WEBVTT

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Fifty years ago, we knew nothing
about how our cells work.

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Since then, biologists have realized that
they hold enormous therapeutic potential,

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and now they’ve become an essential
part of medical research.

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They have acquired economic value, and are now
the object of investment in commercial trading.

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This market in human cells and tissues helps finance
research, but it is also challenging our sense of

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who we are and our ethical beliefs.

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We realize that what was prohibited, for
instance in 1994 or ‘97 throughout the world,

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has now been gradually authorized in a great many
countries. Whether it’s the marketing of gametes,

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sperm and eggs or the
patentability of genes

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or the use of genetic testing for eugenic purposes
or even the creation of human embryos for research,

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all that was illegal 10 or so years ago,

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and in a very great many countries is now possible. Ethical
principles can’t always stand up to scientific advances.

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That’s the problem when we try to
outlaw trading in the human body.

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In the name of personal dignity,
international declarations,

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treaties and laws have decreed that no one may
possess, sell, purchase or profit from his own body

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or from someone else’s. The trading in human
organs has been outlawed by all countries,

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but the law is not so clear when it comes to the
tissues, cells and genes that make up these organs -

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a business that dares not
speak its name has sprung up.

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The question is not so much, are we a
resource? I… I think we are. I mean, ah…

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mothers breastfeed their children, people
give blood, ah… people give organs.

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We understand that our body
can be useful, ah… in society

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and for others. The question
is how far do we go in

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uh… recognizing that while
we… we want to be useful,

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we want to participate, we don’t want to exploit.
How far can the market reach into our bodies?

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In the name of medical science, is it legitimate
to trade in pieces of what makes up the human body

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no matter how small those pieces are?

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Human tissue removed during operations, blood
tests, biopsies and routine medical examinations,

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don’t end up in the trash,
quite the opposite occurs.

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Examined for diagnostic purposes, then preserved,
these tissues are later used for research.

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Our flesh, our blood, our cells,

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our genes become biological human resources. In
Europe and North America, and in Asia as well,

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most of us have a sample of what was once
our body stored somewhere. Liquid or solid,

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healthy or sick, frozen,
fixed or very much alive,

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little bits of our body will survive us. They have become
raw materials, enormously precious for the health industry.

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But who do these human fragments belong to,
the patient from whom they were taken,

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the researcher who will use them, or
everyone? In other words, no one at all.

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These questions haunt people around the
world who are concerned with ethics.

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Thirty years ago, for the first time, these questions
came to the forefront when the John Moore case broke.

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Moore was an American, whose cells were
literally golden and he went to court to demand

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control over how they were used. The new and
extraordinary science of biogenetics may redesign

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the makeup of mankind. But as scientists pursue
these goals and the wealth that may come with them,

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are they balancing the progress of
science with the morals of humanity?

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That’s a question raised in the story of John Moore,
a man claiming his place in the future world.

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On October 20th, 1976, John Moore,
who was suffering from a rare

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and deadly form of leukemia, had his
spleen removed in a Los Angeles hospital.

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The operation is common for that
illness and it saved his life.

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Cells from his spleen were cultured
and the doctor who examined them,

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David Goldie, discovered that they produced
an enormous amount of a hormone, CSF,

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that could be used as a cancer treatment. Dr. Goldie
understood the therapeutic and financial possibilities

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of these golden cells. He decided
to put his patient to work.

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John Moore underwent biopsies. His blood
was taken as well as his skin cells,

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even serum and sperm and bone
marrow samples were removed.

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This went on for nearly seven years. One day his doctor showed
up and asked him to sign a release for the use of his cells.

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Only then did John Moore understand
that the procedures he was undergoing

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had nothing to do with his welfare.

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Who’s gonna argue with their doctor about… over
signing a form when you’re on the operating table

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and your life is in danger. And if you can’t trust
your doctor who can you trust? This is true.

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But I asked things in… in the nature of… of, is there’re
gonna be any commercial value on this down the road?

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Uh… What… What kinds of things are you developing
out of this? The answer usually was always no

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or it’s… it’s something for the
future, it’s way down the road.

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There’s, you know… There’s really nothing,
ah… of immediate impact happening.

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Behind the scenes, a pharmaceutical laboratory
was massively investing in John Moore’s cells.

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The doctor’s goal - by
then he had teamed up

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with a brilliant Harvard biologist, Tom Maniatis
- was to transform these cells into medication.

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Goldie, collected from him as part of the treatment, uh…
John Moore’s spleen. So this was… The spleen was then,

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uh… broken apart into individual
cells and was cultured,

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uh… in a dish, uh… using uh…
growth factors and… and media.

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And this process required a
tremendous amount of skill

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and years actually to establish individual
lines. What Goldie then ultimately

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did is to take a single cell,
and then to amplify that.

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And so now we had a… uh… a series of cells were
identical to each other originating from a single…

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from… from one cell, and
this is called a cell line,

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and then characterize these cell lines, uh…
and found that one of them, the Mo cell line,

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had this incredible ability
to produce large amounts

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of proteins that were of medical
importance, and one of them was GM-CSF.

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And so the way that was done, if
I can amplify this into a cell,

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what happens in the cell is that
it has a thing called a nucleus,

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and in the nucleus are genes. It
was possible then to introduce

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that into another cell line that
produced large amounts of GM-CSF,

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so a tiny amount’s being made here,
and a huge amount is being made here.

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And this then, uh… is used
as the starting point

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for developing a drug to
treat, uh… cancer patients.

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And this… The name of this drug was called Leucomax.
John Moore’s cells provided a kind of shortcut.

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Without them, doctors would have needed
thousands of liters of blood to identify CSF,

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and years before they could replicate the hormone.
Dr. Goldie and Tom Maniatis were pioneers,

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copying nature and creating living
material in vitro was revolutionary,

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and it launched a new industry called biotechnology.
This is where we keep our tissue culture supplies.

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And all of the components
needed to grow cells are here.

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Yes, this is the, uh… Leucomax

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that is used in, uh… patients,
uh… to treat cancer.

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In September of 1984, John Moore commenced legal action against his
doctor, demanding the right to control the use of his own cells

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and challenging the patent
that had been submitted.

