A Conversation with Insoo Hyun, PhD Assistant Professor of Bioethics Case Western Reserve University School of Medicine
Dr. Hyun received a BA and an MA in philosophy from Stanford University and a PhD in philosophy from Brown University. His predominant interest is in biomedical ethics. In the summer 2005, with the help of a Fulbright Research Award, Dr. Hyun collaborated with Korean bioethicists and with South Korean scientist Dr. Woo Suk Hwang to study the ethics of human research cloning. Subsequently, Dr. Hwang, who claimed to be the first scientist to make viable stem cell lines from cloned human embryos, was charged with scientific and ethical misconduct for having fabricated research data involving egg donations. On his return to the U.S., Dr. Hyun became a frequent commentator in the media on the Korean situation.
Dr. Hyun’s long-term goal is to use his findings to begin building collaborative research projects between bioethicists in other countries and the U.S. who share an interest in studying the international and cross-cultural facets of human research cloning and embryonic stem cell research. He was recently appointed Chair of the Ethics and Public Policy Committee of the International Society for Stem Cell Research (ISSCR). In the conversation that follows, Dr. Hyun talks about what it means to be a bioethicist, what may have brought about the collapse of the Korean cloning experiment and what he believes the future holds for stem cell research.
Global Health Nexus (GHN): How did your interest in bioethics develop?
Dr. Hyun: I began as a graduate student in philosophy with a focus on ethical theory and epistemology – both core areas in traditional analytic philosophy. During my graduate work with Dan Brock, a very prominent bioethicist and philosopher, my first big entry into bioethics was a cloning issue. Right after Dolly was cloned by Ian Wilmut in 1997, President Clinton asked his National Bioethics Advisory Committee to come up with two position papers on the ethics of human cloning: one a religious ethics paper and the other a secular ethics paper. Dan Brock, as a member of the President’s Committee, was picked to do the secular ethics paper, and I was his research assistant. I had
been a pre-med major in college until I switched to philosophy, and what I saw at that time was that bioethics was a way for me to combine my interests in biomedicine and science with philosophy.
GHN: What do bioethicists do?
Dr. Hyun: Bioethics is an extremely broad field and bioethicists are a very diverse lot. You have people who work in professional or medical ethics, relating to clinical issues between doctor and patient and in the clinic setting. They deal with ethical issues that are not completely answered by the law and are not purely religious questions, and they’re not medical questions exactly — they’re questions of deep personal values and human rights. Then you have people who do work in health policy, perhaps at the political level, who represent the voice of concern about the implications of health policy for society. Finally, there are those in biomedical research, who consider what implications come from biomedical technology. They serve as the voice of social concern in this area. Bioethicists are also active in teaching, academic publishing and government.
GHN: Both professionally and personally, you’ve had a bird’s-eye view into one of the most ethically controversial episodes in the history of embryonic stem cell research. Could you comment on that experience?
Dr. Hyun: In the spring of 2005, about a year after Dr. Woo Suk Hwang had published his first paper in Science claiming that he and his South Korean colleagues had cloned human embryos for the first time and had produced an embryonic stem cell line from one of these cloned embryos, I was awarded a Fulbright Faculty Research Fellowship to go to Korea for the summer to study the factors that had enabled Korea to make this advance. I eventually arrived in Seoul two weeks after the publication of Hwang’s second paper in Science announcing that his team had produced 11 patient-specific stem cell lines from embryos that were cloned from many different people. The Hwang team was at the height of their popularity internationally during the summer of 2005 — the period of my fellowship.
Dr. Hwang really liked the idea of my being Korean-American — in fact, as far as I know, I’m one of perhaps only two Korean-American bioethicists in the U.S. – and he gave me broad access to his team. Based on Dr. Hwang’s published claims that he and his team had been able to improve efficiency in egg donation, I wanted to study the consent process the team used as a basis for developing an ethical donation system that could be used by other scientists in other countries.
Initially, it appeared that the Hwang team followed rigorous informed consent procedures to procure eggs and somatic cells for their research. As events developed, however, it emerged that Dr. Hwang’s data was distorted, and rather than develop a more efficient system, his team actually had access to 2,000 eggs and was still not able to create a viable cloned stem cell line.
GHN: Before Dr. Hwang’s fabrications came to light, the South Korean government had provided massive public funding for the project. What type of cultural, legal and social environment made it possible for South Korea to invest so heavily in this research?
Dr. Hyun: Koreans, even those who are uncomfortable with embryonic stem cell research, felt an overwhelming sense of pride in Dr. Hwang’s earlier research and in what it appeared his team could further accomplish. This created a willingness to set aside religious qualms in favor of the future economic growth of the country. In other words, one set of values took precedence over another. Also, in Korea, the issue of stem cell research is not wrapped up in the abortion debate as it is in the U.S. Culturally and legally in Korea, an embryo has no protected status until it’s implanted in a woman’s body.
