Conscience and modern medicine.

"A doctor's conscience has little place in the delivery of modern medical care." - New England Journal of Medicine[1]

"The doctor ... if not living in a moral situation ... where limits are very clear, ... is very dangerous."
- Auschwitz survivor.[2]

There was a "special article" published in the New England Journal of Medicine last week which a friend brought to my attention. Entitled, "Religion, Conscience, and Controversial Medical Practices"[3], it purports to "determine what practicing physicians think their obligations are when a patient requests a legal medical procedure to which the physician has a religious or other moral objection."[4] The issue, as the introduction states, has been brought to a head by pharmacists and physicians refusing to dispense contraception. Although several states have passed "conscience laws" protecting medical personnel from repercussions when they refuse to participate in immoral activities, the existence of these laws has the medical establishment gnashing its teeth. "In the wake of recent controversies over emergency contraception, editorials in leading clinical journals have criticized these 'conscience clauses' and challenged the idea that physicians may deny legally and medically permitted interventions, particularly if their objections are personal and religious."[5] The authors are quite correct. Two leading medical journals have published the following verbatim assessment of the problem: "... a doctor's conscience has little place in the delivery of modern medical care ... if people are not prepared to offer legally permitted, efficient, and beneficial care to a patient because it conflicts with their values, they should not be doctors."[6]

In the NEJM study, the authors polled 1820 physicians, receiving 1144 responses. They asked the physicians whether they believed it ethically permissible to explain their moral objections to patients, whether they thought it necessary to explain all options (including "controversial" ones) to patients, and whether they felt obliged to refer a patient to a physician who would perform the "controversial" procedure. The authors also attempted to assess the degree of "intrinsic religiosity" in the physician respondents, and obtained their answers (object, or don't object) to the following "clinically controversial" situations: "terminal sedation" in a dying patient, providing an abortion in the case of failed contraception, and prescribing birth control to a minor without parental approval. Answering the "intrinsic religiosity" questions, the respondents sorted roughly into thirds (low, 37%; moderate, 27%; high, 36%). On the "terminal sedation question, 83% did not object, and 17% did object.[7] Regarding the questions of abortion and contraception, however, things were more evenly split: 48% for and 52% against on abortion, and 58% for and 42% against on contraception. On the final questions, 63% thought the physician should tell the patient why he objects to the procedure, 86% thought they should tell all options, and 71% thought the physician should refer.

On that last question, "obligation to refer", the authors made an astounding claim. They took the percentage who answered "no" (18%), and added that to the percentage who were undecided (11%). They took the sum, 29%, and multiplied it by the population of the United States and said, "... nearly 100 million Americans may be cared for by physicians who do not feel they have an obligation to refer..." They followed a similar scheme to make this claim, "... more than 40 million Americans may be cared for by physicians who do not believe they are obligated to disclose information about medically available treatments they consider objectionable."[8] As if people don't know about abortion and birth control pills.

The authors then worried that about half the physicians objected to abortion for failed contraception, and that about half didn't want to give birth control to minors without parental consent. Finally, the authors made a point that "male physicians and those who are religious are most likely to express personal objections and least likely to disclose information about the interventions or refer patients to more accommodating providers."[9]

I am no stranger to the fact - for fact it is - that the American medical establishment is a major supporter of moral relativism Yet, when I read this article, I was floored: the overarching arrogance of these people just numbs the brain. Let me be clear. The fundamental issue here isn't whether a majority of physicians are for or against abortion or birth control pills; the fundamental issue here is that the American medical establishment rejects the idea that there exists an objective moral order. This fact is stated explicitly. The "conscience clause" controversy, according to another New England Journal of Medicine paper, "represents the latest struggle with regard to religion in America."[10] Because the medical establishment rejects any moral order, it is simply unable to see the "controversial procedures" for what they are: the very seeds of the culture of death. Contraception, its twisted sister abortion, the bastard stepchildren of euthanasia, embryonic stem cell research, vaccines and medicines manufactured from aborted humans, and all the rest; they are not "controversial procedures", any more than murder is. They are intrinsic evils. And, if one recognizes murder for what it is, and is unwilling to do the deed oneself, one doesn't refer to someone who is. The medical machine simply doesn't get it.

"Conscience has no place in medicine." So say the contemporary medical intelligentsia: the writers and editors of the elite medical journals, who occupy the most prestigious university positions. Well, I say thank God that a "substantial number" of individual, work a day docs do still have a conscience, and the courage to act according to that conscience. For without that conscience we are no more than technological barbarians, and no different from those physicians who stood on the ramps at Aushwitz and Dachau decades ago as the trains pulled in, sorting the prisoners into to lines, one line to live, the other line to die.

Endnotes
[1] Curlin, FA et al. Religion, Conscience, and Controversial Clinical Practices New England Journal of Medicine 356(6):593-600, 8 February 2007.
[2] Lifton, RJ. The Nazi Doctors: Medical Killing and the Psychology of Genocide Basic Books Inc., New York, 1986. Pg. 430.
[3] Curlin, ibid.
[4] ibid.
[5] ibid, my emphasis.
[6] Savalescu J. Conscientious objection in medicine. British Medical Journal 2006; 332:294-7. The quote was repeated in the NEJM article under discussion.
[7] I thought this question was ambiguous. The definition of "terminal sedation" given in the paper was, "administering sedation that leads to unconsciousness in dying patients". As written, this description is not necessarily equivalent to "euthanasia", though one suspects that it might be a euphemism.
[8] Curlin, ibid, pg. 597
[9] ibid, pg. 600. My emphasis.
[10] Charo RA. The celestial fire of conscience - refusing to deliver medical care. New England Journal of Medicine 2005; 352:2471-3.

Stem Cells Part VIII: Nanog, parthenotes and Cdx2

Is it possible to obtain hES cells without destroying an embryo? There are some variant methods out there which are touted as filling the bill, including embryo biopsy, as well as a group of methods called pluripotent stem cells derived from biological artifacts. We will look at each in turn.

To understand embryo biopsy, we first need to recall that the primary product of IVF is a zygote. Actually, many zygotes. These zygotes are then allowed to grow in vitro to the blastocyst stage, and the best ones among them are selected for implantation in the mother's womb, while the rest go into the freezer. There are two steps in the selection process: one step is a morphologic assessment where the developing embryos are examined under the microscope, and graded for "quality"[1]. The other step is "pre-implantation genetic diagnosis" (PGD), which is actually performed before the morphologic assessment. It works like this: the IVF zygote is allowed to divide to the 8 cell morula stage (day 3), where the individual cells are still morphologically similar, and known as blastomeres. One of these blastomeres is removed from the morula using established techniques, and its chromosomes checked. If they're OK, the morula from which the single blastomere was removed is allowed to grow to the blastocyst stage, and, if the morphologic grading is OK, implanted. The live birth rate from IVF is abysmal; it varies from 11% (women over 40) to about 35% (women under 35).[2] Nevertheless, advocates of PGD claim that this embryo biopsy, which removes 12% of the embryo's body, doesn't hurt its already slim chances of survival. Recently, researchers from Advanced Cell Technology of Worcester, MA used the PGD embryo biopsy technique to establish a new hES cell line.[3] They obtained cast off embryos from an IVF clinic, and removed blastomeres using standard procedures. These blastomeres were then cultured, and some of them developed into cells with hES cell characteristics. The cells didn't form new embryos. The authors' proposal is that, since a blastomere is clipped from an IVF embryo anyway as part of the PGD process, why not use that blastomere to develop a new hES cell line?[4] No embryo is killed (in theory, anyway) and researchers have a source from which to develop new hES cell lines.

The National Catholic Bioethics Center [5] lists three reasons embryo biopsy is unacceptable.

1. It requires nontherapeutic intervention on a human embryo which, in addition to presenting a serious risk to its life, reduces the "young human to commodities or manipulable products."
2. The method can only be used as an adjunct to IVF, which is itself intrinsically evil.
3. Human ES cells from killed embryos are necessary in co-culture with the blastomeres, so the need to kill embryos in not, in fact, obviated.

