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Stem Cell Research, Biopolitics and Globalization
Paper presented at the Copenhagen ECPR Research Session Workshop, October
15, 2005
Forthcoming In Herbert Gottweis and Kathryn Braun (eds.) Mapping Biopolitics:
Medical-Scientific Transformations and the Rise of New Forms of Governance,
Routledge.
DRAFT ONLY – NOT FOR CITATION
Catherine Waldby
School of Sociology
University of New South Wales,
Sydney, 2052 Australia
Email: [email protected]
Introduction
In this paper, I want to explore the contemporary explosion of the life sciences
as a moment in the history of biopolitics, Foucault’s term for the ways the life and
productivity of bodies are collectively mobilised into power relations. The
deterritorialization of living processes characteristic of contemporary life sciences,
their mastery in vitro, poses particular problems for conceptualising the contemporary
power relations of vitality, classically posed by Foucault as a population-based
politics, with relatively straightforward relationships to the domains of subjectivity,
identity, discourse and citizenship. An understanding of contemporary biopolitics
must also consider the deterritorialization of political power, economic productivity
and communication associated with globalisation and neoliberalism. These
transformations in relations between state, population and capital, particularly the
withdrawal of the state from many aspects of direct health provision, has opened up a
global terrain of commercial medical research and health care. This double
deterritorialization necessarily refigures the space of biopolitics. In Foucault’s work,
biopolitics is primarily framed within the space of the nation-state, as a complex of
strategies, social movements and health practices addressed to the reproduction of
national populations. How can we understand the politics of vitality when they are
inflected through global markets, transnational patient groups and the commercial
engineering of in vitro life?
I want to ask these questions specifically in relation to a relatively new life
science technology – human embryonic stem cell (hESC) lines, which have stepped
into the breach left by the failure of genetic technology to produce much in the way of
therapeutic applications. As their name suggests, hESC lines are derived from human
embryos, generally those left over after in vitro fertilization (IVF) treatment is
completed. Embryonic stem cells are ‘pluripotent’; undifferentiated cells that have the
capacity to develop into almost all of the body’s tissue types. Recent biomedical
developments suggest that it may be possible to produce large numbers of
undifferentiated stem cells that differentiate on demand, providing an unlimited
supply of transplantable tissue. Medical researchers think that stem cells may be very
useful in treating Parkinson’s disease, Alzheimer’s disease, stroke, spinal cord
injuries, arthritis, and other diseases associated with tissue degeneration – through the
introduction of stem cell tissue into damaged sites. They may act as substitutes for
organ donation, repairing an existing heart or kidney rather than replacing it. In these
respects, if successful, they will modify the ways that the developed nations deal with
aging, disability and organ transplantation, all serious public policy and population
health issues as well as matters of individual clinical concern. Currently hESC
research is receiving extensive regulatory and funding support from a number of
national governments, as a potentially profitable industry with useful therapeutic
outcomes (Salter 2005).
In what follows, I want to first explore the broad biopolitical terrain opened
out by the simultaneous deregulation, commercialization and globalization of many
aspects of health and biomedical research. I will then focus more specifically on the
biopolitical terrain specific to hESC lies, and consider what it can tell us about
contemporary biopolitics more generally.
1
Biopower and Globalization
The contemporary era of biopower should be broadly contextualized within
the dynamics of neoliberal globalization, the development of high technology
‘knowledge economies’, and the ways these developments have complicated the
sovereignty and economy of the nation-state. In Foucault’s historical account of
biopower, its emergence as a form of politics in the nineteenth century is intimately
bound up with the formation of modern nation-states and the constitution of national
populations. The term biopower first appears in Foucault’s work in the 1976 lecture
series, Society Must be Defended (Foucault 2003) and then in a few pages at the end
of The History of Sexuality, (Foucault 1980). He distinguishes between pre-modern
sovereign power, exercised through the right to take life, to kill, and biopolitical
power, that emerged during the late eighteenth and nineteenth centuries, concerned to
mobilize and intensify life in particular ways. States and social institutions like
schools and prisons begin to addresses their populations as embodied beings, in order
to improve physical productivity and discipline in the interests of capital formation,
social discipline and military prowess (Foucault 1979). They also began to regulate
and optimize population processes – the life processes of fertility, birth, health,
sexuality, morbidity and life span. ‘Biopolitics deals with the population … as a
political problem, as a problem that is at once scientific and political, as a biological
problem and as power’s problem’ (Foucault 2003: 245). It deals with phenomena like
mortality and fertility that are unpredictable at an individual level but have certain
kinds of regularity at a collective level, and which are susceptible to collective,
regulatory modification – the lowering of the birth rate, the increase in overall
fertility, improvement in morbidity rates, and so on. Above all, Foucault (2003) states,
biopolitics is addressed to the securing of an optimal biological stability in
populations, ‘to compensate for variations within this general population and its
aleatory field …to optimize a state of life’ (246).
