Blood (9 page)

Artemisia Gentileschi overcame the trauma of rape and courtroom torture to become an independent, respected painter in her own time. Perhaps one of the most troubling aspects of the film is that it ran the risk of trivializing the life of Artemisia and the struggles she faced.

Metaphorically and perhaps literally, Gentileschi paid with her own blood in the bed of her rapist, and in the courtroom that slapped her rapist on the wrist but tortured her. In the seventeenth-century Italian court, it was said that Gentileschi scratched Tassi's face and penis in trying to fight him off. But in the film, the attacker is transformed into an artistic enabler. He inspires her genius. The film was criticized for trivializing the spilling, symbolically at least, of the blood of a woman who went on to become a great painter despite — not because of — her attacker. The red blood of humans is as sacred as the golden ichor of the Greek gods. To cause it to be spilled is serious business, and people do not take kindly to having these sacred matters trivialized.

ONE MIGHT IMAGINE, AT
first blush, that blood is something you're stuck with, like the thickness of your wrist or the shape of your head. You get what you get, and that's all there is to it. Perhaps subconsciously, we think of our blood as having fixed, inherent, unchangeable qualities that are entirely unlike the properties of our teeth, skin, or hair. Two years ago, to offer moral support to my brother, who was coping with the disease, I grew a “Movember” mustache to do my small part for fundraising and public awareness for prostate cancer. It was a pathetic mustache — seems that in my family, there were only so many facial-hair genes to be distributed among the siblings, and my older brother bagged all of them. Others might have grown in four days what it took me a month to produce, but it radically changed the look of my face. I was stunned by the change, only because I have never been a man to grow, discard, and then regrow mustaches or beards. But there are many ways that people adjust their looks on a day-to-day basis. We wear braces on our teeth; colour, perm, or restyle our hair; go to beaches or tanning salons; and engage in endless plastic surgeries to mask the effects of aging, to shed excess weight and make ourselves beautiful.

In
Truth and Beauty
, a memoir about her friendship with a writer who had facial deformities as a result of cancer during childhood, Ann Patchett wrote about how Lucy Grealy at first sought to correct the most profound of her deformities, but eventually fell victim to her own self-destructive obsession as she underwent operation after operation in the hope of making herself beautiful.

As I became transfixed by
Truth and Beauty
, I found myself rooting for Grealy in her early struggles to create a new face, but cringing when she appeared to indulge an increasingly dangerous vanity. I may have been too quick to weigh necessity and vanity, but I suspect that many others do the same. Perhaps this informs our own judgements about how we modify our own bodies — including our blood. Perhaps we are far too quick to qualify some interventions as right, and others as wrong.

As Patchett implies in her memoir, when we adjust our outward appearance by means of surgeries and injections, we are generally aiming to enhance our beauty. We believe that this will put us on the path to personal or social gain. Although we don't put it in the same category as plastic surgery, we also aim to enhance something about ourselves — our health, our strength, our endurance — when we change the nature of our blood. This reflects the notion of truth in Patchett's title. The truth is very much at issue when we play with our blood, because many adjustments to our blood are secret, illicit, and violate laws or social rules.

THE USE OF HUMAN
EMBRYONIC STEM CELLS
has generated years of controversy. Some consider it to be legitimate medical practice and scientific research; others say it violates human life or usurps a role best left to God. Like abortion, the creation of stem cells from human embryos — the early stirring of life after conception — incites heated debate about right and wrong. Before examining the issue, let's consider what stem cells are and why they are useful.

The bone marrow is the home of hematopoietic stem cells, immature cells that generate all other blood cells. If your stem cells don't work, or if they have been damaged as a result of radiation or chemotherapy, you may need a bone marrow transplant — carried out by means of blood transfusions — to stay alive. According to the National Institutes of Health, some medical conditions that might require such a transplant are leukemia, lymphoma, sickle-cell anemia, and severe immunodeficiency syndromes. Leukemia, by way of example, is a cancer of the blood or bone marrow, accompanied by an overgrowth of white blood cells (leukocytes) that crowd the bone marrow and impede it from functioning properly.