So much for embryo biopsy. In May, 2005, the President's Council on Bioethics published its "White Paper: Alternative Sources of Pluripotent Stem Cells",[6] which explored several alternatives for obtaining hES cells without harming the embryo. Interestingly, one of the alternatives rejected on ethical grounds (danger to the embryo) was embryo biopsy, though this didn't bother the folks at Advanced Cell Technology when they published in Nature the following year. However, two items of concern here were lumped together under the heading, "Pluripotent Stem Cells Derived from Biological Artifacts."[7] They are (1) oocyte assisted reprogramming - altered nuclear transfer (OAR-ANT) and (2) parthenotes.

OAR-ANT is basically a modification of SCNT. In regular SCNT, a normal somatic cell nucleus is transferred to an enucleated oocyte to produce an embryo who is a clone of the somatic cell's owner. In ANT, the nucleus is altered prior to transfer (hence the name) to knock out some genes (such as a gene called Cdx2) necessary for early embryonic development. The oocyte's cytoplasm is also modified (such as by the addition of the transcription factor Nanog) such that it will better assist the reprogramming of the transferred nucleus to make it grow up into an hES cell instead of an embryo; that's the OAR part of OAR-ANT. The idea is to create an entity which "would therefore lack organized development from the very earliest stages... Such an entity would be a 'biological artifact,' not an organism."[8] To put it more succinctly, the method would "use genetic engineering and somatic cell nuclear transfer to create an embryo-like entity that was designed from the beginning to self destruct after the blastocyst stage."[9]

OAR-ANT precipitated quite a debate among orthodox Catholic theologians. Some agree with the notion that the "artifact" is not, never was, and never will be an embryo, and therefore the method is licit.[10] Others argue that the artifact is, in fact, an embryo, albeit one severely crippled by design.[11] This is not a settled issue. My opinion lies with the latter interpretation.

The final candidate in this sad roundup is the parthenote. Parthenogenesis, where a single egg develops into an adult individual without a male contribution, is common in lower animals. But it doesn't occur naturally in placental mammals. However, experimental parthenogenesis has had limited success in a variety of mammals, including monkeys, though none of the experiments has resulted in a live birth.[12] There have not been, to my knowledge, any experimentally induced human parthenotes beyond the single cell stage, but the point of the exercise is to get a human parthenote to grow to at least the blastocyst stage, and then destroy it for its inner cell mass. Like the "artifact" produced by ANT, the human parthenote is believed to be unable to grow much beyond the blastocyst stage, and therefore is not really a human embryo. The White Paper points out that the only way to test that hypothesis is to create a human parthenote, implant it in a womb, and see what happens.[13] And here we shall let the matter rest.

Endnotes.
[1] Veeck LL. An Atlas of Human Gametes and Conceptuses Parthenon, New York, 1999.
[2] 2003 Assisted Reproductive Technology Report Centers for Disease Control, Dept. Of Health and Human Services, available at www.cdc.gov/ART/ART2003/index.html See 2003 National Summary Table. This is the most recent data reported.
[3] Klimanskaya I, Chung Y, et al. Human embryonic cell lines derived from single blastomeres. Nature 444:481-485, 23 November 2006. Originally published on line in August.
[4] ibid. See also the clarifying letter: Simpson, JL. Blastomeres and stem cells. Nature 444:432-435. 23 November 2006.
[5] On Proposed Method for Extracting Embryonic Stem Cells by Embryo Biopsy. August, 2006. National Catholic Bioethics Center http://www.ncbcenter.org/06-08-25-embryo.asp
[6] White Paper: Alternative Sources of Pluripotent Stem Cells The President's Council on Bioethics Available at http://www.bioethics.gov/reports/white_paper/text.html
[7] ibid, Section III.
[8] ibid.
[9] Byrnes, WM. Partial Trajectory: The Story of the Altered Nuclear Transfer-Oocyte Assisted Reprogramming (ANT-OAR) Proposal. Linacre Quarterly 74(1): 50-59, February, 2007. Emphasis in the original.
[10] Austriaco, NPG. The Moral Case for ANT-Derived Pluripotent Stem Cell Lines. National Catholic Bioethics Quarterly 6(3):517-537. Fr. Austriaco references much of the moral literature, pro and con, in this recent publication.
[11] Byrnes, ibid. This paper is a good and up to the minute synopsis of the OAR-ANT story.
[12] Hipp J & Atala A: Tissue engineering, stem cells, cloning, and parthenogenesis: new paradigms for therapy. Journal of Experimental & Clinical Assisted Reproduction 2004:1:3
[13] White Paper, ibid, Section V D.

Feast days of the week 25 February - 3 March 2007 (1962 liturgical calendar).

SECOND PART OF THE LITURGICAL YEAR: THE EASTER CYCLE (MYSTERY OF THE REDEMPTION).[1]
I. Lent

Sunday, 25 February, 2007
First Sunday of Lent
'Our Lord Jesus Christ, directly after His baptism, prepared Himself for His public life and mission by a fast of forty days in the desert, which extends from Jericho to the Mountains of Judea. Let us prepare ourselves by fast, prayers and works of charity for the solemn Feast of Easter.”
Epistle: II Cor 6:1-10.
Gospel: Matt 4:1-11.

Monday, 26 February, 2007
Monday of the First Week in Lent
Day of fast (traditional)
Lesson: Ezechiel 34:11-16.
Gospel: Matt 25:31-46.

Tuesday, 27 February 2007
Tuesday of the First Week in Lent
Day of fast (traditional)
Lesson: Isaias 55:6-11.
Gospel: Matt 21:10-17.

Wednesday, 28 February 2007
Ember Wednesday
Day of fast (traditional)
Lesson: Exodus 24:12-18.
Lesson: III Kings 19:3-8.
Gospel: Matt 12:38-50.

Thursday, 1 March 2007
Thursday of the First Week in Lent
Day of fast (traditional)
Lesson: Ezechiel 18:1-9.
Gospel: Matt 15:21-28.

Friday, 2 March 2007
First Friday
Ember Friday (II)

Day of fast (Obligatory)
Lesson: Ezechiel 18:20-28.
Gospel: John 5:1-15.

Saturday, 3 March 2007
First Saturday
Ember Saturday (II)

Day of fast and partial abstinence (traditional)
Lesson: Deut 26:12,13,14-19.
Gospel: Thess 5:14-23.


[1] Remarks are abstracted from The Daily Missal and Liturgical Manual, from Editio Typica of the Roman Missal and Breviary, 1962
(Baronius Press Limited, London, 2004, in conjunction with the Fraternal Society of St. Peter, www.baroniuspress.com)

Notes from the Roman Missal (1962): Lent (The Easter Cycle)

SECOND PART OF THE LITURGICAL YEAR: THE EASTER CYCLE (MYSTERY OF THE REDEMPTION).[i]
I. Lent

The Christmas Cycle celebrates the Mystery of the Incarnation. The Easter Cycle celebrates the Mystery of the Redemption and has the following subdivisions:

1. Season of Lent
2. Eastertide
3. After Whitsunday

I. - Season of Lent.
Introduced by three Sundays (Septuagesima, Sexagesima, and Quinquagesima), the season of Lent begins on Ash Wednesday and ends with the death of Jesus in Passion Week. The struggle between our Lord and Satan ends with the victory of the Savior at Eastertide. During the period from Septuagesima to Ash Wednesday, the liturgy speaks no more of our greatness but contemplates the misery of fallen humanity - the fatal consequences of original sin and actual sin - and the sacrifice that God asked from the faithful Melchisedech, symbol of the sacrifice that Jesus brings for the whole of humanity.