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This was the first trial in the United States or anywhere else
that asked the question, who owns the elements of the human body?

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Do you own your own blood
or any of the body parts

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that are taken from you in the hospital during
surgery or any other kind of medical procedure?

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You may think you do, but I’ll tell you what, you may
not. Our first two guests are here to discuss what may be

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one of the most interesting milestone legal
cases taking place in the 80s this morning.

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John Moore and his attorney from
Los Angeles, Jonathan Zackey.

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I didn’t know any of this stuff until
I got into the discovery mode and…

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and ascertained that the doctor has already taken
out patents, the university had patents on… on…

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UCLA! UCLA. That they had formed
and entered into contracts

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with… with Genetics Institute, a large, uh…
bioengineering firm out in the East Coast,

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that they were developing relationships with Sandoz Pharmaceuticals…
International, international pharmaceutical company.

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No, I don’t know. Massive contracts
and… and contractual relationships.

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You were becoming a worldwide business and you didn’t know it? Yeah. I
didn’t know. I had no idea at all. It was… It was such a total shock to me.

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Did John Moore have the right to benefit from the
sales of this drug? No one knew what to think,

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though everyone sensed that this trial would
help decide what relations would be patients,

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researchers and the
pharmaceutical industry.

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The John Moore case was a very dramatic
instance where an individual’s,

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in this case blood cells were very valuable in
and of themselves which was a very rare thing,

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maybe only five or six people in the
history of medicine are in that position.

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He wasn’t treated fairly. Ah… And
he felt that he had been misled

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as to why he was undergoing
certain medical procedures.

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And especially if you think that your life
is in danger, and then you find out later

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that instead of being treated, you were being mined,
this made the John Moore case a very symbolic case

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of how do we treat people when we need
their blood or tissue for research.

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And he raised the question,
if the doctor knows

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that my blood cells are valuable,
why don’t I get some of the value.

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The people who do the research on
the tissue for drug development,

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may discover something that’s very
valuable in a tumor or in a… a blood cell,

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and they may develop a drug
that attacks that tumor,

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and they may make millions of dollars
from doing that. So, the person at

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the research discovery end
may make a lot of money

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and the patient has no claim to any of that. So, as
long as we have a capitalist system of drug discovery

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and the government’s not funding all of it, people
aren’t going to do it if they can’t make money.

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But they also spend millions of dollars,
in some cases billions of dollars,

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in creating the infrastructure to turn
tissue and blood into medical breakthroughs,

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and that is why they’re also
the ones to profit from it.

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Who do the golden cells belong to? Common
sense seems to be on John Moore’s side,

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but the work and investment needed to modify
his cells open the way for researchers

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to demand their rights over the product.
On July 10th, 1990,

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after seven years of legal jockeying, the
justice system was about to have its say.

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The crux of the John Moore case is

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that a patient owns his own body,
his own issues, his own DNA.

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The California Supreme Court disagreed, saying
what happened to Moore might be unethical,

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but it wasn’t illegal. People have no
property rights to their own body.

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Moore spent the next decade fighting for
patients’ rights before he died last year.

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Ironically, Leucomax - the product
made from John Moore’s cells -

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was never a success. A competing drug
took the lion’s share of the market.

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But his cells are still alive, kept
in the world’s largest biobank.

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[sil.]

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So the John Morse cell line called Mo,

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is maintained in a repository
of frozen cells in Washington.

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And this repository has many thousands
of cells from all sorts of organisms,

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from humans, from mice, from rats.
And these cells are used,

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uh… for research and so you can
actually find these cells online

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and order them and so, uh…
you can buy this for $330.

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When you receive them, you thaw them
out and can, uh… grow them in a…

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in a tissue culture.

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Thanks to the biotech revolution. Today, we have
drugs that aren’t inert or chemical but biological,

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made of living cells. By becoming the raw
material for the pharmaceutical industry,

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the human body has taken on new status.

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It is now a part of the contradictory
pool of business, ethics, and health.

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The conflict over the Man with the
Golden Cells is more relevant than ever.

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Lori Andrews began her
career as a legal expert.

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She was a witness for John Moore
during his trial. Today, she works

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at Chicago’s Kent School of Law, where she’s a tireless
crusader against what she calls the ‘human body bazaar’.

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For the past 25 years, I’ve been
haunted by the John Moore case.

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If they had recognized a patient’s right
to control what’s done with his tissue,

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many of the abuses that we’ve
seen today would not occur,

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because researchers are treating
people like commodities.

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In fact, in that case, the legal
position I took was to argue only that

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he should have a right to
informed consent and to be able

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to have the doctor have a fiduciary duty to
act in a way that did not harm the patient.

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I didn’t argue the property aspect of it,

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because I was worried that
the criticism would be that

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ah… people are just it for the money. And the
court really didn’t intend that to happen.

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They really thought they were
protecting the patient in some way.

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They uh… felt that they didn’t want to see

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the important human body
trivialized in some way.

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They were worried about the
haunting of the image of slavery

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in our country, where bodies
were sold for profit.

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And so, they thought they were
adding dignity to a person

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by not holding that a
tissue could be property.

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What’s happened now
though is totally unjust.

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What is said is that the tissue, the
genes, can’t the property of the person

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from whom they came, but can
be property of the researcher.

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So, it’s not that we don’t have a
commercial… a commercial system,

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we have one, but it’s just the property
is given to the wrong individual.

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The court’s decision in the Moore case

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did not halt trading in the
human body, quite the contrary.

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We are giving our tissue, cells, genes
and blood samples to health systems

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that can use them as they
wish in the marketplace.

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At the heart of this market
is the patent system,

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which is particularly important
to the health industry.

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In the business, people say that laboratories
don’t produce drugs, they produce patents.

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A patent is a grant between the
government and an inventor

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that allows the inventor to exclude others
from making and using his invention

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for up to 20 years. In
exchange for that grant,

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the public is given the full written description of
what the invention is with an enabling disclosure

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that allows one of ordinary skill and
the art to reproduce that invention.