There are two ways to obtain donations for bone marrow transplants for people suffering from leukemia. The stem cells can be taken from the blood of another patient with a matching blood type. Or they can be harvested from the blood of the umbilical cord of a baby right after birth, and frozen until ready for use.

The donated stem cells enter the body of the patient by moving into the blood through a venous catheter, much like an ordinary blood transfusion. Miraculously, donated stem cells know how to navigate through the bloodstream and find their way into the bone marrow. It is a complicated and risky procedure. The donor's bone marrow, if not a good match, could perceive the body of the patient as foreign, and attack it. This is called graft-versus-host disease, and it can be fatal. Conversely, the patient's body might attack and destroy the donated bone marrow. This is called graft rejection. Infections are another serious risk. If the transplant is to succeed, the patient is likely to require antibiotics and multiple blood transfusions. The patient can feel acutely ill for weeks, and a full recovery can take six or more months. But by the time the process is over, the patient has a new system of blood and marrow.

Imagine a doctor going back in time and telling a bloodletter in 500
CE
that one day, it would be possible to entirely replace a sick person's blood, as well as the spongy material inside big bones that generates the blood cells. Imagine telling Hippocrates that if a person's blood is failing, then it will be possible to replace it entirely. Consider his reaction if you informed him that blood originated from microscopic cells made inside the bones, and that by means of harvesting and then injecting stem cells, you could alter not just a person's blood but the life-giving stuff inside their bones. I like to think that Hippocrates would grow wide-eyed, grip the arms of his chair, bone up on life sciences, and apply to a modern medical school.

Bone marrow transplants are about replacing not only the blood but also what manufactures the blood, so that it will become free of disease. The first bone marrow transplants were conducted after the Americans dropped atomic bombs on Nagasaki and Hiroshima, effectively ending World War II. Thousands of Japanese citizens died, and thousands more suffered from the fallout of nuclear radiation. Scientists began to look into means of protecting people against the effects of irradiation. The first experiments were conducted on dogs and mice. In 1959, the first bone marrow transplants were attempted in humans, with little success. However, in 1969, the American E. Donnall Thomas — who would later receive the Nobel Prize — demonstrated that it was possible to inject bone marrow cells into the bloodstream to build up the bone marrow and create new blood, and in so doing, to save the life of a person with cancer of the blood.

In the following decades, along with improvements in the science of bone marrow transplants, international registries were developed to assist with the complex process of matching patients to viable stem cell donors. Most bone marrow recipients will not have a family member with compatible blood, so they require a matching service to connect them to millions of potential international donors. Out of the ashes left by the most devastating bomb ever dropped has emerged not just the science of stem cell transplants but also a massive network of international cooperation to assist in locating blood donors for patients who might otherwise perish.

In modern society, although most people accept the need to intervene medically to save the lives of patients with blood cancers, a related issue has proven to be one of the most controversial aspects of contemporary medicine.

The controversy began in 1998, when U.S. researchers discovered human embryonic stem cells. The embryonic stem cells could be derived from the inner cell mass of an early human embryo called a blastocyst. About the size of a period at the end of a sentence, a blastocyst begins to form five days after fertilization in humans. Embryonic stem cells have an additional, nearly miraculous quality called pluripotency, which means that they can transform into any other type of cell or tissue in the body.

Through a process called differentiation, which means maturation, the embryonic stem cell can become a cardiac muscle cell, an islet cell to process insulin, a neuronal cell in the brain, or another cell in the body. But once it has started down the path of differentiation toward becoming, say, a cardiac muscle cell, it can never change course and become a neuronal cell. It has become too specialized, too committed to its future. The ability to control the direction of this maturation, to choose the sort of cell that we need and want them to become, is what excites scientists and makes them believe that the embryonic stem cell could well be tied to major medical advances that could help people overcome diseases and save many lives in the future. Indeed,
Science
magazine hailed the identification and culturing of embryonic stem cells as the “breakthrough of the year” in 1998.

