in my first couple of months in practice, the people that are in my office here told me, ‘Don’t even bother,’ ” she said of wanting to perform abortions. For family-practice doctors, medical-malpractice insurance is an additional barrier. According to one 2008 study, coverage for abortion often costs them an extra $10,000 to $15,000 a year.

Even doctors who practice solo and have all the insurance they need can find themselves in delicate negotiations over abortion. Ray, who is in his 30s, is an OB-GYN in upstate New York who learned to do abortions during his residency. As a teenager, Ray (who asked that I use only his middle name) saw his brother’s fear when he got his girlfriend pregnant. Race also mattered in Ray’s decision to become a provider; he is African-American. “We utilize the service a lot, but publicly we don’t really support it,” he said of the local black community.

We talked in his office, which was simple and old-school: issues of Redbook and Good Housekeeping were in the racks in the waiting room. The office is in a building that has a volatile history. In the early 1990s, protesters from Operation Rescue came frequently to the building to protest the presence of an outspoken OB-GYN who provided abortions. When Ray took over a different practice in the building, he decided to get hospital privileges so he could schedule surgical abortions in the O.R. He also wanted to give patients the pills for a medical abortion in his office.

But first Ray sat down to talk with Ann, the nurse who’d worked for more than 25 years in the practice. Now in her early 60s, Ann (her middle name) is a Catholic grandmother who celebrates Mass every Sunday. She was adamantly opposed to abortion. She was also a fixture in the office; she knew all the patients. “Here I am, a young doctor, taking over an old practice with a lot of women patients who have kids my age,” said Ray, who has children of his own. “I needed someone to back me up when I got here. She did that for me. I didn’t want to let her go.”

And so Ray and Ann worked out a compromise: He would handle the abortion patients entirely on his own. When a woman calls to ask for a termination, Ann and the office manager take down the patient’s name and number and then have nothing more to do with the case. Ray does the scheduling, counseling and billing along with the care. He and Ann agreed that when he did medical abortions, he would give the patients the pills in the office, because the women actually ended their pregnancies at home. “We have a mutual understanding: no surgical abortions here, and we treat medical abortion as a gray area,” Ray says.

When I talked to Ann — Ray offered her his office chair while he saw a patient — she said that when Ray took over the practice, she and the office manager, another woman in her 60s, weren’t sure if they would stay. “We didn’t want a young doctor with attitude,” Ann said. “We’re too old for that. But we gave him a chance. And he has exceeded our expectations wildly. I thank God every day, because he’s so good with the patients. I’m just blessed. Other than the little termination thing — ” she made a small box with her fingers and then moved her hands to her left, as if to set the box aside.

Ann reassures herself that Ray is never casual about abortion. “He makes the women think about it longer, to make sure they know this is something you have to live with forever.” She also told me something Ray hadn’t mentioned. “If a patient calls and she’s not sure, I ask, ‘Have you looked into other things?’ I say, ‘Come in and let’s talk.’ I tell her that if adoption might be a difficult situation, there is other help out there. I may refer her to a crisis pregnancy center” — an anti-abortion organization that counsels pregnant women to keep their babies. In 2006, Congressional investigators found that most federally financed crisis pregnancy centers they contacted gave out wrong information like tying abortion to breast cancer or infertility or mental illness. Yet as part of the compromise between doctor and nurse, that is where Ann says she refers some women who call Ray’s office.

At the same time, Ray is on guard for the warning signs that a pro-life activist is posing as a patient: the woman who calls at an odd time of day close to the anniversary of Roe v. Wade, or who says that her name is “Rebekah, spelled the Biblical way,” or who seems too motivated. “When Operation Rescue was in the building, it was borderline terrifying,” Ann told me. “Seriously. You didn’t know — would there be a pipe bomb? I don’t want the doctor to get in trouble. I don’t want to go back to that.”

EVEN IF DOCTORS like Ray were to suddenly multiply, stand-alone abortion clinics would still be the mainstay of abortion provision in the U.S. for the foreseeable future. For one thing, the clinics are efficient and relatively low cost. For another, “training to competency” demands a high volume of patients for residents to treat. Most hospitals and doctor’s offices do dozens or at the most hundreds of abortions a year. High-volume clinics do thousands.

