Atul Gawande is an assistant professor of surgery at Harvard Medical School and a staff writer for The New Yorker. He is the author of ''Complications: A Surgeon's Notes on an Imperfect Science.''
Midway through ''Merchants of Immortality,'' Stephen S. Hall takes us inside a laboratory in central Massachusetts. Like the rest of the book, the fascinating episode is intensely researched, and it's the simple, mundane details that make it work. We're given the tiny cow eggs harvested in Iowa from the ovaries of slaughtered cattle, the small white plastic tubes the hundreds of eggs were plopped into, the thermoslike container that kept the tubes warm in the overnight mail to Worcester. The container arrived at a drab brick laboratory building, where a technician drew out the eggs, put them under a high-powered microscope and, using an extremely fine needle, sucked the cow DNA out of them. Taking one of these emptied eggs, another technician stuck it with a needle loaded with a human's cells. And then, ''with a barely perceptible squeeze of one hand, she deposited a single adult skin cell, with its unique payload of human DNA, into the egg of a creature that moos.''
'Merchants of Immortality':By ATUL GAWANDE
A Medical Opportunity Collides With Politics
With this, we become witnesses to one of history's earliest human cloning experiments. The hybrid eggs were given a 15-microsecond, 120-volt electric zap, effectively fusing the two cells into one. The cells were made to begin replicating in an incubator. And with enough replications, some of these fused cells went on to form what seemed to be a very human embryo.
Making an embryo was as much as the scientists believed they could achieve and as far as they wanted to go, Hall tells us. With such an embryo in hand, their real aim was to harvest stem cells from it. As a surprising number of people seem to know nowadays, embryonic stem cells are capable of forming almost any tissue in the human body from scratch -- muscle, bone, blood vessels, even brain. Just the knowledge that such cells exist poses the heady possibility of rejuvenation, of using them to grow an endless supply of spare parts -- cardiac tissue for heart attack patients, brain cells for victims of strokes or Parkinson's disease, pancreatic tissue for diabetics.
This ultimate scientific quest -- this attack on the ravages of aging, potentially on mortality itself, and the lengths to which we are now taking it -- is what brings Hall here. The full tale spills out in a daunting number of directions. There is the biology of ''longevity genes,'' telomeres, stem cells and even African clawed toads to explain. There are battles between laboratories, questions of the morality of the work and collisions with national politics. There is history and economics. And there are the individual people involved to tell about, too.
It is a measure of Hall's skill as a science writer -- this is his fourth book and he has often written for The New York Times -- that he manages to navigate through all this as lucidly as he does. The book is not successful in everything it tries to do. Hall can be almost too evenhanded. He has a reporter's instinctive reticence about giving us his own thinking, and the book works best when he's not pulling punches. But he makes the biology clear without stooping to condescension. He is admirably thorough. And he does not sacrifice vividness, understanding or the voices of the many key players.
Its title notwithstanding, this book is not really about anyone chasing the elixir of immortality. Hall himself shies away from the word inside the first 50 pages. And that's as it should be -- even the most fanatic researchers claim nothing like the possibility of finding such a potion. The scientists Hall follows are after what he prefers to call ''life-extension technology.'' Even that is an inapt term: most medicine is a form of life-extension technology. And the threads connecting cloning, stem cells and longevity are pretty slender. But these are the revolutionary fields in medical research. They all have genuine, radical promise -- like vaccines and transplants and open-heart surgery not so long ago. One can see why Hall is interested in them.
So then, how are these new sciences unfolding? Hall's answer is: messily. In part, that's how all science tales go -- they are full of failure, weird findings, unexpected success and egos. (The opening chapter is a small gem of an example, trailing the mercurial Leonard Hayflick, who discovered 40 years ago that human cells do not replicate indefinitely but instead simply stop after a while and die.) In part, however, the messiness is due to something that makes Hall's book a lot darker and less heroic than the usual science story -- the new and now constant awareness in the field of money to be made. (Hence the ''merchants'' of the title.)
Just the fact that the cow-human experiment did not take place in a publicly funded laboratory but instead at a private company -- in this case one called Advanced Cell Technology and led by Michael West, a maverick entrepreneur and notorious provocateur -- has fundamental implications. Divorced from the traditions of academic basic research, where the emphasis is on open information and profit is not the priority, standards begin to slip. As Hall notes, ''ACT's scientists have not published a single word about the cow-human experiments in the scientific literature,'' where they could be independently reviewed, ''although they have spoken exhaustively about them in the popular press.'' In several instances, he found more information on research work from patent filings than from scientific publications. He saw ethics controls weaken and companies dominating the public debate.
This increasingly is the norm. Nearly all basic research in these important fields has moved out into the private sector, largely, Hall shows, because of politics. He devotes a significant part of the book to peeling back the messy, contradictory, often incoherent debates and policies. The Clinton administration proved simply unable to design a viable policy on stem cell or cloning research in the aftermath of the Lewinsky scandal. The Bush administration comes off even worse.
Hall takes us through President Bush's months of indecision about what position to take on stem cell research and then their strange culmination: on Aug. 9, 2001, in a televised speech ''which may have come as close as any presidential address to a national lesson in sex education,'' Bush announced that federal funding for human embryo stem cell research would be banned except for work on ''existing cell lines.'' There were, he said, ''more than 60'' of them. But within days it became apparent that this was not the case. In the next year, researchers found at most four usable cell lines. And what embryonic stem cells exist turn out to be mostly commercially owned. Academic research ground to a halt, and overnight a handful of companies struggling to stay afloat in today's uncertain economy were given nearly complete control over future research and the new generation of treatments that could result.
Hall tells the entire story in very close. You end up hungry for regular intervals with the camera pulled back far enough to see where the tale is heading. In the end, though, the book is about our arrival in a place of tremendous medical opportunity and also baffling political idiocy. ''The long-term promise of stem cell therapy is everything it has been cracked up to be: the potential clinical impact is staggering, on a par with the therapeutic importance of antibiotics,'' Hall writes. ''But solving all the biological problems is a staggering task, too, and it is a task that has been largely assigned, by politics and happenstance, to a handful of underfinanced, understaffed and scientifically overwhelmed boutique biotech companies.''
There are serious consequences to contemplate in the prospect that science could significantly lengthen the human life span. Children born today can be expected to live to 90, and major breakthroughs could make that 100 (or more?). Hall considers the strain on social and environmental resources of an older population, the endless arguments over whether a 30-cell embryo is life, the effects of aging societies on family life, traditions and the location of political power. But he finds many reasons to believe that the enterprise must continue. And the deepest is moral duty. Faced with a doctor's waiting room full of patients with Alzheimer's disease or Parkinson's disease or one of a dozen other dehumanizing illnesses, can we morally say we will not pursue our era's most promising chance to relieve their misery? Hall shows that we may already have done so.
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