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The one thing that’s excluded from patentable subject matter is human beings.
The Patent and Trademark Office does not issue patents on human beings,

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however, anything else
made by the hand of man,

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whether it be a transgenic animal, whether
it be a plant or whether it be an extract

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from a human plant or an animal and that includes
DNA, it includes enzymes, it includes proteins,

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it includes cell lines such as embryonic cells, it includes
immortal cell lines that we use in the diagnostics of diseases.

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It must be something that was taken
from nature in a purified form

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that has a specific, substantial
and credible utility.

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Only inventions can be patented, the
discovery of what already exists in

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the natural state cannot be patented.
But by legal trickery, today,

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part of the human body, especially a gene if
it is isolated and its function discovered,

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can be protected by a patent and become
a laboratory’s private property.

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Is the human body still sacred? Or has
it been converted into a merchandise?

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How many patented genes are there now?

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Probably between 5,000 and 6,000. We
know that of the 30,000 human genes,

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almost three quarters of them are in the process
of being patented directly or indirectly.

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Within four or five years, this will solve
an issue raised by a lot of people.

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Are human genes patentable?
It’ll no longer be a question,

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they’ll have been patented. As
things move faster and faster,

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the market economy dictates the rules and speeds past ethical
thought that lags behind with these rules and regulations.

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Pat Mooney is the director of an association that
is fighting the patenting of living organisms.

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You’re not sure how many patents
there are related to the human body.

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But we and… and… and many others have been trying to
sort through the maze of patents that are out there,

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and companies are getting better and better
at hiding their tracks. It’s harder to see

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what is being patented, what its purpose
is, is it the same material over

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and over again or what’s… what’s going on there. But as best
as researchers have been able to sort it out at this stage,

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it looks like about two thirds of all of
the human and related patents that exist,

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the genomic patterns that exist, the gene patents that exist,
related to human beings, two thirds of that material is actually

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owned by three companies.

00:18:40.000 --> 00:18:44.999
I’m a professor of bioethics
at a business school.

00:18:45.000 --> 00:18:49.999
I think that bioethics is merely
chasing after scientific achievements

00:18:50.000 --> 00:18:54.999
and their industrial applications and it’s these applications
that let us anticipate how this debate on bioethics

00:18:55.000 --> 00:18:59.999
might evolve.

00:19:00.000 --> 00:19:04.999
We keep saying that human body parts are
not marketable, they’re off limits.

00:19:05.000 --> 00:19:09.999
They cannot be the subject
of a commercial transaction.

00:19:10.000 --> 00:19:14.999
This non-commercialization principle,
stems from the abolition of slavery,

00:19:15.000 --> 00:19:19.999
in which human being were bought and sold.

00:19:20.000 --> 00:19:24.999
It applies to organs and also the
smallest parts of these organs -

00:19:25.000 --> 00:19:29.999
the genes, chromosomes, cells and so on.

00:19:30.000 --> 00:19:34.999
What’s more controversial these days is that it’s
not just inventions that are being patented,

00:19:35.000 --> 00:19:39.999
but also discoveries. And these discoveries,
because they already existed in nature,

00:19:40.000 --> 00:19:44.999
I’m thinking particularly of genes,
natural genes for which the sequence

00:19:45.000 --> 00:19:49.999
or partial sequence has been identified, these genes
which are not the result of a creative activity

00:19:50.000 --> 00:19:54.999
should not give rise to a monopoly.
To hold a patent on a gene

00:19:55.000 --> 00:19:59.999
means you can control how it is used,
including any applications to public health.

00:20:00.000 --> 00:20:04.999
In May of 2001, an American
company, Myriad Genetics,

00:20:05.000 --> 00:20:09.999
was able to patent two genes that determine whether an
individual has a predisposition to develop breast cancer.

00:20:10.000 --> 00:20:15.000
Genetic laboratories had already carried out tests around
the world including at the Curie Institute in Paris.

00:21:00.000 --> 00:21:05.000
[sil.]

00:22:00.000 --> 00:22:04.999
With its patents in hand, Myriad Genetics,

00:22:05.000 --> 00:22:09.999
the owner of the genes, informed
geneticists across Europe

00:22:10.000 --> 00:22:14.999
that they were forbidden to perform
breast cancer tests themselves.

00:22:15.000 --> 00:22:19.999
Hospitals were forced to use their services,
even if their fees were three times higher

00:22:20.000 --> 00:22:24.999
than the actual cost.

00:22:25.000 --> 00:22:29.999
In September of 2001, Dominique
Stoppa-Lyonnet and the Curie Institute,

00:22:30.000 --> 00:22:34.999
supported by scientists and
politicians from 11 countries,

00:22:35.000 --> 00:22:39.999
set out to topple Myriad
Genetics monopoly in Europe.

00:22:40.000 --> 00:22:44.999
I believe the patent system
is not at all a bad system.

00:22:45.000 --> 00:22:49.999
I think it really can advance research.

00:22:50.000 --> 00:22:54.999
But the system becomes bad when the
balance is upset between knowledge,

00:22:55.000 --> 00:22:59.999
that is making an invention
available in the public domain,

00:23:00.000 --> 00:23:04.999
and granting patents via its patent rights.

00:23:05.000 --> 00:23:09.999
And when that balance is
upset, it doesn’t work.

00:23:10.000 --> 00:23:14.999
That’s what happened in the
Myriad Genetics affair.

00:23:15.000 --> 00:23:19.999
The balance was upset from the outset
since they were claiming a monopoly.

00:23:20.000 --> 00:23:24.999
And it’s odd that they
would claim that monopoly.

00:23:25.000 --> 00:23:29.999
I think that if they had licensed it
fairly broadly at a very low cost,

00:23:30.000 --> 00:23:34.999
no one would have reacted. Even
though we might wonder about it

00:23:35.000 --> 00:23:39.999
and say it’s not normal for Myriad to
have those patents since they’re not

00:23:40.000 --> 00:23:44.999
the only inventors of BRCA1, they’re not
the only ones who showed a link between

00:23:45.000 --> 00:23:49.999
the BRCA gene and the
predisposition to breast cancer.

00:23:50.000 --> 00:23:54.999
But still if they had a softer
policy to using their patent rights,

00:23:55.000 --> 00:23:59.999
no one would have said anything.

00:24:00.000 --> 00:24:08.000
[sil.]