Given the importance of the clinics, many abortion-rights physicians would like to pull them into the medical-school orbit. At the moment, universities tend to keep clinics at arm’s length. If they send residents for training, it’s sometimes for an off-site rotation that the medical-school faculty does not supervise. But the relationship can be closer.

I went to visit Rachael Phelps, who is the associate director of Planned Parenthood for the Rochester/Syracuse region and a fellowship-trained doctor who works in a stand-alone clinic. She is a pediatrician with a special interest in adolescent reproductive health. Phelps, who is 40, has flower stickers plastered on the E-ZPass on her windshield. She is steely, though: she does the kind of job that many other doctors shy away from — she walks or drives by protesters every day. When we ate lunch at a restaurant down the street from her office, they waited for her outside. “Dr. Phelps, you kill babies and hurt women,” one shouted as she walked past. “What’s the matter with you?”

Before Phelps became a doctor, she was a patient. As a teenager, she developed endometriosis, a painful, scarring condition with no known cause in which the cells that line the uterus — and sometimes other parts of the body — grow out of control. Phelps’s case went undiagnosed for years. During her first year of medical school, at Johns Hopkins, she had major abdominal surgery to reconstruct her ovaries, which had been damaged by the spreading uterine cells. But nine months later, the endometriosis had spread again. The only treatment option left was a hysterectomy and removal of her ovaries. She was 23. Her doctors balked. “The doctors didn’t have the guts to say it,” she says. “I had to beg for the thing I didn’t want. I promised myself that if I ever got well enough to finish medical school, I would never do that to a patient.”

At Planned Parenthood, Phelps can throw herself into that promise. “Women who come to us for abortions are sometimes scared and upset and heartbroken,” she says. They often have young children at home. “If I have the capability to help them, then I should do it. Because most people will not. So if I’m willing, how can I stand by?”

While doctors like Godfrey bring abortion into academia, Phelps is bringing academia to abortion. She has been working with two members of the University of Rochester OB-GYN faculty to start a joint program for residents. The idea is for all three physicians to work alongside one another at Planned Parenthood while they train younger doctors — another kind of mainstreaming.

IF YOU THINK of the effort to increase training and access to abortion as a marathon, has it reached the halfway point? I asked Rachael Phelps a version of this question when she dropped me off at the Rochester airport. She looked out the window, at all the people whom she wished could feel the urgency she does, and pointed out that change in medicine comes slowly. “It takes 10 years from the beginning of medical school to get someone fully trained,” she said. “Remember, we’ve had a lot of catching up to do.” She brightened, mentioning a family-planning faculty position at Syracuse University that had just been filled after a three-year search. “It is changing,” she said. “When I was in medical school, there was no curriculum, no national conferences with exposure to speakers with amazing training. Now I’m here, and so are my colleagues at the university, and we have this new person coming to Syracuse. It’s so much easier when you’re not on your own.”

Emily Godfrey, too, is looking ahead. She’s about to apply for tenure — the only clinical faculty member in her department to do so. “You know, we’re now getting to the point where the people in our cohort are starting to take on these positions at the senior level,” she said. “It kind of makes you laugh, to think of yourself like that. But we see the new residents and fellows coming in, and we have a whole structure set up for them.”

We were talking in the office of one of Godfrey’s OB-GYN colleagues. The door opened, and a 33-year-old family-planning fellow walked in. She and Godfrey conferred about a paper they’re writing together. Then the younger doctor hurried off. She had patients to call.

While such work can evoke images of Frankenstein-like scientific tinkering, it also is exciting hopes that it could eventually lead to new fuels, better ways to clean polluted water, faster vaccine production and more.

Is it really an artificial life form?

The inventors call it the world’s first synthetic cell, although this initial step is more a re-creation of existing life — changing one simple type of bacterium into another — than a built-from-scratch kind.

But Maryland genome-mapping pioneer J. Craig Venter said his team’s project paves the way for the ultimate, much harder goal: designing organisms that work differently from the way nature intended for a wide range of uses. Already he’s working with ExxonMobil in hopes of turning algae into fuel.

“This is the first self-replicating species we’ve had on the planet whose parent is a computer,” Venter told reporters.

