Closing the Planned Parenthood LoopholeScott Gottlieb, M.D.
By Scott Gottlieb
(The Wall Street Journal) – Disturbing videos that show Planned Parenthood personnel casually discussing the sale of fetal organs from abortions have caused widespread outrage. As each new video is released, the calls for Congress to cut Planned Parenthood’s federal funding grow stronger. No matter where you stand in that debate, the videos provide unarguable proof that current laws governing the fetal-tissue trade don’t work. Congress must tighten them.
Those laws, passed more than two decades ago, were meant to ensure clear separation between the act of abortion and the procurement of tissue for research. The provisions originated from the 1988 “Fetal Tissue Transplantation Panel,” appointed by PresidentRonald Reagan and charged with deciding in the first instance whether it was appropriate to use fetal tissue for clinical research. The question gained prominence that year after the National Institutes of Health sought to fund a study to test whether implanted fetal tissue could reverse the effects of Parkinson’s disease. These clinical experiments eventually did go forward, and largely failed.
But the panel’s recommendations were codified into law in the 1993 National Institutes of Health Revitalization Act, which passed the Senate 93 to 4 and the House 290 to 130. A bipartisan majority in Congress agreed that the diversion of fetal tissue for research shouldn’t be used to encourage women to have an abortion, affect the conduct of the procedure, or financially reward those performing it.
Planned Parenthood insists that it didn’t violate the statute. But the videos suggest that some abortion clinics flout the spirit if not the letter of that law. Dr. Deborah Nucatola, senior director of medical services at Planned Parenthood Federation of America, is shown explaining that many providers use ultrasound images to guide the procedure so as to obtain intact tissue. “We’ve been very good at getting heart, lung, liver, because we know that, so I’m not gonna crush that part,” she says.
A congressional inquiry reached the same conclusion 15 years ago, as did an investigation that same year by ABC’s “20/20.” Yet the law wasn’t revised after these episodes.
Defenders of Planned Parenthood also assert that medical research using fetal tissue is essential and saves many lives. But that argument distorts the facts. Research directly using fetal tissue is uncommon. At Massachusetts General Hospital in Boston, only about 10 of 8,000 active research protocols involve fetal tissue, according to an official there. By my count, from 1993 to 2014 the NIH funded only 30 grants involving fetal tissue transplant, out of hundreds of thousands of total grants—about 10,000 are awarded every year.
Instead researchers generally use fetal tissue as a source of stem cells, which can be coaxed into many different kinds of tissue and are thus valuable for cell-based therapeutic research. But even work with fetal stem cells comprises a tiny subset of research. Most such studies involve either embryonic stem cells—often derived from embryos developed for in vitro fertilization that go unused and are then donated—or adult stem cells that have been derived from normal adult tissue. A search of PubMed for studies published in the past five years returns 10,000 articles related to “embryonic stem cells”; 5,500 related to search strings for adult stem cells; and fewer than 200 articles related to “fetal stem cells.”
More important, when scientists want to use fetal cells, they typically can draw on existing cell lines that were derived from fetal organs procured many years (and sometimes decades) earlier. These cells continue to divide and self-propagate, often indefinitely. There are hundreds of these cell lines already in existence, requiring no further use of new fetal tissue.
There are also clinical and practical reasons why the vast majority of fetal tissue research involves these self-propagating cell lines. Some of these cell lines show significant promise as therapeutics and are in development for the treatment of a range of vexing diseases. There are far fewer clinical uses for newly procured “fresh” tissue.
Even Planned Parenthood was only brokering fetal tissue in three states (California, Washington and Oregon). This is because the market for fetal tissue is limited, marked by small companies that act as middlemen precisely because the demand for the tissue isn’t that high.
With a few straightforward changes, the law can be toughened to achieve its original purpose, with little consequence to this research. The aim should be to achieve the objectives set out in 1988—banning abortion providers from changing the conduct of the procedure as a way to “harvest” fetal tissue or seek reward from its procurement. Congress should also confine the use of fetal tissue to valid science that involves the study of the human body’s function or treatment of human disease.
Today the law requires the doctor to certify that “no alteration of the timing, method, or procedures used to terminate the pregnancy was made solely for the purposes of obtaining the tissue.” Congress can nix the word “solely” from the statute and make anyintentional alteration illegal. In the videos, the absoluteness of the current language seems to give Planned Parenthood wiggle room to skirt the spirit of the provision. There’s also little enforcement, and that must change, too.
Those who want to safeguard this science should welcome legal provisions that would inspire more public confidence in the entire enterprise of regenerative medicine. Americans broadly consent to funding clinical research because they believe in the promise of medical research. But people support scientific work only if they trust that it serves societal interests, respects patient dignity and operates with guardrails. If it’s shown that the scientific enterprise is giving short shrift to these ideals, that support will erode. Then much more than a small subset of fetal tissue experiments will be at risk.