00:24:10.000 --> 00:24:14.999
The DNA will adhere, and
last for a long time.

00:24:15.000 --> 00:24:19.999
[sil.]

00:24:20.000 --> 00:24:24.999
In 2005, these patents were finally revoked in
Europe and the genes reentered the public domain,

00:24:25.000 --> 00:24:29.999
but the world is a big place.
By 2006, Myriad Genetics

00:24:30.000 --> 00:24:34.999
had sold more than 100,000 tests
at a cost of $3,000 each.

00:24:35.000 --> 00:24:39.999
This gene was literally golden. Everything in the
world is patentable. Once you’ve allowed for

00:24:40.000 --> 00:24:44.999
microbial patenting, you really leave
the door open to virtually any part of

00:24:45.000 --> 00:24:49.999
human genetic material or other
living material can be patented.

00:24:50.000 --> 00:24:54.999
And once you’ve allowed, of course, for the patenting
of matter, which is… is a natural part of patent law,

00:24:55.000 --> 00:24:59.999
compositions of matter
or patentable material,

00:25:00.000 --> 00:25:04.999
once you’ve allowed for that, then you also allow for the
patenting of… of… of the building blocks of life itself,

00:25:05.000 --> 00:25:09.999
the actual atomic material
and its built DNA.

00:25:10.000 --> 00:25:14.999
We need to remember that, of course,
DNA is really nothing more than…

00:25:15.000 --> 00:25:19.999
than hydrogen, nitrogen, oxygen and
carbon, a bit of sugar thrown in.

00:25:20.000 --> 00:25:24.999
That’s the building block of life. So if you
allow for… for the… the manipulation of

00:25:25.000 --> 00:25:29.999
hydrogen, nitrogen, oxygen and carbon
and some sugars, then… then you…

00:25:30.000 --> 00:25:34.999
you are allowing the patenting of the
building blocks of life and of humans.

00:25:35.000 --> 00:25:39.999
[sil.]

00:25:40.000 --> 00:25:44.999
Whenever you extract DNA, there’s
always that little feeling

00:25:45.000 --> 00:25:49.999
at the end where you think,
a person’s entire patrimony

00:25:50.000 --> 00:25:54.999
is here in this little tube.

00:25:55.000 --> 00:25:59.999
It always affects us.

00:26:00.000 --> 00:26:04.999
The exploration of the human body
has radically changed scales.

00:26:05.000 --> 00:26:09.999
The body is no longer the
sacred temple it once was.

00:26:10.000 --> 00:26:14.999
From organs to tissue, from tissue to
cells, from cells to DNA and genes,

00:26:15.000 --> 00:26:19.999
modern medicine has progressively
lost sight of the big picture.

00:26:20.000 --> 00:26:24.999
Far from their patients, doctors and researchers
are developing a science of the invisible,

00:26:25.000 --> 00:26:29.999
abstract and nearly virtual, yet touching
on the basic building blocks of humanity.

00:26:30.000 --> 00:26:34.999
Reduced to their genetic code, patients
becomes a series of four letters,

00:26:35.000 --> 00:26:39.999
an A, a T, a G and a C.

00:26:40.000 --> 00:26:44.999
As humans become fragmented,

00:26:45.000 --> 00:26:49.999
their bodies are no longer sacred, they’ve
become the stuff of business and industry.

00:26:50.000 --> 00:26:54.999
[sil.]

00:26:55.000 --> 00:26:59.999
Hey, long time no see.

00:27:00.000 --> 00:27:08.000
[sil.]

00:27:10.000 --> 00:27:14.999
In the United States, companies have
specialized in trading human tissues.

00:27:15.000 --> 00:27:19.999
They’ve become go-betweens for
the research laboratories

00:27:20.000 --> 00:27:24.999
that place their orders with them, and the
hospitals that provide the raw materials.

00:27:25.000 --> 00:27:33.000
[sil.]

00:27:35.000 --> 00:27:39.999
It’s supply and demand. The more diseased
the tissues are, the rarer the pathology,

00:27:40.000 --> 00:27:44.999
the greater the value of the samples.

00:27:45.000 --> 00:27:49.999
[sil.]

00:27:50.000 --> 00:27:54.999
Well, guys, we got another one. That’s the ZeptoMetrix
bell. We ring that every time we get a new contract.

00:27:55.000 --> 00:27:59.999
ZeptoMetrix Corporation is
a large bio repository.

00:28:00.000 --> 00:28:04.999
We house here millions of human clinical
specimens that are used for medical research.

00:28:05.000 --> 00:28:09.999
A lot of these materials, first start out as a raw…
raw material, which we would call a plasma unit.

00:28:10.000 --> 00:28:14.999
The plasma units are collected
by plasma fractionators,

00:28:15.000 --> 00:28:19.999
and they’re used for making a
number of medical products.

00:28:20.000 --> 00:28:24.999
In this case here, this represents
HIV serial conversion donor.

00:28:25.000 --> 00:28:29.999
We also have well over a million
clinical specimens in our archive,

00:28:30.000 --> 00:28:34.999
from a wide range of diseases, relating to autoimmune,
infectious diseases and many, many cancers,

00:28:35.000 --> 00:28:39.999
that are all inventoried by type, completely
anonymized with a barcode reference

00:28:40.000 --> 00:28:44.999
back to our database system. These are
the samples that we would then pull out,

00:28:45.000 --> 00:28:49.999
ship to clients and then they would
use these for their medical research.

00:28:50.000 --> 00:28:58.000
[music]

00:29:00.000 --> 00:29:04.999
If you want specimens including
tissue, serum, plasma,

00:29:05.000 --> 00:29:09.999
viable cells, any other biological fluids,

00:29:10.000 --> 00:29:14.999
products, it’s a very specialized product,
so you cannot just get it off a shelf

00:29:15.000 --> 00:29:19.999
and sell in a supermarket, but you have a
customer who comes to you and tells you,

00:29:20.000 --> 00:29:24.999
I would like to get this type of specimens
prepared, to these specifications,

00:29:25.000 --> 00:29:29.999
frozen or fixed and paraffin-embedded
or prepared in a special media.