And the report, being published Friday in the journal Science, is triggering excitement in this growing field of synthetic biology.

“It’s been a long time coming, and it was worth the wait,” said Dr. George Church, a Harvard Medical School genetics professor. “It’s a milestone that has potential practical applications.”

Following the announcement, President Barack Obama directed the Presidential Commission for the Study of Bioethical Issues he established last fall to make its first order of business a study of the milestone.

“The commission should consider the potential medical, environmental, security and other benefits of this field of research, as well as any potential health, security or other risks,” Obama wrote in a letter to the commission’s chairwoman, Amy Gutmann, the president of the University of Pennsylvania.

Obama also asked that the commission develop recommendations about any actions the government should take “to ensure that America reaps the benefits of this developing field of science while identifying appropriate ethical boundaries and minimizing identified risks.”

Scientists for years have moved single genes and even large chunks of DNA from one species to another. At his J. Craig Venter Institute in Rockville, Md., and San Diego, Venter’s team aimed to go further. A few years ago, the researchers transplanted an entire natural genome — the genetic code — of one bacterium into another and watched it take over, turning a goat germ into a cattle germ.

Next, the researchers built from scratch another, smaller bacterium’s genome, using off-the-shelf laboratory-made DNA fragments.

Friday’s report combines those two achievements to test a big question: Could synthetic DNA really take over and drive a living cell? Somehow, it did.

“This is transforming life totally from one species into another by changing the software,” said Venter, using a computer analogy to explain the DNA’s role.

The researchers picked two species of a simple germ named Mycoplasma. First, they chemically synthesized the genome of M. mycoides, that goat germ, which with 1.1 million “letters” of DNA was twice as large as the germ genome they’d previously built.

Then they transplanted it into a living cell from a different Mycoplasma species, albeit a fairly close cousin.

At first, nothing happened. The team scrambled to find out why, creating a genetic version of a computer proofreading program to spell-check the DNA fragments they’d pieced together. They found that a typo in the genetic code was rendering the manmade DNA inactive, delaying the project three months to find and restore that bit.

“It shows you how accurate it has to be, one letter out of a million,” Venter said.

That fixed, the transplant worked. The recipient cell started out with synthetic DNA and its original cytoplasm, but the new genome “booted up” that cell to start producing only proteins that normally would be found in the copied goat germ. The researchers had tagged the synthetic DNA to be able to tell it apart, and checked as the modified cell reproduced to confirm that new cells really looked and behaved like M. mycoides.

“All elements in the cells after some amount of time can be traced to this initial artificial DNA. That’s a great accomplishment,” said biological engineer Ron Weiss of the Massachusetts Institute of Technology.

Even while praising the accomplishment — “biomolecular engineering of the highest order,” declared David Deamer of the University of California, Santa Cruz — many specialists say the work hasn’t yet crossed the line of truly creating new life from scratch.

It’s partially synthetic, some said, because Venter’s team had to stick the manmade genetic code inside a living cell from a related species. That cell was more than just a container; it also contained its own cytoplasm — the liquid part.

In other words, the synthetic part was “running on the ‘hardware’ of the modern cell,” University of Southern Denmark physics professor Steen Rasmussen wrote in the journal Nature, which on Thursday released essays of both praise and caution from eight leaders in the field.

The environmental group Friends of the Earth said the new work took “genetic engineering to an extreme new level” and urged that Venter stop until government regulations are put in place to protect against these kind of engineered microbes escaping into the environment.

Venter said he removed 14 genes thought to make the germ dangerous to goats before doing the work, and had briefed government officials about the work over the course of several years — acknowledging that someone potentially could use this emerging field for harm instead of good.

But MIT’s Weiss said it would be far easier to use existing technologies to make bioweapons: “There’s a big gap between science fiction and what your imagination can do and the reality in research labs.”

Venter founded Synthetic Genomics Inc., a privately held company that funded the work, and his research institute has filed patents on it.

Copyright © 2010 The Associated Press. All rights reserved.

The scientists did not clone the pigs – instead they adapted a procedure used in mice and human stem cell researchand were able to grow a specific kind of cell, induced pluripotent stem cells, or IPS cells.