GHN: Might some of the same motivations that led the nation to support Dr. Hwang’s research also have contributed to the ethical breaches that occurred?
Dr. Hyun: Given the enormous public funding that Dr. Hwang had received, there was immense pressure on him to show very grand results. I think he may have thought that if he claimed to be the first scientist to make viable stem cell lines from cloned human embryos, someone somewhere in the world where active research is occurring in this area — in China, India, Britain, Singapore, Sweden or the U.S. —would soon succeed at getting stem cells from cloned embryos, and his claims would be validated.
GHN: The possibility that he might have been willing to take credit for something he did not, in fact, accomplish indicates a lapse in integrity, as well as in ethics. Would you agree?
Dr. Hyun: Yes. The issue of integrity is central. Integrity means that you consistently act in accordance with your own principles of moral wholeness; in fact, the word shares a root with integer as it relates to wholeness and unity. To take credit for something that had not occurred is obviously in conflict with a posture of moral wholeness.
The issue of integrity is also relevant in terms of a society’s willingness to support stem cell research. When one is morally opposed to the destruction of a human embryo, it’s a challenge to preserve a sense of integrity, especially if one also appreciates the value of the long-term therapeutic aims of embryonic stem cell research. If you think that a pre-implantation embryo has rights, it’s very hard to accept its destruction, even if you also desperately want to see cures for serious medical conditions that may afflict some of your loved ones.
GHN: Do you think this conflict can ever be resolved?
Dr. Hyun: I do, because eventually some really significant clinical breakthrough will occur that will silence a lot of the debate. People need more than an abstract concept in order to get behind funding for stem cell research. When they see some kind of significant patient benefit — if the pluses outweigh the minuses — people will become more accepting. Just think back to the 1970s when the first in vitro babies were born. Initially, people thought it was unnatural and wrong, but once a lot of cute babies were born, they became more accepting. If you can envision the potential benefits for someone you love and are in a relationship with, it’s going to be very difficult to withhold support based on a much more abstract idea of the moral status of an embryo.
GHN: Why is embryonic stem cell research so important? Why not just study adult stem cells, which would not require the destruction of any human tissue?
Dr. Hyun: I think it’s important to pursue both kinds of research — it’s not an either/or situation. Embryonic stem cells are pluripotent — they can turn into basically any kind of tissue, whereas adult stem cells are much more limited. So while it’s very hard to clone even many animals and we’re still very far away from successful embryonic human cloning, there are nevertheless a number of immediate benefits to be had from studying embryonic stem cells. Take, for example, those that are genetically matched to particular diseases. We could set up models to study the progression of a particular disease — a kind of storyboard of the disease. We could watch the disease’s progress unfold without incurring the risks of studying it in a human being. This would also allow us to test drugs without the dangers inherent in human trials. So we would achieve both a better understanding of the disease and a better understanding of targeted therapies.
But adult stem cell research is important also. Indeed, one of the most promising directions in this area is nuclear re-programming of adult stem cells so that they behave like early-stage stem cells. Researchers in Japan are working on this.
GHN: That begs the question: Where does the U.S. stand in terms of stem cell research vis-à-vis the rest of the world?
Dr. Hyun: Human embryonic stem cell research is in dire straits in the U.S. We are ahead in adult stem cell research because there’s been funding in this area for the past 30 years. But unless there is a change in federal funding policy, we’re going to lose our advantage. Already there is a major brain drain of scientists from the U.S. to the U.K., Singapore, Japan and other countries that provide better funding for this research. Advantages will come where money is being spent.
GHN: Finally, what do you say to people who say that stem cell research is not cost-effective?
Dr. Hyun: Here is my answer. There is strong evidence that the most effective use of cloning and stem cell technology is for spinal cord injuries and diabetes, because these conditions would not require genetic manipulation of patients’ stem cells. And while the cost to undertake this kind of treatment would be great, so too would be the cost-effectiveness. Just think: It currently costs hundreds of thousands of dollars annually to provide care for a patient with a spinal cord injury. Also, the complications arising from diabetes in the U.S. cost our healthcare system millions. Stem cell research could reduce such medical expenses dramatically if it could lead to cures for both of these kinds of conditions. In fact, one could make a case that it would be unethical not to fund embryonic stem cell research for spinal cord injury and diabetes. There are major opportunity costs that must be acknowledged when the social choice is made to withhold funding.
"The way one deals with ethical challenges is so important to me and to our department that for the past four years whenever I interview prospective faculty members, I present them with various hypothetical scenarios requiring them to wrestle with an ethical challenge. Their responses are invaluable to me in assessing their potential as faculty members."
Dr. Leila Jahangiri
Assistant Professor and Chair,
Blatterfein Department Of Prosthodontics