00:29:30.000 --> 00:29:34.999
We’re asked by many organizations and many
people, what is your major business activity.

00:29:35.000 --> 00:29:39.999
And after some consideration,

00:29:40.000 --> 00:29:44.999
I decided to answer, it’s a project management.
So, what we do? We identify the need

00:29:45.000 --> 00:29:49.999
with the customer in the United States or
Western Europe or even Eastern Europe.

00:29:50.000 --> 00:29:54.999
We find the source to fulfill this need.

00:29:55.000 --> 00:29:59.999
And it’s our procurement centers,

00:30:00.000 --> 00:30:04.999
back in Eastern Europe and Central Asia.
So since this product

00:30:05.000 --> 00:30:09.999
doesn’t have price, human tissues are not
priceable. They are… They’re worth zero.

00:30:10.000 --> 00:30:14.999
But we work behind those
tissues, it’s the extensive.

00:30:15.000 --> 00:30:19.999
So then we charge our customers for selling those products
to them. We’re charging them for our work basically.

00:30:20.000 --> 00:30:24.999
[sil.]

00:30:25.000 --> 00:30:29.999
As the John Moore case showed,
people trading in the human body

00:30:30.000 --> 00:30:34.999
would rather stay out of the limelight. This is
because our sense of decency is offended by the idea

00:30:35.000 --> 00:30:39.999
that our bodies have become merchandise. This
is why only services such as processing,

00:30:40.000 --> 00:30:44.999
conservation and transport can be billed.

00:30:45.000 --> 00:30:49.999
The business is controversial, but it can
contribute to the advance of medical research

00:30:50.000 --> 00:30:54.999
and the curing of the sick.
So, isn’t it justified?

00:30:55.000 --> 00:30:59.999
The public sector is also involved when it comes
to offering patients the latest treatment.

00:31:00.000 --> 00:31:04.999
For example, the worldwide network
that stores umbilical cords,

00:31:05.000 --> 00:31:09.999
given by anonymous donors during birth,
is part of a nonprofit health system.

00:31:10.000 --> 00:31:14.999
Every year, France imports bags of
blood taken from umbilical cords

00:31:15.000 --> 00:31:19.999
in order to treat patients suffering from blood cancer,
leukemia, lymphoma and deadly hereditary diseases.

00:31:20.000 --> 00:31:24.999
This therapy works through transfusion.

00:31:25.000 --> 00:31:30.000
Cells taken from an umbilical cord during birth are
transferred to a patient in need of treatment.

00:31:45.000 --> 00:31:49.999
[music]

00:31:50.000 --> 00:31:54.999
In 1988, Elaine Gluckman was the first to carryout
transplants with blood from unbiblical cords.

00:31:55.000 --> 00:31:59.999
In the last 20 years, this has
become a common procedure

00:32:00.000 --> 00:32:04.999
and an alternative to
bone marrow transplants.

00:32:05.000 --> 00:32:09.999
The advantage of cord blood is
that it lets you do transplants

00:32:10.000 --> 00:32:14.999
that are not strictly compatible, so the tissue
incompatibility system barrier no longer exists.

00:32:15.000 --> 00:32:19.999
Whereas for marrow transplantation,
you need a perfect match,

00:32:20.000 --> 00:32:24.999
so it’s much easier to find donors. The second
obstacle, that there may not be enough cells

00:32:25.000 --> 00:32:29.999
in a single cord to transplant an adult, that
barrier has been eliminated in recent years.

00:32:30.000 --> 00:32:34.999
We showed that transplants
could be used for adults too

00:32:35.000 --> 00:32:39.999
in all current indications for bone marrow transplantation,
and that if there’s not enough in one cord,

00:32:40.000 --> 00:32:44.999
we could use two. So nowadays, 100% of
patients who are transplant candidates,

00:32:45.000 --> 00:32:49.999
should have a transplant. France
was a pioneer in this new therapy,

00:32:50.000 --> 00:32:54.999
but the government did not sufficiently fund the
collection of umbilical cord blood in maternity wards,

00:32:55.000 --> 00:32:59.999
and neither did it pay for storing it in biobanks.
France quickly became dependent on foreign sources.

00:33:00.000 --> 00:33:04.999
Imported blood costs between
20,000 and 30,000 euros

00:33:05.000 --> 00:33:10.000
depending on its origin.

00:33:20.000 --> 00:33:25.000
[sil.]

00:34:15.000 --> 00:34:19.999
[sil.]

00:34:20.000 --> 00:34:24.999
The use of umbilical cord blood for
transplants raises no ethical problems,

00:34:25.000 --> 00:34:29.999
but the commercial maneuvering around
the blood supply does create dilemmas.

00:34:30.000 --> 00:34:34.999
The cells contained in that
blood have also become golden.

00:34:35.000 --> 00:34:39.999
A very lucrative business has sprung
up around Elaine Gluckman’s work.

00:34:40.000 --> 00:34:44.999
After the baby has been delivered,

00:34:45.000 --> 00:34:49.999
the doctor uses the blood bag supplied by Cordlife
to collect the blood from the umbilical cord.

00:34:50.000 --> 00:34:54.999
Private biobanks offer future parents the
possibility of storing their umbilical cord blood

00:34:55.000 --> 00:34:59.999
at their expense for future personal use.
Significantly lower chances of contamination

00:35:00.000 --> 00:35:04.999
and sample mix up. Whether from a local hospital…
This business is particularly profitable.

00:35:05.000 --> 00:35:09.999
The hope is that one day the cells contained in
the cord will help treat any number of diseases.

00:35:10.000 --> 00:35:15.280
…handling of human tissue. In the future, more diseases may be treated
including spinal cord injury, heart disease, cystic fibrosis…

00:35:20.000 --> 00:35:24.999
People are sensitive to this possibility and are ready
to pay big money to protect their future health

00:35:25.000 --> 00:35:29.999
and the health of their children. We strongly
recommend you contact us immediately

00:35:30.000 --> 00:35:34.999
to ensure all necessary steps are
undertaken in time for your delivery.