Pluripotent stem cells have the ability to turn into any cell in the body. IPS cells were first developed about five years ago by Shinya Yamanaka, who used four genes to coax a regular mouse cell into acting like an embryo. Creating stem cells with this method is less controversial than harvesting them from an embryo, which destroys the fertilized egg in the process.

According to Dr. Steve Stice, director of the University of Georgia Regenerative Bioscience Center, his team took a bone marrow cell from a pig and injected six new genes, which caused it turn into an embryo-like cell.  Pluripotent stem cells were harvested from this embryo-like cell and injected in another pig embryo. 

The first piglets carrying these new stem cells were born September 3, 2009. 

So far human embryonic stem cell research has not actually found its way into the human body.  Most of the research is still in mice.  But mice aren’t the best animal models to get more accurate data on how a treatment may affect a person.  For example, mice hearts beat four times faster than a human heart and mice don’t get atherosclerosis (clogged arteries) – but pigs do.  That’s why pigs are much better animal models says Stice. “Physiologically, pigs are much closer to a human,” he says.

The researchers also found that unlike mouse embryonic stem cells, which can turn into cancer cells, none of the pigs developed any signs of tumors.

But it has been very difficult to harvest embryonic pluripotent stem cells from pigs. Stice credits his research assistant Franklin West with finding a way to make the existing IPS technology work in pigs.  

Now researchers hope to find many different applications for these new pig stem cells and the pigs they can produce.  They are already working with scientists at Emory University to develop insulin-producing pancreatic islet cells, which might be transplanted into people with diabetes.

Stice thinks this new method can also be used to genetically engineer healthier livestock for other tissue transplants and food consumption. He suggests these stem cells may someday be used to make “artificial bacon,” which would eliminate the need to slaughter pigs.

The research will be published in the online journal “Stem Cell and Development.”

[AP] The Vatican is pushing for research of adult stem cells as an alternative to the use of embryonic stem cells, which the Catholic Church opposes because it maintains that the destruction of the embryo amounts to the killing of human life.

On Friday, the Catholic Church threw its support and resources behind the study of intestinal adult stem cells by a group of experts led by the University of Maryland School of Medicine. The group wants to explore the potential use of those cells in the treatment of intestinal and possibly other diseases, and is seeking an initial $2.7 million to get the project going, officials said.”This research protects life,” Cardinal Renato Martino said during a meeting with Italian and American scientists and health officials to outline the project. “I want to stress that it doesn’t involve embryonic stem cells, where one helps oneself and then throws the embryo away and kills a human life.”

 The church is opposed to embryonic stem cell research because it involves the destruction of embryos, but it supports the use of adult stem cells, which are found in the bodies of all humans. Human embryonic stem cells are produced from surplus embryos of in vitro fertilization procedures used to help infertile women get pregnant.

Both are prized for their ability to morph into other kinds of cells, offering the possibility of replacing tissue damaged by ailments such as Parkinson’s disease.

But adult cells are thought to be less versatile than embryonic ones, and scientists have had more trouble growing adult stem cells in the laboratory than embryonic cells.  Still, adult stem cells could be easier to use if they are taken from patients themselves, because the replacement tissue would have less chance of being rejected.

Martino, a powerful cardinal and retired head of the Pontifical Council for Justice and Peace, told The Associated Press after the meeting that he had “no doubt” that the Vatican would help finance the project through its Rome hospital, Bambin Gesu, and other funding. The exact amount and modalities will be worked out in future meetings with the University of Maryland and other scientists involved in the project.

In 2007, Pope Benedict XVI said the Catholic Church can encourage somatic stem cell research — also known as adult stem cell research — “because of the favorable results obtained through these alternative methods,” and more importantly because it respects “the life of the human being at every stage of his or her existence.”

During his visit to Washington last year, Benedict underscored his beliefs about stem cells by giving President Barack Obama a copy of a Vatican document on bioethics that hardened the church’s opposition to using embryos for stem cell research, cloning and in-vitro fertilization.

Obama has lifted restrictions, imposed by his predecessor President George W. Bush, on federal funding of research using human embryonic stem cells.