In this period we also prepare for the fasting and penance of the season of Lent. The season can be recapitulated with the words of the Preface of Lent: 'Who by this bodily fast dost curb our vices, lift our minds, and bestow strength and rewards.' Our souls are slaves of the Devil, flesh and the world. Jesus came into the world, not to be crowned king of the Jews, but to deliver us from this threefold bondage and to restore to us the divine life which we had lost.

The season of Lent ends with Passiontide (from Passion Sunday to Easter). The Judica me... and the Gloria Patri are omitted because the very ancient Masses of Passiontide date from an age before these prayers were added to the Roman Mass. The Liturgy commemorates the sorrowful events of the last week of Jesus' mortal life. On Thursday evening, He had the Last Supper with His Apostles, and on the following day He was crucified on Calvary.

'Who didst establish the salvation of mankind on a tree of the Cross, that whence death came thence also life might arise again, and that we, who were overcome by a tree, by a tree might also overcome.'

The struggle between our Lord and Satan ends with the apparent success of Satan on Good Friday. The priests are robed in vestments of mourning, and the whole Church wears an aspect of sadness. But by the sacrifice of Himself, the Son of God triumphs and gloriously comes forth from the sepulchre on Easter morning.

The three Sundays preceding Ash Wednesday are called Septuagesima, Sexagesima, and Quinquagesima, which mean, respectively, the seventieth, sixtieth, and fiftieth day, that is, before Easter. They are mere names to correspond with the name of Lent (Quadragesima in Latin: fortieth); obviously they do not actually correspond with the period they indicate.

Man, victim of the sin of Adam and of his own sins, is justly afflicted, groans and sorrows encompass him.

On these Sundays the Gloria in excelsis and Alleluia are omitted, except when the Mass of a feast is said, and the purple vestments are used in preparation for Lent.

It is Jesus who, by the merits of His Passion, is to open the eyes of man as He did those of the blind man of Jericho, and deliver him alike from the bondage of sin and error.

Ash Wednesday is from a liturgical point of view one of the most important days of the year. In the first place this day opens the liturgical season of Lent, which formerly began with the First Sunday and comprised only thirty-six days. The addition of Wednesday and the three following days brought the number to forty, which is that of our Lord’s fast in the desert.

In the Old Law ashes were generally a symbolic expression of grief, mourning, or repentance. In the Early Church the use of ashes had a like signification, and with the sackcloth formed part of the public penances. The blessing of the ashes is one of the great liturgical rites of the year. It was originally instituted for public penitents, but is now intended for all Christians, as Lent should be a time of penance for all. The ashes used this day are obtained by burning palms of the previous year. Traditionally they are blessed by four ancient prayers, sprinkled with holy water and incensed, and then placed in the form of a cross on the foreheads of each of the faithful with the words: ‘Remember, man, that thou art dust, and unto dust thou shalt return.’ The ancient prayers of the blessing suggest suitable thoughts for the opening of Lent. They are summarized here:

‘Almighty and everlasting God, spare the penitent ... bless these ashes, that they may be a remedy to all who invoke Thy Name ... O God, who desirest not the death but the conversion of sinners, look in kindness upon our human frailty ... and bless those ashes, so that we, who know ourselves to be but ashes ... and that we must return to dust, may deserve to obtain pardon and the rewards offered to the penitent.’

[i] Remarks are abstracted from The Daily Missal and Liturgical Manual, from Editio Typica of the Roman Missal and Breviary, 1962
(Baronius Press Limited, London, 2004, in conjunction with the Fraternal Society of St. Peter, www.baroniuspress.com)

Stem Cells Part VII: Why is cloning necessary?

Last week we saw the distinction between somatic cell nuclear transfer (SCNT) used for reproductive cloning, and SCNT used for therapeutic cloning, and that the difference lies not in the embryo produced, but the fate of that embryo. In reproductive cloning, the embryo is implanted in a uterus, where it will, perhaps, grow to birth. In therapeutic cloning, the embryo is not implanted in a womb; rather, it destroyed for research.

"What happens to clones depends on decisions made by the researchers in question; if they want a clone to grow, it is implanted in the uterus of a woman, and if its stem cells are to be used for research, it is destroyed. Thus, the terms of common usage (reproductive cloning vs. therapeutic cloning - TPC) refer to the applications for which the technology is to be used, which is to say, the intentions of the researchers involved, and not the cloned embryo itself."[1]

We also saw that the name, therapeutic cloning, is a lie: there are no therapies at this time from human embryonic stem cell (hES cell) research, nor are there any therapies on the horizon. However, that is the term which is used and so, to avoid confusion, we'll use it, too. So, why is therapeutic cloning so necessary to a mature hES cell R&D program?

The answer is: "immune mediated tissue rejection".

Our immune systems function by being able to recognize self from non-self. All the cells in my body have unique molecular identifiers, defined by my genome, tagging them as part of me, so that my immune system will recognize them as such, and not destroy them. Conversely, other cells - bacteria, fungi and, these days, transplanted tissues and organs, have tags which identify them as "from away", and the immune system goes after them. Because of this tagging, in a conventional tissue or organ transplant, a search is made to find donor material as immunologically similar as possible. Outside of autologous (self-sourced) donations or donations from identical twins, exact matches are rare. Thus, the transplant recipient generally needs to be on some sort of immune suppression regimen for the rest of his life, so that his own immune system doesn't reject the transplant. As you might imagine, chronic immune suppression carries its own set of problems. The theoretical ideal would be to have an unlimited supply of tissues and organs which were exact immunologic matches to the original equipment. The immune system wouldn't attack them, and there would be no need for chronic suppression.

Recall that the stated near term goal of hES cell research is to generate replacements for diseased systems. When - or if - this will ever actually come to fruition is anybody's guess[2] (I am among the unbelievers) but it is, nevertheless, on the basis of these incessantly repeated claims that the dollars flow. In addition, the less clearly stated goal is ... is what? Immortality, with each and every one of us having his own garage full of spares? Who knows. Regardless, hES cells are pushed as the best theoretical route to this brave new medical world. As we saw in the previous essays, ES cells, human or otherwise, will differentiate, but currently this differentiation cannot be controlled. Instead, they just grow into globs unorganized mature tissues (the box of spare parts in last week's essay) like embryoid bodies and teratomas. Suppose, for sake of argument, the ability to direct hES cell differentiation were a reality instead of a fantasy. Could a patient receive them?

Yes, but. The but is that the patient would still need to be immunosuppressed, to keep from rejecting the hES-derived replacements. True, in this hypothetical brave new world of hES therapy there would (presumably) be a wide selection of cell line genotypes to select from. Large banks of genetically diverse hES cells are envisioned by the National Academies of Science[3], which increases the possibilities of an exact match. This is one of the rationales given for "generating additional hES cell lines from a wider spectrum of the population."[4] However, an exact match would still be rare. The best alternative, from the point of view of the stem cell therapist (a medical qualification I just invented) would be to have replacement tissues which are genetic clones of the patient. Schemata abound as to how this might be accomplished; a representative one goes like this[5]: first, the patient needing replacement tissue is biopsied to obtain somatic cells. For discussion, any somatic cells will do, skin is a good example. Next, SCNT is performed using nuclei from the patient's biopsy and oocytes from some woman donor[6]. The new embryo, currently described as a "created entity with and undefined status",[7] would be grown to the blastocyst stage, and then destroyed to harvest the cells of the inner cell mass. These cells - now cultured and known as hES cells - are then "engineered" using methods not extant, to produce the desired replacement material, which is then implanted in the patient. Since the created entity of an undefined status was, in fact, a clone of the patient, he (she?) was a genetic match, as would be the tissues derived from him (her?). Hence, the patient would not need chronic immunosuppression and the cloned tissue, in theory, gets around the immune rejection problem.

Over the past few essays, we have seen that human embryonic stem cell research requires (1) the creation of viable human embryos, either specifically for research or as cast-offs from IVF procedures, and (2) the destruction of those embryos to obtain their inner cell masses ("harvest"). We have also seen that a mature, fully developed hES program will require cloning, as well as the production of chimeras. All of this is, of course, hopelessly evil. The question we will next take up is whether there are any alternatives which are not immoral.