Even former U.S. president George W. Bush, who introduced rules limiting federal funding of stem cell research in 2001, acknowledged at the time the potential importance of the science. On the day of his announcement of the funding restrictions, President Bush said: “Scientists believe further research using stem cells offers great promise that could help improve the lives of those who suffer from many terrible diseases — from juvenile diabetes to Alzheimer's, from Parkinson's to spinal cord injuries. And while scientists admit they are not yet certain, they believe stem cells derived from embryos have unique potential.”

When the Nobel Prize–winning American physician E. Donnall Thomas was doing his work in advancing stem cell transplants, Canadians too were very involved with this pursuit. Ernest McCulloch, a Toronto-born physician and cellular biologist trained at the University of Toronto, teamed up with physicist James Till and proved the existence of stem cells in 1961. Two years later, they demonstrated two essential features of stem cells: they are capable of self-renewal and they can differentiate into more specialized cells. McCulloch and Till reached their conclusions by means of working with rats: first exposing them to potentially lethal amounts of radiation and then injecting them with bone marrow cells. They discovered that rats given more stem cells were more likely to survive. In their spleens, the surviving rats developed clumps of cloned cells that formed as a result of the stem cell injections.

Since that time, stem cell research has shot forward. One of the most notable steps took place in 1998, when the University of Wisconsin biologist James Thomson successfully removed stem cells from an early human embryo that had been donated for research purposes. Thomson's research ignited a debate that continues to this day: Are scientific and medical advances that could result from obtaining and using embryonic stem cells justifiable, in the face of moral and religious objections about the use of human embryos generally?

Those who oppose embryonic stem cell research say that the embryo — even a surplus embryo that is stored in an in-vitro clinic, just a few days old, and destined to be discarded after it is no longer needed by the parents who produced it — is a human life and must not be destroyed for the purposes of medical experimentation. The Center for Bioethics and Human Dignity at Trinity International University in Illinois cites passages from the Bible in arguing that human embryonic life exists for God's own purpose, not that of humans. Essentially, the center argues that people have no right to help themselves at the expense of other human life, and likens research using human embryos to other “horrific examples” of medical experimentation over the course of history.

On the other hand, many people — including President Bill Clinton, who first proposed federal funding for embryonic stem cell research in 1999, and President Barack Obama, who in 2009 relaxed restrictions on U.S. federal funding for embryonic stem cell research that had been imposed nearly a decade earlier by George W. Bush — believe that the potential medical and scientific benefits outweigh the moral objections. Even the late South Carolina senator Strom Thurmond — an arch-conservative whom I will mention in another context in chapter three — argued in favour of the potential benefits from embryonic stem cell research. Many people who support embryonic stem cell research make a key distinction: the embryo normally used in such research is just a few days old, has been cultivated in an in-vitro fertilization lab, would not be capable of developing into a human being without further medical steps, and would normally be discarded at any rate because it would not be used in efforts to establish a pregnancy. (In the case of in-vitro fertilization, many ova are fertilized with sperm but few of the resultant embryos are actually used.)

Although the debate has raged for years, other forms of human stem cells are available. Stem cells can be removed from umbilical cord blood without endangering newborn babies. And it is possible to use “adult” stem cells (which do not come only from adults — the term refers to the maturity of the cells, not to the age of the donor) that have already moved down the differentiation pathway described earlier. Additionally, adult stem cells can be harvested with little intervention and no harm: a skin biopsy, cheek swab, or blood draw can all provide adult stem cells. But adult stem cells do not have the pluripotency of embryonic stem cells. For many years, the debate was stalled on a key point: Should researchers destroy embryos to obtain more robust embryonic cells, or use the less promising adult stem cells, which can be harvested without ethical concerns?