The Vatican has drawn criticism for its opposition to embryonic stem cell research. But it insists there are scientifically viable alternatives and that the efforts of the scientific community should go in that direction.

Supporting this university project is part of those efforts.

“Ethically, the rules the Catholic Church promotes are really very simple: That all research be respectful of human life,” said Father Bob Gahl, an American professor of Moral Philosophy at the Pontifical University of the Holy Cross. “Nobody should be killed in the process of doing medical research. So this new project falls exactly within the Catholic Church’s ethical guidelines.”

Dr. George Daley, a stem cell expert at Children’s Hospital in Boston and past president of the International Society for Stem Cell Research, said both adult and embryonic stem cells may prove useful for treating different diseases.

“I applaud the Vatican for being interested in supporting biomedical research,” Daley said Friday, “but I can’t help but think there’s an agenda.”

He called intestinal stem cells “a very exciting area of basic research” but said therapeutic uses are only speculative at this point.

Researchers involved in the Vatican-backed project are convinced that intestinal stem cells — a relatively new field —hold promise and want to assess their potential for therapeutic use.

“We want to harvest them, we want to isolate them, we want to make them grow outside our body,” and transform them into cells of any kind, said Alessio Fasano, the scientist leading the project and the director of the University of Maryland’s Center for Celiac Research.

“If we reach that phase, if we are able to achieve that goal, then our next step is to eventually move to clinical application,” Fasano told the AP before Friday’s announcement.

Intestinal stem cells have certain features that make them appealing for this kind of research, Fasano said.

They are very active cells — the intestine replenishes all its cells every few days — and they are intrinsically flexible — already programmed to generate all the various kinds of cells such as mucus cells or epithelial cells present in the highly complex organ. Furthermore, harvesting them can be done through a routine medical procedure, Fasano noted.

Fasano said his team hopes to decide about the feasibility of the project within the next two to three years. He said the network of experts, expected to be around 40 people, would work at their respective facilities, sharing information and the workload to speed up the process.

A new, separate report by a group headed by the United Nations reached a very different conclusion on maternal mortality, saying the figure remains as high as 500,000 deaths a year.

The disagreement reveals the politics behind public health, where progress made in tackling a health problem can jeopardize funding. Public health officials are gearing up to ask for billions of dollars at U.N. meetings.

U.N. Secretary-General Ban Ki-moon is holding a press conference later Wednesday in New York to kick off a new global initiative on reproductive, maternal and newborn health.

The British medical journal Lancet rushed out a paper on Sunday that found the number of women who die in pregnancy or childbirth has dropped by more than 35 percent over 28 years.  Richard Horton, editor of the Lancet, said he was disappointed when maternal health advocates pressured him to delay publishing the report until September, after several critical fundraising meetings. He also wrote a commentary in Lancet on the pressure.

”Activists perceive a lower maternal mortality figure as actually diluting their message,” he told The Associated Press on Wednesday. ”Advocacy can sometimes get in the way of science.”

He did not name any group or individual who tried to pressure him.

In their paper, Christopher Murray and colleagues at the Institute for Health Metrics at the University of Washington found that maternal deaths have fallen from about 500,000 deaths in 1980 to about 343,000 in 2008. The study in the Lancet was based on more data than was previously available in addition to statistical modeling and was paid for by the Bill & Melinda Gates Foundation.

It was a surprising finding for experts who have long assumed that little progress has been made in maternal health.

But on Tuesday, another report by the Partnership for Maternal, Newborn and Child Health, a global alliance hosted by the World Health Organization, claimed progress in maternal health has ”lagged.” According to their ”detailed analysis,” from 350,000 to 500,000 women still die in childbirth every year. The authors did not explain where their data came from or what kind of analysis was used to obtain that wide range of figures.

In that report, U.N. officials also claimed they need $20 billion every year between 2011 and 2015 to save women and children in developing countries.

Dr. Flavia Bustreo, director of the Partnership for Maternal, Newborn and Child Health, denied there was any conflict between her group’s study and the Lancet study. She said her group was not involved in pressuring the journal not to publish Murray’s study.

”The debate on numbers may continue,” Bustreo told the AP on Wednesday. ”But we welcome this as good news. There is hope at last for maternal health.”