Endnotes.
[1] Bobbert, M. Ethical questions concerning research on human embryos, embryonic stem cells and chimeras. Biotechnology Journal 2006, 1:1352-1369. cf. pg 1354, my emphasis.
[2] ibid, pg. 1357.
[3] "Guidelines for Human Embryonic Stem Cell Research." National Research Council and Institute of Medicine of the National Academies National Academy Press, Washington, D.C. 2005 Pg. 34
[4] ibid
[5] Hipp J & Atala A: Tissue engineering, stem cells, cloning, and parthenogenesis: new paradigms for therapy. Journal of Experimental & Clinical Assisted Reproduction 2004:1:3
[6] The topic of women being paid for their oocytes is an essay in itself. Suffice it so say that egg sales are already a big, big subcomponent of the IVF industry, and young, attractive college coeds with high SAT score can be tens of thousands of dollars for their eggs in California.
[7]de Wert G & Mummery, C. Human embryonic stem cells: research, ethics and policy. Human Reproduction 18(4):672-682, 2003 pg. 679.

Feast days of the week 18-24 February 2007 (1962 liturgical calendar).

SECOND PART OF THE LITURGICAL YEAR: THE EASTER CYCLE (MYSTERY OF THE REDEMPTION).[1]
I. Prelude to the Season of Lent: Season after Septuagesima
II. Lent

"The Christmas Cycle celebrates the Mystery of the Incarnation. The Easter Cycle celebrates the Mystery of the Redemption and has the following subdivisions:

1. Season of Lent
2. Eastertide
3. After Whitsunday

I. - Season of Lent.
Introduced by three Sundays (Septuagesima, Sexagesima, and Quinquagesima), the season of Lent begins on Ash Wednesday and ends with the death of Jesus in Passion Week. The struggle between our Lord and Satan ends with the victory of the Savior at Eastertide. During the period from Septuagesima to Ash Wednesday, the liturgy speaks no more of our greatness but contemplates the misery of fallen humanity - the fatal consequences of original sin and actual sin - and the sacrifice that God asked from the faithful Melchisedech, symbol of the sacrifice that Jesus brings for the whole of humanity.

In this period we also prepare for the fasting and penance of the season of Lent. The season can be recapitulated with the words of the Preface of Lent: 'Who by this bodily fast dost curb our vices, lift our minds, and bestow strength and rewards.' Our souls are slaves of the Devil, flesh and the world. Jesus came into the world, not to be crowned king of the Jews, but to deliver us from this threefold bondage and to restore to us the divine life which we had lost.

The season of Lent ends with Passiontide (from Passion Sunday to Easter). The Judica me... and the Gloria Patri are omitted because the very ancient Masses of Passiontide date from an age before these prayers were added to the Roman Mass. The Liturgy commemorates the sorrowful events of the last week of Jesus' mortal life. On Thursday evening, He had the Last Supper with His Apostles, and on the following day He was crucified on Calvary.

'Who didst establish the salvation of mankind on a tree of the Cross, that whence death came thence also life might arise again, and that we, who were overcome by a tree, by a tree might also overcome.'

The struggle between our Lord and Satan ends with the apparent success of Satan on Good Friday. The priests are robed in vestments of mourning, and the whole Church wears an aspect of sadness. But by the sacrifice of Himself, the Son of God triumphs and gloriously comes forth from the sepulchre on Easter morning."

Sunday, 18 February, 2007
Quinquagesima Sunday
"The three Sundays preceding Ash Wednesday are called Septuagesima, Sexagesima, and Quinquagesima, which mean, respectively, the seventieth, sixtieth, and fiftieth day, that is, before Easter. They are mere names to correspond with the name of Lent (Quadragesima in Latin: fortieth); obviously they do not actually correspond with the period they indicate.

Man, victim of the sin of Adam and of his own sins, is justly afflicted, groans and sorrows encompass him.

On these Sundays the Gloria in excelsis and Alleluia are omitted, except when the Mass of a feast is said, and the purple vestments are used in preparation for Lent."

“It is Jesus who, by the merits of His Passion, is to open the eyes of man as He did those of the blind man of Jericho, and deliver him alike from the bondage of sin and error.”
Epistle: I Cor 13:1-13.
Gospel: Luke 18:31-43.

Monday, 19 February, 2007
Ferial
Epistle: I Cor 13:1-13.
Gospel: Luke 18:31-43.

Tuesday, 20 February 2007
Ferial.
Epistle: I Cor 13:1-13.
Gospel: Luke 18:31-43.

Wednesday, 21 February 2007
Ash Wednesday
Beginning of Lent
Day of Fast and Abstinence.
“Ash Wednesday is from a liturgical point of view one of the most important days of the year. In the first place this day opens the liturgical season of Lent, which formerly began with the First Sunday and comprised only thirty-six days. The addition of Wednesday and the three following days brought the number to forty, which is that of our Lord’s fast in the desert.
In the Old Law ashes were generally a symbolic expression of grief, mourning, or repentance. In the Early Church the use of ashes had a like signification, and with the sackcloth formed part of the public penances. The blessing of the ashes is one of the great liturgical rites of the year. It was originally instituted for public penitents, but is now intended for all Christians, as Lent should be a time of penance for all. The ashes used this day are obtained by burning palms of the previous year. Traditionally they are blessed by four ancient prayers, sprinkled with holy water and incensed, and then placed in the form of a cross on the foreheads of each of the faithful with the words: ‘Remember, man, that thou art dust, and unto dust thou shalt return.’ The ancient prayers of the blessing suggest suitable thoughts for the opening of Lent. They are summarised here:
‘Almighty and everlasting God, spare the penitent ... bless these ashes, that they may be a remedy to all who invoke Thy Name ... O God, who desirest not the death but the conversion of sinners, look in kindness upon our human frailty ... and bless those ashes, so that we, who know ourselves to be but ashes ... and that we must return to dust, may deserve to obtain pardon and the rewards offered to the penitent.’”
Lesson: Joel 2:12-19.
Gospel: Matt 6:16-21.

Thursday, 22 February 2007

Chair of St. Peter (Traditional day of fast).
Epistle: 1 Peter 1:1-7.
Gospel: Matt 16:13-19.

Friday, 23 February 2007
Friday after Ash Wednesday.
Fast (Obligatory)
Lesson: Isaias 58:1-9.
Gospel: Matt 5:43-48; 6:1-4.

Saturday, 24 February 2007
Saturday after Ash Wednesday.
Fast (Traditional)
Lesson: Isaias 58:9-14.
Gospel: Mark 6:47-56.


[1] Remarks are abstracted from The Daily Missal and Liturgical Manual, from Editio Typica of the Roman Missal and Breviary, 1962
(Baronius Press Limited, London, 2004, in conjunction with the Fraternal Society of St. Peter, www.baroniuspress.com)

Stem Cells Part VI: Cloning.

We have covered a lot of material in the first few essays, on stem cells in general and human embryonic stem cells (hES cells) in particular. We've looked in some detail at how hES cells are obtained in the laboratory, and seen that the process involves the destruction of a human embryo. It is this destruction of the embryo at the blastocyst stage to obtain its inner cell mass - those cells which will give rise to in vitro hES cells - which is the source of the immorality of the procedure[1]. We have also seen that a fully developed and mature hES cell research and development program such as that desired by the majority of our elite will require the production of human-animal chimeras,[2] a process which is immoral prima facie. Now we will look at another immorality which is a necessary component of our hypothetical mature hES cell R&D program: cloning of human embryos via somatic cell nuclear transfer (SCNT). We'll begin with some definitions.