00:35:35.000 --> 00:35:39.999
What you see here are collection boxes.
Every month we collect roughly

00:35:40.000 --> 00:35:44.999
about 200 samples from parents who are
expecting. The cost of this service

00:35:45.000 --> 00:35:49.999
is 1,400 Singapore dollars, which
is roughly about 700 euro or 900US.

00:35:50.000 --> 00:35:54.999
This covers all the costs in the first year -
doctor’s fees, hospital’s fees, processing fees,

00:35:55.000 --> 00:35:59.999
testing fees, everything. And then there’s this 250 a
year, annual storage fee from the second year onwards.

00:36:00.000 --> 00:36:04.999
The Cordlife unit is stocked with
us for a contract of 21 years

00:36:05.000 --> 00:36:09.999
and know, the blood doesn’t last
just 21 years. In theory, the blood,

00:36:10.000 --> 00:36:14.999
if properly stored in a facility
such as this, it can last forever.

00:36:15.000 --> 00:36:19.999
In the future, it might
be entirely possible

00:36:20.000 --> 00:36:24.999
that the Cordlife unit becomes a precious heirloom
that is passed from one generation to the next.

00:36:25.000 --> 00:36:29.999
[music]

00:36:30.000 --> 00:36:34.999
Seven hundred and fifty thousand umbilical cords have
been stored frozen in private banks around the world,

00:36:35.000 --> 00:36:39.999
that’s three times more than in public banks.
Will they be useful one day? No one knows.

00:36:40.000 --> 00:36:44.999
Should we prevent parents from buying what
they might see as insurance for the future?

00:36:45.000 --> 00:36:49.999
France and Italy are among the few
countries that outlaw these banks.

00:36:50.000 --> 00:36:54.999
They have forbidden banks in the name of equal
access to healthcare for all, and also,

00:36:55.000 --> 00:36:59.999
because they want to limit the
commercial exploitation of ourselves.

00:37:00.000 --> 00:37:04.999
[sil.]

00:37:05.000 --> 00:37:09.999
Of course, in all these
stories of cord blood,

00:37:10.000 --> 00:37:14.999
there’s an underlying desire not to
grow old, to be eternally youthful.

00:37:15.000 --> 00:37:19.999
I think the appeal of umbilical cord blood,

00:37:20.000 --> 00:37:24.999
remember it’s the blood
of infants, is that aging

00:37:25.000 --> 00:37:29.999
people want to regain their youth.

00:37:30.000 --> 00:37:34.999
That’s nothing new. We see it
in the banking of cord blood.

00:37:35.000 --> 00:37:39.999
That’s why it’s so appealing to the public.

00:37:40.000 --> 00:37:44.999
Because otherwise why would people suddenly want
to store their children’s umbilical cord blood?

00:37:45.000 --> 00:37:49.999
They’re in some way hoping it
will give them eternal youth.

00:37:50.000 --> 00:37:54.999
But that’s more fantasy than reality.

00:37:55.000 --> 00:37:59.999
Today, our cells have a potential that
was unimaginable in John Moore’s time.

00:38:00.000 --> 00:38:04.999
They can be used to directly regenerate
failing tissue and cure incurable illnesses.

00:38:05.000 --> 00:38:09.999
That’s the hope of regenerative
medicine, which is in its infancy.

00:38:10.000 --> 00:38:14.999
Is it fantasy or reality?

00:38:15.000 --> 00:38:19.999
Today, dozens of teams around the world are
working in this new branch of medicine,

00:38:20.000 --> 00:38:24.999
engineering the dream of an ageless body. These
researchers hope to orient the development

00:38:25.000 --> 00:38:29.999
of undifferentiated cells towards specific functions,
the clinical applications are still uncertain.

00:38:30.000 --> 00:38:34.999
Everywhere, this research
raises ethical questions

00:38:35.000 --> 00:38:39.999
since it uses cells derived from human
embryos, stem cells - the new gold rush.

00:38:40.000 --> 00:38:44.999
An egg, a single sphere round egg,

00:38:45.000 --> 00:38:49.999
has the capability of
being, after it divides,

00:38:50.000 --> 00:38:54.999
every cell in the human body.

00:38:55.000 --> 00:38:59.999
I mean, everybody who can listen to what
I’m saying now started out as an egg.

00:39:00.000 --> 00:39:04.999
We were all fertilized eggs at one time. And
if you think about all the complex cells

00:39:05.000 --> 00:39:09.999
that are in your body,

00:39:10.000 --> 00:39:14.999
all of those cells are really
descendants of this one circular

00:39:15.000 --> 00:39:19.999
undifferentiated globe of an egg.

00:39:20.000 --> 00:39:24.999
So, stem cells, and there are some
stem cells in the human body,

00:39:25.000 --> 00:39:29.999
stem cells are cells that have the capacity
to differentiate and become some set of

00:39:30.000 --> 00:39:34.999
differentiated cells. Problem is,

00:39:35.000 --> 00:39:39.999
very few cells can develop into all
the possible cells of the human body.

00:39:40.000 --> 00:39:44.999
An egg, fertilized egg, is the ultimate stem
cell. It can become every cell in a body.

00:39:45.000 --> 00:39:49.999
[sil.]

00:39:50.000 --> 00:39:54.999
So, all of the frozen embryos are
stored in tanks of liquid nitrogen.

00:39:55.000 --> 00:39:59.999
The idea is to keep them as cold as
possible and preserve the structures

00:40:00.000 --> 00:40:04.999
of those embryos for as long as we possibly
can. And this room is filled with tanks

00:40:05.000 --> 00:40:09.999
of frozen embryos stored,

00:40:10.000 --> 00:40:14.999
many of them waiting for their respective
parents to come back and use those embryos.

00:40:15.000 --> 00:40:19.999
Some of them will never be used for
people for their reproductive purposes

00:40:20.000 --> 00:40:24.999
and they will be donated for research like the
embryonic stem cell research that we’re talking about.

00:40:25.000 --> 00:40:29.999
[sil.]

00:40:30.000 --> 00:40:34.999
And what we do is, we wait
until the patient calls us up

00:40:35.000 --> 00:40:39.999
and say, we have no more interest in
those embryos, please discard them.

00:40:40.000 --> 00:40:44.999
And only after they say that do we say to
them, there is another option for you.