In the world of public health, good news can paradoxically be bad news. The more people who are dying, the more money U.N. officials can raise, making some experts less keen to acknowledge that a problem is not as bad as they once thought.

The U.N. is hosting a meeting of public health experts and heads of state on maternal and child health this week in New York, followed by another one in Washington in June.

For years, U.N. AIDS officials threatened that the epidemic would spread among general populations in countries worldwide, and claimed more than 40 million people were infected. Money for projects fighting AIDS, meanwhile, grew exponentially.

When U.N. officials finally admitted they had been overestimating the numbers for years and dramatically revised their figures — down to 33 million — donors began to rethink their financial commitments.

Experts say public health figures need to be taken with a huge grain of salt, particularly when they come from people who are also soliciting funds for the campaign.

”The U.N. has a track record of inflating disease figures to keep the aid money flowing, so I’d probably place more faith in the figures which show a lower disease burden,” said Philip Stevens, of International Policy Network, a London think tank. ”This is yet more confirmation that whoever paints the most apocalyptic picture gets the most cash, even if they have to manipulate and spin the data.”

The promotion, which has been described by some as a raffle, has sparked an ethical debate in Britain about whether women should be paid for their eggs — which is illegal in the European Union, but not in the United States.

The Genetics and IVF Institute held a free educational seminar for British couples on Wednesday. Of the participants, one will win a treatment cycle for donated in-vitro fertilization, to produce eggs. The prize is not based on a paid raffle.

In a statement, the clinic said its egg donors are college-educated women between 19 and 32. In the U.S., women are routinely paid from $10,000 to $35,000 or more for their eggs.

In Britain, women cannot be paid for their eggs and can only be compensated for their travel expenses and time off work; that cannot exceed more than 250 pounds (USD $384) per treatment cycle. To donate eggs, a woman must undergo a monthlong treatment that involves injecting herself with hormones and then undergoing a surgical procedure to retrieve the eggs.

Because the donated eggs — which may result from paying a woman for treatment — will happen in the U.S., the clinic is not technically breaking any British laws. But experts slammed the event as a publicity stunt.

“There’s something shocking in the association of a raffle and giving away a human product,” said Dr. Francoise Shenfield, a fertility and medical ethics expert at University College London. “In Europe, we have the general idea that altruism is a good thing and we don’t want to turn human body parts into a commodity.”

Shenfield, who has studied how many Europeans go abroad for infertility treatment, said it was impossible to know how many Britons were going to the U.S., since they are not obliged to report it. Many Europeans commonly seek treatment elsewhere to get around loopholes in their own country, like the number of eggs that can be retrieved or implanted, how much donors can be paid, and who is eligible to be treated.

Britain’s Human Fertilisation and Embryology Authority, which regulates fertility treatment, said the U.S. clinic’s raffle was inappropriate. “It trivializes altruistic donation,” the agency said, and runs contrary to the regulations that exist “to protect the dignity of donors and recipients.”

Trina Leonard, a spokeswoman for the Genetics and IVF Institute in Fairfax, Virginia, said the U.S. clinic was simply offering a seminar in London commonly held in the U.S.

“They’re not raffling off a human egg,” she said. Leonard said one person who comes to the seminar who wants to pursue a donated egg is given a free treatment cycle. She said the giveaway was promotional to introduce “new options” for people hoping to start a family.

She said the winner would be picked randomly, not according to need because that would be too complicated. The clinic has been giving away donor cycles valued at more than $10,000 for about a year, she said. Far more egg donors are available in the U.S. than in Britain.

According to the European Union’s Tissues and Cells Directive, donors may only be paid for their inconvenience. But the figure varies across the continent. In Spain, women can receive up to about euro900 (about $1,200) for donating eggs.

Allan Pacey, a fertility expert at the University of Sheffield, said the British supply of donated eggs might be increased if women received more money for their time. “To donate an egg, you’re really inconvenienced, and 250 pounds barely scratches the surface,” he said.

Some women weren’t sure if offering more money for eggs was a good idea.

Rhiannon Prytherch, 28, an actress and theatre manager in Darby, England, said even if she was offered money, she would not sell her eggs. “It doesn’t feel like a commodity that should be profitable,” she said. “I could never charge someone for that.”