Somatic cell: Any cell of a plant or animal other than a germ cell or germ cell precursor.[3]
Germ cell: A sperm or egg or a cell that can become a sperm or egg. All other body cells are called somatic cells.[4]
Somatic cell nuclear transfer: The transfer of a cell nucleus from a somatic cell into an egg from which the nucleus has been removed.[5]

The human genome has 46 chromosomes, but a germ cell has only half that number, 23. That is because the father's germ cell, his sperm, will contribute half of his genetic makeup to the new baby, and the mother's germ cell, her oocyte, will contribute her half. Upon conception, mom's 23 chromosomes and dad's 23 chromosomes combine to form a new, genetically distinct individual with 46 chromosomes. This new individual starts out, as we all did, as a single celled zygote, but soon divides and divides again to form, eventually, a grownup person. From conception until death, every cell a person forms will be a somatic cell[6], with a complete copy of the 46 chromosomes inherited from mommy and daddy that fateful day long ago up in mom's fallopian tube. Even though all somatic cells have a complete copy of the genome, in any given cell, for example, a liver cell, the majority of the genome is turned off, and only those parts necessary for the cell to function as a liver cell are turned on. However, in theory, if one could properly activate the genome of that liver cell, one could manufacture a complete new human being, a genetic copy of the human from whom the original liver cell came. Nice theory. How might it be accomplished in practice?

The oocyte has some interesting characteristics. In addition to being a germ cell, the egg is much, much larger than the sperm. This is because the oocyte contains, in addition to mom's half of the genetic contribution, all the molecular machinery necessary to activate the newly formed genome. This molecular machinery is contained within the egg's cytoplasm, the part of the egg which is not the nucleus. Thus, when a new genome appears within the oocyte - such as at conception - the oocyte's cyoplasmic machinery fires up, unzips the new genome, and starts it on its way. SCNT takes advantage of this capability of the oocyte. First, the nucleus is first removed from an oocyte such as, for example, the oocyte of a Scottish blackface ewe. Then, the nucleus containing the genome of a somatic cell from somewhere else, say the mammary gland of a 6 year old Finn Dorset ewe, is transferred to the enucleated oocyte. Hence the name, somatic cell nuclear transfer. That new combination of Finn Dorset ewe mammary gland nucleus and Scottish blackface sheep oocyte cytoplasm will form a new embryo which has the genome of the original Finn Dorset ewe. If implanted in the uterus of a sheep, this embryo might grow to live birth. That is how Dolly the Finn Dorset sheep was cloned, and gestated to birth in the womb of a Scottish blackface sheep, ten years ago, back in 1997[7]. A similar technique was reported for the efficient cloning of human embryos by the South Korean researcher WS Hwang in the world renowned journal Science in 2004.[8] A second paper came out in Science in 2005;[9] both were heralded by the world's lay, political, and scientific organs as great breakthroughs in hES cell research, because cloned human embryos could now be produced reliably in large quantities. Dr. Hwang became an instant celebrity on the stage of the world. Sadly, the research turned out to be fake, and Science had to retract the articles[10].

The process of using SCNT to produce a cloned embryo which is then implanted in a womb and gestated to birth has come to be known as "reproductive cloning"[11]. If, instead if implantation, the cloned embryo is destroyed to obtain its inner cell mass for the purpose of generating embryonic stem cells, the process is commonly known as "therapeutic cloning"[12]. It has been pointed out this latter term is misleading as it implies that therapies derived from hES cells are a reality[13], when such therapies exist only as fiction. But the name has stuck, so we shall use it. The point is this: there is not an iota of difference between the embryo produced by therapeutic cloning and the embryo produced by reproductive cloning. The only difference is what is done with the cloned embryo: destroyed for its inner cell mass, or implanted in the hopes of producing a liveborn. In the case of the cloned human embryo, whether it has a soul is known only to God.

Next week: why cloning is so necessary in hES cell research.

Endnotes.
[1] This is not to say that other activities associated with hES cell research are without moral problems. For example, in vitro fertilization, the source of many cast-off blastocysts, is in itself immoral. However, we are confining ourselves here to hES cell research only.
[2] "Guidelines for Human Embryonic Stem Cell Research." National Research Council and Institute of Medicine of the National Academies National Academy Press, Washington, D.C. 2005. See Ch. 2, "Scientific background", pg. 31.
[3] Guidelines, ibid, Glossary.
[4] ibid.
[5] ibid.
[6] This is not strictly true, for the new person will also have her own set of germ cells, but that doesn't concern us here.
[7] Wilmut I, Schnieke AE, McWhir J, Kind AJ & Campbell KHS. Viable offspring derived from fetal and adult mammalian cells. Nature 385 (6619):810-813, 7 Feb 1997.
[8] Hwang, WS, Ryu, YJ, Park, JH et al. Evidence of a pluripotent embryonic stem cell line derived from a cloned blastocyst. Science. 2004; 303:1669-1674.
[9] Hwang, WS, Roh SI, Lee BC et al. Patient-specific embryonic stem cell line derived from a cloned blastocyst. Science. 2005; 308(5729):1777-1783.
[10] Science 311(5759):335. 20 Jan 2006.
[11] Hipp, J & Atala, A. Tissue engineering, stem cells, cloning, and parthenogenesis: new paradigms for therapy. Journal of Experimental & Clinical Assisted Reproduction 2004,1:3; 8 Dec 2004.
[12] ibid.
[13] de Wert G & Mummery, C. Human embryonic stem cells: research, ethics and policy. Human Reproduction 18(4):672-682, 2003.

What in the world is going on with Gardasil?

Last Friday, Texas Governor Rick Perry issued an executive order - an executive order - that Merck’s HPV vaccine, Gardasil, be required for all Texas girls entering 6th grade, beginning September, 2008.[1] Well.

We discussed The HPV Vaccine a couple of weeks ago, and we’ll recall that human papilloma virus (HPV) is a virus, transmitted by sexual contact, and which causes venereal warts (condylomata) and cervical dysplasia, a precursor to cervical cancer. Since most cervical cancers originate in HPV induced cervical dysplasia, it is fair to call cervical cancer a sexually transmitted disease. Transformation from dysplasia to malignancy takes years, even decades, and it’s quite predictable; that's why cervical cytology screening programs - the venerable Pap smear and its modern congeners - are so effective. Prior to the 1950’s, cervical cancer was the number one cancer killer of women in the U.S. It still is, in the third world, but in developed countries cervical cancer has been pushed way down: in 2007, the NCI estimates 11,000 new cases, and 3700 cancer related deaths.[2] However, HPV infection remains ubiquitous and costly, in terms of dollars for treatment and screening programs, as well as medical morbidity.

Gardasil protects against four of the most common high risk HPV subtypes, which account for 70% of cervical dysplasia and 90% of genital warts. The three shot series costs $360.00. Duration of action and need for boosters is unknown. It is not manufactured using material derived from aborted babies, and therefore does not have the moral problems of those other Merck products, Varivax and the rubella component of MMR II. Gardasil does not eliminate the need for screening programs. The presumption is that cervical cancer rates will decrease with mass vaccination, but that is by no means certain, and it may be years (decades?) before the effect, if any, will be seen, due to the long latency from infection to invasive disease.

In June, 2006, the Advisory Council on Vaccine Practices “recommended” universal vaccination with Gardasil for all girls starting at age 11, but starting as early as age 9. That same month, it was approved by the FDA. These recommendations were incorporated into the American Academy of Pediatrics immunization guidelines.[3] ACIP recommendations quickly the form of law, and twenty six states including Texas are considering mandating the vaccine,[4] [5] [6] The Catholic Medical Association encourages its use, but “...rejects efforts...to mandate that girls be vaccinated.”[7] The National Catholic Bioethics Center has taken a similar position.[8]

With all this data firmly in hand, it is time to consider Governor Perry’s action. An executive order. That seems to imply a clear and present danger, so great that things cannot await their usual course. The Governor likened HPV to polio, but that comparison is absurd. HPV is not “like polio”, or smallpox, or any other serious, highly transmissible vaccine preventable illness. It is a disease obtained by sexual intercourse, vaginal, anal or oral, and by no other route. It is slow and indefinite in its effects (many cases spontaneously regress). Yes, it is a big public health problem. But it is not a public health emergency. A little girl who goes to school is not going to get HPV by sitting next to someone who has it. Parents may elect to vaccinate their little girls with Gardasil, and there is nothing wrong with that. However, it is a violation of the Catholic social principle of subsidiarity for a governing body to require this vaccine, because the State is arrogating to itself a right and a role which belongs to the parents: proper training of the child regarding sex. In other words, the State has no moral right to order me to vaccinate my girls with Gardasil. Governor Perry’s executive order strikes me as a florid misuse of his power.