00:40:45.000 --> 00:40:49.999
If you’d like, you could donate those embryos to
this human embryonic stem cell research program

00:40:50.000 --> 00:40:54.999
that we’re doing with Harvard University.
It’d be a wonderful opportunity to improve

00:40:55.000 --> 00:40:59.999
the health of mankind, specifically
targeted on this work with diabetes.

00:41:00.000 --> 00:41:04.999
And we really had a wonderful response to this. A lot
of patients were really enthusiastic about the idea,

00:41:05.000 --> 00:41:09.999
because they’re feeling kind of bad that
their embryos would simply be discarded.

00:41:10.000 --> 00:41:18.000
[sil.]

00:41:20.000 --> 00:41:24.999
The embryo is right here. A human embryo,

00:41:25.000 --> 00:41:29.999
a potential person for some, a
mass of stem cells for others,

00:41:30.000 --> 00:41:34.999
is an infinitely precious
resource, but not a rare one.

00:41:35.000 --> 00:41:39.999
There may be as many as two million
frozen embryos around the world,

00:41:40.000 --> 00:41:45.000
only a few hundred of them have been used for
research purposes. There it is. Thank you.

00:41:50.000 --> 00:41:58.000
[music]

00:42:00.000 --> 00:42:04.999
These embryos, that are three to five
days old, are cultured and transformed

00:42:05.000 --> 00:42:09.999
into stem cell lines. The embryo is
at the origin of all human life.

00:42:10.000 --> 00:42:14.999
Its use in research is an ethical issue

00:42:15.000 --> 00:42:19.999
and public opinion is dramatically divided about
it. Nearly all countries have passed laws.

00:42:20.000 --> 00:42:24.999
The production of stem cells
is illegal in Germany,

00:42:25.000 --> 00:42:29.999
Italy, Ireland, and with
some exceptions France.

00:42:30.000 --> 00:42:34.999
Production is highly regulated
in 20 other countries.

00:42:35.000 --> 00:42:39.999
The list of these countries is always changing depending on
political tendencies and the rewriting of laws governing bioethics.

00:42:40.000 --> 00:42:44.999
[non-English narration]

00:42:45.000 --> 00:42:49.999
The initial goal of bioethics was noble.

00:42:50.000 --> 00:42:54.999
It was to set limits, to establish
a framework, to prevent abuses.

00:42:55.000 --> 00:42:59.999
But what we gradually realized
is that the framework shifts

00:43:00.000 --> 00:43:04.999
to accommodate the changes. There are
always limits established by law,

00:43:05.000 --> 00:43:09.999
but since the laws are being
constantly updated and amended,

00:43:10.000 --> 00:43:14.999
we see the limits gradually stretching

00:43:15.000 --> 00:43:19.999
and loosening as the principles
are loosened by technologies

00:43:20.000 --> 00:43:24.999
that are inevitably trumpeted
with fantastic promises.

00:43:25.000 --> 00:43:29.999
So the framework becomes elastic.
In my opinion,

00:43:30.000 --> 00:43:34.999
the utility of bioethics is not to
prevent changes from happening,

00:43:35.000 --> 00:43:39.999
but to a acclimatize public opinion, to get
the public used to what it disapproves of

00:43:40.000 --> 00:43:44.999
at the time of the innovation.

00:43:45.000 --> 00:43:49.999
Singapore is the new
Eldorado for biotechnology

00:43:50.000 --> 00:43:54.999
and stem cell research. Unlike
in the rest of the world,

00:43:55.000 --> 00:43:59.999
the government here is investing directly
and massively in private companies,

00:44:00.000 --> 00:44:04.999
and it has given scientists a lot of
leeway when it comes to ethical questions.

00:44:05.000 --> 00:44:09.999
A city within the city, Biopolis was created
to attract researchers from around the world.

00:44:10.000 --> 00:44:14.999
I was working in a company in Edinburgh.

00:44:15.000 --> 00:44:19.999
And the technology we then
worked with led to Dolly.

00:44:20.000 --> 00:44:24.999
Dolly was just a proof of
principle of a technology.

00:44:25.000 --> 00:44:29.999
I mean, Dolly was just a Friday afternoon experiment.
It wasn’t something planned by either the company

00:44:30.000 --> 00:44:34.999
or the research institution, it was just
something sort of inserted at the last minute.

00:44:35.000 --> 00:44:39.999
So that showed what a powerful
technology this nuclear transfer was.

00:44:40.000 --> 00:44:44.999
And I’d already knew that, because my work in frogs
previously had been involved with nuclear transfer.

00:44:45.000 --> 00:44:49.999
But I didn’t see a whole raft

00:44:50.000 --> 00:44:54.999
of medical applications coming
directly from the technique,

00:44:55.000 --> 00:44:59.999
and so wanted to get nearer technology,
which was likely to give medical benefit,

00:45:00.000 --> 00:45:04.999
and that led me to embryonic stem cells and
away from the nuclear transfer technique.

00:45:05.000 --> 00:45:09.999
Now, I feel very comfortable
with the… the work that we do,

00:45:10.000 --> 00:45:14.999
that involves the use of surplus

00:45:15.000 --> 00:45:19.999
in vitro fertilization embryos
to make a limited number

00:45:20.000 --> 00:45:24.999
of human embryonic stem cell lines because,
you know, our objective in using those lines

00:45:25.000 --> 00:45:29.999
is to cure sickness and illness in humans.

00:45:30.000 --> 00:45:34.999
The scientists at the Biopolis
facility are ahead of everyone else.

00:45:35.000 --> 00:45:39.999
They’re already working on the clinical
applications of stem cell research.

00:45:40.000 --> 00:45:44.999
Ah Pikin, can you please
handle over her cells?

00:45:45.000 --> 00:45:50.000
Oh, thank you very much.

00:45:55.000 --> 00:45:59.999
[sil.]

00:46:00.000 --> 00:46:04.999
So, let’s see whether we can find
some beating embryonic bodies here?

00:46:05.000 --> 00:46:13.000
[sil.]

00:46:15.000 --> 00:46:19.999
Hmm… hmm… hmm… Okay. So, what we can
see here is a nice little clump,

00:46:20.000 --> 00:46:24.999
of differentiated human embryonic
stem cells. And you can see

00:46:25.000 --> 00:46:29.999
that this clump is slowly contracting.