But Prytherch said she might feel differently if she were the one needing eggs. “If I were a woman who wanted to have a child, I would be willing to pay.”

Pacey said the U.S. clinic’s approach risked turning human eggs into a commercialized product. “Having a lottery (to get eggs) is not how we do things in this country,” Pacey said.

Associated Press Writers Brett Zongker in Washington, DC and Chonel LaPorte in London contributed to this report.

Copyright © 2010 The Associated Press. All rights reserved.

The Dubai Gynaecology and Fertility Centre that stores an estimated 5,000 eggs fertilised through In-Vitro Fertilisation (IVF) will start the disposal procedure next week, according to a notice issued by the Dubai Health Authority (DHA). Another 5,000 frozen embryos are believed to be stored at the Al Tawam Hospital in Al Ain.

The law that was passed by the Federal National Council two years ago rejected the medical procedure on religious grounds, fearing mixing in the lineage.  It was also unclear how the fertilised eggs would be disposed of since DHA did not provide any details on the issue on Sunday. “Recognised scientific methods will be used to complete the procedure,” read the notice.

This move is expected to affect several families, who have sanctioned the storing of the embryos. In normal circumstances, the centre asks for the couple’s consent before disposing of any stored egg.  “It is a huge and drawn out process and this will definitely affect many women psychologically,” opined a senior gynaecologist, who did wished not to be named. “The fertilised eggs can be valuable any time since surrogacy and adoption are becoming a common practice the world over. Women need to have the option of having to choose fertility methods,” added the gynaecologist.  The Dubai centre has been freezing embryos for over nine years and charges an annual maintenance fee.

Private clinics in the emirate are banned from carrying out the IVF procedure and freezing embryos, leaving the Dubai centre as the only option. Many a times, patients have to wait for years to avail themselves of the facility. Other emirates, however, continue to offer IVF treatments but not storage of embryos.

Since its inception in 1991, the centre has served thousands of couples with fertility problems. In 2008, the first ‘designer baby’ in the country was born to a UAE couple with fertility issues after they received treatment at the centre. However, the gender selection process was done only on two conditions: family balancing and genetic complications.

Frozen embryos are artificially implanted in women who cannot conceive naturally.

The extra embryos (those left over after the transfer of fresh embryos following IVF) can be frozen and have been known to be viable for up to 10 years. Embryos are stored in industry-standard cryo-storage tanks that are monitored regularly for liquid nitrogen level. 

 asmaalizain@khaleejtimes.com Original Article here.

So how might the new Bioethics Commission operate? Fortunately, we have some idea because its new chair, Amy Gutmann, outlined her views on how bioethics commissions should be run in an article, “Deliberating About Bioethics” in the Hastings Center Report back in 1997. Most of the 13 member panel hasn’t been appointed yet, but Gutmann is well-known for her scholarly work on deliberative democracy, which she defines “as a form of government in which free and equal citizens (and their representatives), justify decisions in process in which they give one another reasons that are mutually acceptable and generally accessible, with the aim of reaching conclusions that are binding in the present on all citizens but open to challenge in the future.”  

In her article (co-authored with political philosopher Dennis Thompson), Gutmann distinguishes deliberative democracy from proceduralism and constitutionalism. In proceduralism, once basic rules of the game have been hammered out, moral disagreements are resolved through political bargaining or by moving them out of politics into the private sphere. Constitutionalism tries to avoid moral disagreement by creating a sphere of protected rights that are shielded from ordinary politics.

In Gutmann’s conception, deliberative democracy is an ongoing, transparent, society-wide discussion of fundamental values. Deliberative democracy is supposed to serve four important social purposes by addressing four ineradicable sources of moral disagreement. She identifies the four sources of moral disagreement as arising from (1) the scarcity of resources; (2) limited generosity; (3) incompatible moral values; and (4) the incomplete understanding that characterizes almost all moral conflicts. The four social purposes that deliberative democracy is supposed to address are (1) the promotion of the legitimacy of collective decisions; (2) the encouragement of public-spirited perspectives on public issues; (3) the promotion of mutually respectful decisionmaking: and (4) the correction of inevitable collective action mistakes.