So, what in the world is going on with Gardasil? I don’t know. Perhaps many of the people involved in this, including Governor Perry, are truly well meaning. But they are misinformed. The question isn’t whether Gardasil is a potentially useful vaccine. It is; and I’m not against the vaccine per se. If the state wants to allocate money to make it available, that’s fine. But the disease doesn’t warrant universal mandatory vaccination.

Merck will make a ton of money on this. Wall Street estimates that 60% of the price of the vaccine will be profit[9], which comes to $72.00 profit per shot. Seventy two dollars times every American girl age 11 or more, then that number times three (three shots, remember?) and that’s a lot of dollars - estimates up to $4 billion[10]. There is much on the internet about a money trail between Merck and those who make public policy.[11] Now, companies give money to politicians of their choice, which is to be expected. However, if the allegations are true, it is wrong for Merck to try to purchase legislation requiring that people use their product.

Finally, we have the nanny state. The State is increasingly usurping the rights of parents, usually under the guise of “what’s best for the child,” and the medical establishment has been a willing accomplice. Regarding Gardasil, the American College of Obstetricians and Gynecologists recommends it "...be routinely given to girls when they are 11 or 12...".[12] The American Academy of Family Practice concurs with the ACIP recommendations,[13] and we have already discussed the AAP. This should come as no surprise, insofar as these organizations have pushed contraception among minors, with or without parental knowledge, for years.[14] It becomes increasingly difficult for me to view these organizations dispassionately when so much of what they teach so blatantly reflects left wing political agendas.

In summary: I am not opposed to mass vaccination in principle. I am not opposed to Gardasil in principle. I am opposed to mandatory vaccination with Gardasil. If you want to use Gardasil, or have your little girls vaccinated with it, go right ahead. But its use should not be mandated.

Endnotes.
[1] Texas Gov. orders anti-cancer vaccine. by Liz Austin Peterson, AP Writer, Available at http://news.yahoo.com/s/ap/
[2] Cervical cancer. National Cancer Institute Cancer Topics, available at http://www.cancer.gov/cancertopics/types/cervical
[3] Recommended Immunizations Schedules for Children and Adolescents - United States, 2007. Pediatrics 2007; 119:207-208. Available at http://www.pediatrics.org/cgi/content/full/119/1/207
[4] Drug firm pushes vaccine mandate. by Laura Smitherman BaltimoreSun.com, 29 January 2007, available at http://www.baltimoresun.com
[5] Daily Women’s Health Policy in Daily Reports, 1 Feb 2007, kaisernetwork.org
[6] STD vaccine campaign sweeping the nation. by Bob Unruh WorldNetDaily 8 Feb 2007 at http://www.worldnetdaily.com/news/article.asp?ARTICLE_ID=54143
[7] CMA Issues Statement on Implementation of HPV Vaccine. 18 January 2007. Catholic Medical Association, www.cathmed.org
[8] NCBC Statement on Vaccination against Human Papilloma Virus (HPV). National Catholic Bioethics Center, 11 July 2006. www.ncbcenter.org/06-07-11-hpv_vaccine.asp
[9] Drug firm pushes, ibid. See the pie chart labeled “HPV Vaccine”
[10] STD campaign, ibid.
[11] Drug firm pushes, ibid. See also:
STD campaign, ibid. See also:
Family group compares HPV vaccine to condoms. by Bob Unruh WorldNet Daily 6 Feb 2007 at http://www.worldnetdaily.com/news/article.asp?ARTICLE_ID=54102 See also:
Trouble for Texas Catholics: Governor Violates Parental Authority - Kowtows to Merck. Children of God for Life 5 February 2007, available at http://www.cogforlife.org
[12] HPV Vaccine - ACOG Recommendations, 4 August 2006. American College of Obstetricians and Gynecologists, at http://www.acog.org/departments/dept_notice?recno=7&bulletin=3945
[13] AAFP Provisional Recommendations for the Use of Quadrivalent HPV Vaccine. 7 September 2006. American Academy of Family Practice, available at http://www.aafp.org/online/en/home/clinical/immunizationres/hpv.html
[14] Policies and Materials on Adolescent Health of the American College of Obstetricians and Gynecologists. 29 January 2007. American College of Obstetricians and Gynecologists, at http://www.acog.org The entire section reads as follows:
Sex and Family Life Education:"The American College of Obstetricians and Gynecologists supports the inclusion of age-appropriate sexuality education from grades kindergarten through 12th grade as an integral part of comprehensive health education in schools and communities. The American College of Obstetricians and Gynecologists encourages its members to advocate for and participate in such education." "All sexuality education programs should provide scientifically accurate information about sexuality, STDs, contraception, and preventive health care." ACOG supports “ongoing rigorous evaluation of the effectiveness of a variety of forms of sexuality education in terms of their effect on sexual behavior, as well as unintended pregnancy and abortion rates."
Contraception or Family Planning for Minors:"Health professionals have an obligation to provide the best possible care to respond to the needs of their adolescent patients. This care should, at a minimum, include comprehensive reproductive health services, such as sexuality education, counseling… [and] access to contraceptives ..." "Legal barriers that restrict the freedom of health care practitioners to provide these services should be removed."
Reproductive Health Services For Adolescents:"The potential health risks to adolescents if they are unable to obtain reproductive health services are so compelling that legal barriers and deference to parental involvement should not stand in the way of needed health care for patients who request confidentiality. Therefore, laws and regulations that are unduly restrictive of adolescents' confidential access to reproductive health care should be revised."
Confidentiality: " Because the involvement of a concerned adult can contribute to the health and success of an adolescent, policies in health care settings should encourage and facilitate communication between a minor and her parent(s), when appropriate." "Most adolescents underuse existing health care services. A major obstacle to the delivery of health care to adolescents is their concern about confidentiality." "… physicians should work with the political process to eliminate laws unduly restrictive of confidential health services for adolescents." “To overcome barriers to confidentiality imposed by legal and economic constraints, physicians should discuss confidentiality with both the adolescent girl and, where appropriate, her parent(s) or guardian(s). Health care provides should be familiar with current state and local statutes on the rights of minors to consent to healthcare services, as well as those federal and state laws that affect confidentiality. It also is important to involve and inform office staff about those policies and procedures that facilitate and ensure confidentiality." Available at http://acog.org/departments/dept_notice.cfm?recno=7&bulletin=4107

See also:
Adolescent Health Care. American Academy of Family Practice, at http://www.aafp.org
Specifically, the subsection entitled. "Sexuality and Contraception", Part C. "Adolescents receiving contraceptive services should be accorded strict patient confidentiality." Available at http://www.aafp.org/online/en/home/policies/a/adolescent.html
It is true that many state laws require physicians to provide contraception without parental knowledge, but the medical establishment has not opposed these laws.

Feast days of the week 11-17 February 2007 (1962 liturgical calendar).