00:46:30.000 --> 00:46:34.999
So now, why is it contracting? What we have
used is the expanded human embryonic stem cells

00:46:35.000 --> 00:46:39.999
and then we have used a specific
protocol that we have developed here

00:46:40.000 --> 00:46:44.999
at Embryonic Stem Cells International to drive
them towards a cardiac differentiation,

00:46:45.000 --> 00:46:49.999
because what we finally
want to use in the clinic

00:46:50.000 --> 00:46:54.999
is cardiomyocytes.

00:46:55.000 --> 00:46:59.999
So, we test them first in animal
experiments. We inject them in the heart

00:47:00.000 --> 00:47:04.999
and we test whether they improve the
heart function in this animal models.

00:47:05.000 --> 00:47:09.999
And in the next stage then, we would like to…
we will finally try them in clinical trials,

00:47:10.000 --> 00:47:14.999
where we’d like to support and to replace

00:47:15.000 --> 00:47:19.999
the loss of cardiomyocytes in the human heart,
for example, after a myocardial infarction.

00:47:20.000 --> 00:47:24.999
So, that’s the final goal.

00:47:25.000 --> 00:47:29.999
One day, this tiny cluster of
cells may repair someone’s heart.

00:47:30.000 --> 00:47:34.999
The regenerative medicine is
only a dream for the time being.

00:47:35.000 --> 00:47:39.999
It is inspiring financial investments
equal to the hope it represents.

00:47:40.000 --> 00:47:44.999
I think one interesting question
is why are all these countries

00:47:45.000 --> 00:47:49.999
spending so much energy
and money in biomedicine.

00:47:50.000 --> 00:47:54.999
Is it simply because the economics?
I don’t think so.

00:47:55.000 --> 00:47:59.999
I think what’s happening
here is that biomedicine

00:48:00.000 --> 00:48:04.999
is part of the expectation
of the population,

00:48:05.000 --> 00:48:09.999
just as much as energy was the expectation
of populations to have a warm house,

00:48:10.000 --> 00:48:14.999
which 300 hundred years ago, you
didn’t expect to have a warm house,

00:48:15.000 --> 00:48:19.999
you were lucky to have a warm house.

00:48:20.000 --> 00:48:24.999
Now, everybody expects your house to
have a heater that generates energy.

00:48:25.000 --> 00:48:29.999
Right now, in the progress of
humanity, we all expect health.

00:48:30.000 --> 00:48:34.999
Part of our expectation is
actually to take this science

00:48:35.000 --> 00:48:39.999
and make ourselves healthier,
make ourselves more productive,

00:48:40.000 --> 00:48:44.999
to live longer and to live better lives.

00:48:45.000 --> 00:48:49.999
Everyone wants to live better.
But at what price

00:48:50.000 --> 00:48:54.999
and who will benefit? Biology and genetics
are going to revolutionize healthcare.

00:48:55.000 --> 00:48:59.999
But by reaching into our very selves,

00:49:00.000 --> 00:49:04.999
these scientists are touching
the essence of who we are.

00:49:05.000 --> 00:49:09.999
In the name of health, are we ready
to compromise our principles?

00:49:10.000 --> 00:49:18.000
[music]

00:49:25.000 --> 00:49:29.999
For me, human dignity is not a right.

00:49:30.000 --> 00:49:34.999
For me, human dignity is the
foundation of all the other rights,

00:49:35.000 --> 00:49:39.999
the privacy, the autonomy, ah… the… the
solidarity, security of the individual

00:49:40.000 --> 00:49:44.999
and so on, integrity. For me, dignity is
not in between all these other rights.

00:49:45.000 --> 00:49:49.999
You cannot have these other rights
given to human persons if the fact

00:49:50.000 --> 00:49:54.999
that human persons are… are not
recognized as having dignity.

00:49:55.000 --> 00:49:59.999
What is the limit to the freedom of
research in the absence of a law saying

00:50:00.000 --> 00:50:04.999
you must not do this or this or that in a criminal sense?
And that to me, human dignity then is the ultimate arbiter,

00:50:05.000 --> 00:50:09.999
the ultimate limit of the
freedom of research.

00:50:10.000 --> 00:50:14.999
Right now, the power of the technologies is that
we can actually get down to the exact nucleotides

00:50:15.000 --> 00:50:19.999
that could be tied to subtle biological,

00:50:20.000 --> 00:50:24.999
medical outcomes, okay, including,

00:50:25.000 --> 00:50:29.999
umm… not only eye color and the
susceptibility of disease,

00:50:30.000 --> 00:50:34.999
but sometimes even to taste and personalities and
what have you. So, when we get into such precision,

00:50:35.000 --> 00:50:39.999
the danger comes in, umm… with the…

00:50:40.000 --> 00:50:44.999
who’s actually owning this information. All the
secrets of who you are could conceivably be exposed.

00:50:45.000 --> 00:50:49.999
In which case we need a set
of laws that will protect

00:50:50.000 --> 00:50:54.999
that individual from undue
invasions of their privacy.

00:50:55.000 --> 00:50:59.999
At the same time, we need to
have, ah… an understanding

00:51:00.000 --> 00:51:04.999
that knowledge of these differences
can actually help us cure diseases.

00:51:05.000 --> 00:51:09.999
So, this balance becomes one of the most
critical ethical questions of our time.

00:51:10.000 --> 00:51:14.999
[music]

00:51:15.000 --> 00:51:19.999
The Moore case was the first to ask questions
about the legal status of the body

00:51:20.000 --> 00:51:24.999
and the trading of living cells. Recent advances in
science have challenged the very foundations of life.

00:51:25.000 --> 00:51:29.999
Behind the fantasy of endless good health, we can spot
the dangerous desire to master all biological processes.

00:51:30.000 --> 00:51:34.999
Without international cooperation,
without a well-defined legal framework,

00:51:35.000 --> 00:51:39.999
there will be no barriers to the commercial
and industrial exploitation of our bodies,

00:51:40.000 --> 00:51:45.000
and the manipulation of the
living beings that we are.