Gutmann offers some concrete examples of how she thinks deliberative democracy might work. Let’s take scarcity. She notes that far more people need organs than there are organs available for transplant. How do we decide who gets them? She suggests that “deliberation can help those who do not get what they want or even what they need come to accept the legitimacy of a collective decision.” As it happens in 1984, the U.S. Congress passed the National Organ Transplant Act which made organ sales illegal. Since then donated organs have been allocated by the United Network of Organ Sharing based on various medical criteria depending on the specific organ. Although some voices (including mine) have been arguing for compensating donors as a way to increase supplies, it is true that there has not been much public pressure to change the current system. However, one hopes that the deliberative process will someday correct this particular collective action mistake. On the other hand, we can expect a lot more bioethical deliberation if the U.S. adopts a more centralized and increasingly government-controlled health care system. In another article Gutmann favorably cites the United Kingdom’s National Institute for Health and Clinical Excellence (NICE) as an example of how democratic deliberation works in making decisions about what medicines and treatments will be made available to patients in that country’s National Health Service.

The next issue is limited generosity. Gutmann acknowledges, “Deliberation will not turn self-centered individualists suddenly into public-spirited citizens.” She argues that members of bioethics commissions should not be chosen just to represent specific interest groups; that would simply result in old-fashioned interest group bargaining. Gutmann asserts that the number and diversity of voices on a bioethics commission is not necessarily the most important factor in making deliberation work. Instead bioethics commissioners “must come to the forum open to changing their own minds as well as to changing the minds of their opponents.” Bioethics commissioners will be more amenable to changing their minds on such limited questions as when is it appropriate to include minors in medical research rather than issues like abortion and assisted suicide.

Which brings us to Gutmann’s third source of moral disagreement—incompatible moral values. Here she recommends that bioethics commissions isolate irresolvable conflicts and focus on areas where agreement might be possible, e.g., minors in medical research. As an example of how deliberation can “economize” on moral disagreements, she cites the fetal tissue research guidelines issued in 1975 by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The commission held extensive public hearings and consulted legal experts, scientists, ethicists, and philosophers before promulgating its regulations allowing fetal tissue research. Those regulations included the requirement that researchers seeking to harvest tissue not have any part in the timing, method, or procedures used to terminate a pregnancy; no inducements to terminate a pregnancy could be made; both parents must consent; and artificial life support for nonviable fetuses was prohibited. But this deliberative outcome did not hold. In 1988, arguing that the fetal tissue research could encourage abortion, the Reagan administration imposed and later the Bush administration maintained a federal funding moratorium on fetal tissue transplant research. The moratorium was lifted by President Bill Clinton in 1993.

The history of the bioethical deliberation over fetal tissue research might be seen as an example of Gutmann’s fourth purpose of deliberation, the correction of mistakes. In the fetal tissue case, later experts did argue that political appointees under Reagan and Bush were mistaken in their belief that federal funding of fetal tissue research would lead to more abortions. On the other hand, given that a National Institutes of Health advisory panel in 1988 recommended after considerable deliberation that the moratorium be lifted, one suspects that the encourages-more-abortions argument for banning federal funding was a stand-in for a deeper philosophical repugnance toward all abortion. In any case, the fetal tissue case and President Obama’s decision last year to overturn President George W. Bush’s limits on federal funding of human embryonic stem cell research shows that bioethics decisions in the U.S. are already provisional and open to challenge.

I generally agree with the proceduralists and constitutionalists. In order to keep the social peace and allow various visions of the human to flourish along side of one another, certain big questions about birth, death, and the meaning of life must be isolated from politics, making them private concerns to be protected from majoritarian tyranny. But for her part, Gutmann concludes hopefully, “By making democracy more deliberative, we stand a better chance of resolving some of our moral disagreements, and living with those that will inevitably persist, on terms that all can accept.” Given the current stark polarization that characterizes our national political institutions (if not public opinion), Gutmann, as head of the new Presidential Commission for the Study of Bioethical Issues, has her work cut out. Good luck to her.

Ronald Bailey is Reason’s science correspondent. His book Liberation Biology: The Scientific and Moral Case for the Biotech Revolution is available from Prometheus Books.