SECOND PART OF THE LITURGICAL YEAR: THE EASTER CYCLE (MYSTERY OF THE REDEMPTION).[1]

I. Prelude to the Season of Lent: Season after Septuagesima

"The Christmas Cycle celebrates the Mystery of the Incarnation. The Easter Cycle celebrates the Mystery of the Redemption and has the following subdivisions:

1. Season of Lent
2. Eastertide
3. After Whitsunday

I. - Season of Lent.
Introduced by three Sundays (Septuagesima, Sexagesima, and Quinquagesima), the season of Lent begins on Ash Wednesday and ends with the death of Jesus in Passion Week. The struggle between our Lord and Satan ends with the victory of the Savior at Eastertide. During the period from Septuagesima to Ash Wednesday, the liturgy speaks no more of our greatness but contemplates the misery of fallen humanity - the fatal consequences of original sin and actual sin - and the sacrifice that God asked from the faithful Melchisedech, symbol of the sacrifice that Jesus brings for the whole of humanity.

In this period we also prepare for the fasting and penance of the season of Lent. The season can be recapitulated with the words of the Preface of Lent: 'Who by this bodily fast dost curb our vices, lift our minds, and bestow strength and rewards.' Our souls are slaves of the Devil, flesh and the world. Jesus came into the world, not to be crowned king of the Jews, but to deliver us from this threefold bondage and to restore to us the divine life which we had lost.

The season of Lent ends with Passiontide (from Passion Sunday to Easter). The Judica me... and the Gloria Patri are omitted because the very ancient Masses of Passiontide date from an age before these prayers were added to the Roman Mass. The Liturgy commemorates the sorrowful events of the last week of Jesus' mortal life. On Thursday evening, He had the Last Supper with His Apostles, and on the following day He was crucified on Calvary.

'Who didst establish the salvation of mankind on a tree of the Cross, that whence death came thence also life might arise again, and that we, who were overcome by a tree, by a tree might also overcome.'

The struggle between our Lord and Satan ends with the apparent success of Satan on Good Friday. The priests are robed in vestments of mourning, and the whole Church wears an aspect of sadness. But by the sacrifice of Himself, the Son of God triumphs and gloriously comes forth from the sepulchre on Easter morning."

Sunday, 11 February, 2007
Sexagesima Sunday
"The three Sundays preceding Ash Wednesday are called Septuagesima, Sexagesima, and Quinquagesima, which mean, respectively, the seventieth, sixtieth, and fiftieth day, that is, before Easter. They are mere names to correspond with the name of Lent (Quadragesima in Latin: fortieth); obviously they do not actually correspond with the period they indicate.

Man, victim of the sin of Adam and of his own sins, is justly afflicted, groans and sorrows encompass him.

On these Sundays the Gloria in excelsis and Alleluia are omitted, except when the Mass of a feast is said, and the purple vestments are used in preparation for Lent."
Epistle: II Cor 11:19-33; 12:1-9.
Gospel: Luke:4-15.

Monday, 12 February, 2007
The Seven Holy Founders of the Servite Order, Confessors
“Seven noble Florentines founded in 1233 the Order of Servites of the Blessed Virgin Mary. The Servites led an austere life, meditating constantly on the Passion of Our Lord and venerating the Blessed Virgin as Our Lady of Sorrows.”
Lesson: Ecclesiasticus 44:1-15.
Gospel: Matt 27-29.

Tuesday, 13 February 2007
Ferial.
Epistle: II Cor 11:19-33; 12:1-9.
Gospel: Luke:4-15.

Wednesday, 14 February 2007
Commemoration of St. Valentine, Priest, Martyr
"This holy Poman priest assisted with other pious Christians a great number of maryrs. He was beheaded under Aurelian, A.D. 270.”
Lesson: Wisdom 10:10-14.
Gospel: Matt 10:34-42.

Thursday, 15 February 2007
Commemoration os SS. Faustinus and Jovita, Martyrs.
"SS. Faustinus and Jovita were brothers of noble origin. After having suffered various tortures, they were beheaded at Brescia A.D. 117."
Epistle: Heb 10:32-38.
Gospel: Luke 12:1-8.

Friday, 16 February 2007
Ferial.
Epistle: II Cor 11:19-33; 12:1-9.
Gospel: Luke:4-15.

Saturday, 17 February 2007
Our Lady's Saturday
Lesson: Ecclesiasticus 24:14-16.
Gospel: John 19:25-27.


[1] Remarks are abstracted from The Daily Missal and Liturgical Manual, from Editio Typica of the Roman Missal and Breviary, 1962
(Baronius Press Limited, London, 2004, in conjunction with the Fraternal Society of St. Peter, www.baroniuspress.com)

Stem Cells Part V: Chimeras.

We left off last week with the dawn of the human embryonic stem cell era, Dr. Thomson's landmark Science paper published in November of 1998[1]. There are a number of "defining properties" of a human embryonic stem cell (hES cell),[2] but they are generally boiled down to three: first, it must come from a human pre-implantation embryo. Second, it must be able to replicate itself indefinitely in the laboratory, while maintaining genetic stability and remaining undifferentiated. Finally, it must possess "stable developmental potential to form derivatives of all three embryonic germ layers...". This last criterion is crucial, it is, in fact, the heart of "stem cell-ness". If a cell growing in culture isn't pluripotent, it's just a cell growing in culture, and will not have the miraculous ability to cure every disease known to man and keep us all age 28 forever. So, Dr. Thomson demonstrated that his five cell lines met the first two criteria: they came from pre-implantation human embryos, and they could be grown indefinitely in culture, without differentiating. This left only the third criterion: demonstrating pluripotentiality. Demonstrating this last criterion in a putative embryonic stem cell line is crucial. How is it done?

There are three primary ways a stem cell can be shown to be pluripotent[3]. The first way is in vitro differentiation. When hES cells (or, for that matter, mouse embryonic stem cells, which have been being researched since the early 1980's) are grown in culture, they must be carefully maintained on a layer of feeder cells, generally a specific cell known as mouse embryonic fibroblasts. As mentioned last week, this need for feeder cells is a major technological hurdle which has only been partially solved, but that doesn't concern us. If the hES cells aren't properly maintained on a feeder layer, they will spontaneously round up into embryoid bodies,[4]and it was this characteristic that Dr. Thomson used to demonstrate pluripotentiality in his cell lines. What are embryoid bodies? They are "clumps of cellular structures that arise when embryonic stem cells are cultured. Embryoid bodies contain tissue from all three germ layers: endoderm, mesoderm, and ectoderm. Embryoid bodied are not part of normal development and occur only in vitro."[5] We hear much from the opposition describing the early human embryo as a blob of tissue. This is not true, of course; the early human embryo is an early human being. However, embryoid bodies are, in fact, blobs of tissue. Human ES cell lines do not, in and of themselves, have the ability to self organize into a human embryo; that ability was lost when the true embryo, the blastocyst, was ripped apart for its inner cell mass. However, they may well develop into a meaningless aggregation of random tissues, not unlike the box in my garage filled with old engine parts. When Dr. Thomson's hES cells were removed from their feeder cells and placed in liquid suspension, they formed embryoid bodies. If the embryoid bodies are allowed to attach to a tissue culture plate, they will form mature tissue types, similar to a teratoma[6].

What is a teratoma? A teratoma is a naturally occurring tumour which consists of fully mature, random tissues. They are quite common in the ovary, and less commonly found in the testis. They are usually, but not always, benign, and the most common types are called "dermoid cysts" because they are big cystic things growing off the ovary, filled with hair and goo. The prognosis is generally excellent. They are dramatic, though, being filled with hair, skin, and other mature tissue types. Occasionally fully formed teeth are present, and, vary rarely, there may be a structure called a fetiform teratoma (also known as a homunculus)[7]. As we saw, the first method of demonstrating putative hES cell pluripotentiality is to let them form embryoid bodies, then put the bodies in a dish. They will form things similar to teratomas. The second method, though, of demonstrating hES cell pluripotentiality is to inject them into a mouse. If truly pluripotent, they will form teratomas. This was the second method Dr. Thomson used in his paper: he injected his hES cells into mice and, sho'nuff they developed teratomas of mature, human tissue types. This brings us to the last, "gold standard" method of demonstrating pluripotentiality: chimeras.

Chimera: An organism composed of cells derived from at least two genetically different cell types. The cells could be from the same or separate species.[8] As with teratomas, there are naturally occurring chimeras, but they don't concern us. In mouse ES cell research, the "gold standard" for demonstrating pluripotentiality is to produce a chimera. The mouse ES cells are injected directly into the cavity of a mouse blastocyst. The blastocyst is then implanted in the uterus of a female mouse, and the resulting babies will be chimeras, with organs and tissues derived from both the original blastocyst and the injected mES cells[9]. The reason that the production of chimeras is considered the "most rigorous test" of pluripotentiality is because the researcher can assess the functionality of the tissue thus produced, something one cannot do with teratomas or embryoid bodies. Thomson's original article did not produce human/mouse chimeras. However, today researchers want to. Why? Quoting from the National Academies of Science's 2005 publication, Guidelines for Human Embryonic Stem Cell Research directly,

"Those types of differentiation assays (embryoid bodies and teratomas) do not provide conclusive evidence that the resulting cell types are functioning normally, nor whether hES cells have the capacity to participate in normal development in the context of the three-dimensional embryo in the reproductive tract. Such conclusive evidence requires testing in blastocyst chimeras as is routinely done with mES cells.[10]

Make no mistake, human/animal chimeras are part and parcel of hES cell research. So is cloning, which we will take up next week.

Endnotes
[1] Thomson, JA et al Embryonic Stem Cell Lines Derived from Human Blastocysts. Science 282:1145-1147, November 6, 1998.
[2] "Stem Cells: Scientific Progress and Future Directions June 2001" National Institutes of Health, Department of Health and Human Services pg. 13 Entire report downloadable in pdf format at http://stemcells.nih.gov/info/scireport/2001report
[3] "Guidelines for Human Embryonic Stem Cell Research." National Research Council and Institute of Medicine of the National Academies National Academy Press, Washington, D.C. 2005. See Ch. 2, "Scientific background", pg. 30 ff.
[4] In fact, if the cells are kept in the dish on a lawn of feeder cells, and are simply allowed to grow up to the sides of their dish, becoming a bit crowded, they will begin to spontaneously differentiate. See Thompson et al, ibid.
[5] Guidelines, ibid, Glossary.
[6] Ibid, pg. 31.
[7] Crum, CP & Lee, KR Diagnostic Gynecologic and Obstetric Pathology Elsevier Saunders, Philadelphia. 2006. Pp 915-917.
[8] Guidelines, ibid, Glossary. To flesh this out a little, a chimera consists, essentially, of distinct populations of cells with two (or more) separate genetic make ups, and as such should not be confused with hybrids, where the genomes of two species, say a horse and a donkey, are combined at conception to produce a mule.
[9] Paraphrased from ibid, pp31ff.
[10] Ibid, page 33. My emphasis.

Introibo ad altare Dei

This was first posted on Introibo ad altare Dei 16 November 2006. I've been meaning to move it over here anyway, but Rorate caeli has posted an excellent essay on 31 Jan which is quite relevant. It's worth your time. However, what follows are my own sentiments on the matter.

"Introibo ad altare Dei: I will go unto the altar of God." So intones the priest as he begins the liturgy of the Traditional Latin Mass. So well known were some of these Latin phrases prior to 1970 that they were part of the vernacular: Buck Milligan would say the Introibo (sardonically) when preparing to shave in James Joyce's Ulysses, and I recall the Doonesbury character Zonker quipping Mea culpa (from the Confiteor) in a strip from the early 1970's. Finally, to round things out, we have hocus pocus, a lovely phrase used originally to identify jugglers, tricksters, and the tricks they performed. There are various theories regarding the origin of hocus pocus; one of these is that the words are an intentional ridicule of part of the Mass, the consecration of the bread by the priest: Hoc est enim corpus meum, "For this is My Body..." You see, in the center of the Mass is the re-presentation (in the sense of, making present), in an unbloody way, of Christ's sacrifice for us. When the ordained priest says the words of consecration in the Mass, Christ becomes present, entirely, Body, Blood, Soul and Divinity, under the accidents of the bread and wine. After consecration it is The Precious Body which is there, in the consecrated hands of the priest, under the accident of bread. Likewise it is The Precious Blood truly present, under the accident of the wine. So the Church teaches. This is not magic, and it is not hocus pocus. It is the Sacrament of the Eucharist, instituted by Christ himself.

All of these popular references became obscure, however, when the Novus ordo - New Order - Mass of Pope Paul VI was promulgated in 1970. Although it was popularly held that the Traditional Latin Mass, also known as the Tridentine Rite (in reference to the Council of Trent) was officially suppressed at the same time the Novus ordo was promulgated, such was not the case. It did, however, go underground for a variety of reasons, but recently it's been making a comeback throughout the Catholic world. The Coalition Ecclesia Dei lists 20 Latin Masses in 1980 in the U.S., and over 220 in 2006. In addition, there are at least three orders forming priests in the Traditional ways of the Church, to include properly saying the Traditional Latin Mass: The Priestly Fraternity of St. Peter, The Institute of Christ the King, Sovereign Priest, and The Society of St. Pius X. The Society of St. Pius X is in a somewhat irregular status vis a vis the Vatican, the details of which do not concern us here. Suffice it to say that, in my opinion, we would have neither the Fraternal Society of St. Peter nor the Institute of Christ the King were it not for the Society of St. Pius X, and there we shall let the matter rest.

Why is any of this important, since most American Catholics have hazy memories, or none at all, of the Mass of All Time? Simply this: most Catholics today who love the Church know that something is wrong, very wrong. A generation ago the Church opened her arms to the world, and rapidly found herself ensnared in the web of the world's evil, from which it sometimes seems that there is no escape. The more she struggles, the tighter the web pulls. One of the surest and saddest symptoms of the sickness within the Church is the loss of understanding, and the loss of faith, among the faithful. This is reflected in the lack of understanding among Catholics on many things which concern us in this journal: Church teaching on contraception, abortion, and the long and growing list of things derived from those first two. But, these are peripheral things, and they are all symptoms, surface presentations of the deep sickness within the Body of Christ: a lack of faith in Christ and the Church that He founded. That is the illness. What is the cure?

Lex orandi, lex credendi. Fr. Anthony Manupella, in the March, 2002 issue of Homiletic and Pastoral Review, wrote that the original axiom was stated by Pope St. Celestine in 422 AD as, Legem credendi statuit lex orandi, or, "the rule of prayer determines the rule of faith." This has been shortened to, "As we pray, we believe". As is sometimes the case, those who are in opposition to the Church see this more clearly than many within the Church: a brief scan of any atheist website will produce short paragraphs explaining that how a person prays will influence what a person believes. This is why how we worship God, that is, the form (liturgy) we use in worship, has such an influence in the long run regarding what we believe about God, and our relationship to Him. If we worship God in a casual way, focusing more on ourselves than Him, we will come to believe He is a casual God, Who is ready, at our convenience, to chat about things over a nice cup of latte. Conversely, if we worship God like He is the Creator and Lord of all, and further, that He is a mystery, who nevertheless loves us and desires our salvation, well, sooner or later we'll begin to believe that, and accept it.

This is not to say that a reversion to the Traditional Latin Mass will magically fix the problems in the Church. After all, the forces unleashed by the Second Vatican Council in 1965 were endorsed by men who were formed within the Traditional Latin Mass. However, I believe that the resumption of widespread use of the Latin Mass is a necessary first step in order to begin the long process of restoration. Lex orandi, lex credendi. Further, I believe that this will happen, given time. The Novus ordo is sterile, you see. It doesn't make priests. Forty years from now who will be saying the Novus ordo? But as I look around in the little chapel where I and my family assist at Mass, and see the five or six (or seven) altar boys (including the oldest of my sons) in the procession, surrounding the altar, assisting the priest, who has himself become small, blending himself into the Holy Sacrifice at the great altar of God, I believe this (and these are not my words, but the words of our priest): the Church will right herself, the Divine equilibrium will assert itself, in God’s own time.