In each case, the ordering and management of the population’s living
productivity was central, I would argue, to the formation of the modern nation-state.
[Eduard ref?] The social contract between state and citizens was organized around the
obligation to defend the state’s borders, contribute to the productivity of the economy
and the fecundity of the population, in exchange for the management and amelioration
of biological risks - risks of illness, sexuality, starvation, epidemic, aging,
reproduction and child-rearing – as well as the risks to welfare associated with market
economies – unemployment etc. These risks were managed through the public health
procedures and surveillance which took hold of the social body in Western Europe
from the 1830s onward, and, in the twentieth century, through the provision of
varying degrees of social security (pensions, welfare support) and the broadening of
access to hospitals and clinical health care, among other strategies1.
This regularization of life is then an important right of modern citizen
populations, and involves their active participation. In Foucault’s account, biopolitics
takes place not through force or policing, but through diffused, devolved mechanisms
involving both state and non-state actors, and a collaborative and cooperative
enrollment of the pleasures and capacities of embodied populations into social
strategies. As Rabinow and Rose (2003) argue biopower involves ‘modes of
subjectification, in which individuals can be brought to work on themselves … in the
name of individual or collective life or health’ (MS 4). The exercise of biopower
works through the embodied agency of individuals, families and other collectives, and
hence it involves contestation and reformulation. Life, health, sexuality, vitality,
longevity and reproduction all entered into the discourse of rights and demands, to be
2
negotiated as elements in the social contract between citizens and modern state.
Moreover, according to Foucault, biopolitical processes take place through a sphere of
social autonomy associated with liberalism, the state’s critique of ‘excess
government’ and promotion of market mechanisms of regulation and a separation
between social and economic spheres of life and the activity of governments.
According to Patton,
[Foucault suggests that] liberalism …formed the historical framework, the
system of government reason, within which the techniques of biopower would
be deployed. …liberalism is presented as a distinct practice of government
defined above all by its acceptance of the idea that society and its economic
processes follow laws of their own which governments must understand and
respect. … Against the idea that the population was in need of detailed and
constant regulation, liberalism advanced a conception of society and the
economy as naturally self-regulating systems which government should leave
alone (Patton 2004: 7)
This suggests that biopolitical strategies and forms of contestation multiply
and develop in a relatively deregulated social space.
If this is the case, how can we characterise the biopolitical developments
attendant on the current forces of globalisation and neoliberalism? Globalisation is a
highly complex and over-determined phenomenon, but for the purposes of this
discussion, I will use it as a term to designate the deterritorialization of capital from
the boundaries of the nation-state precipitated by the crisis in Atlantic Fordism, the
deterritorialization of communications from national control, and the multifarious
political, social and technological consequences of these transformations.
Neoliberalism is the political rationality that emerged from and guided this process to
a certain extent. The early 1970s saw a dramatic decline in profitability of the
nationally based, Fordist modes of mass manufacture that underpinned both the postwar economic boom and the Keynesian welfare states. Finance capital, seeking to
improve its profitability, withdrew from the OECD manufacturing industries and
became far more geographically mobile, flexible and dispersed. In a search for a
different basis of profitability, it sought low-cost environments and placing direct
institutional pressure or indirect threats of capital flight on nation states to provide
them (Harvey 1989, Arrighi 1994). It also sought new forms of material productivity,
looking particularly to scientific developments as possible investment sites (Petit
1999). At the same time, advocates of neo-liberalism, notably the Chicago school in
the USA and the Institute for Economic Affairs in the UK, were arguing for a new
relationship between capital, population and the state. Economic rationality, they
argued, should be expanded to include all domains of social and political life. In his
exegesis of Foucault’s analysis of US neo-liberalism2, Tom Lemke writes,
[The neo-liberals] transpose economic analytical schemata and criteria for
economic decision making onto spheres which are not, or certainly not
exclusively, economic areas … [they] attempt to re-define the social sphere as
a form of the economic domain. The model of rational-economic action serves
as a principle for justifying and limiting governmental action, in which context
government itself becomes a sort of enterprise whose task it is to universalize
competition and invent market-shaped systems of action for individuals,
groups and institutions (Lemke 2001: 197).
3
Neoliberal approaches to the governance of populations involve their participation in
market relations as the primary form of social integration, and the personal, rather
than state, assumption of risk assessment and management. ‘Each individual is to be
his or her own political economy, an informed, self-sufficient consumer of labour
markets, personal security markets, and other consuming interests’ (Ericson et al
2000: 533). In the neoliberal optic, populations are simply aggregates of selfmanaging individuals, with greater or lesser capacities to assess their own risks and
opportunities.
This reformulation of capital and of political rationality had two effects
relevant to understanding contemporary biopolitics. The first of these was the shift
from state to individual responsibility for health, and the constitution of populations
as transnational health markets. The second was the emergence of the global
biotechnology industries, and their speculative reformulations of life. I will expand of
these points in turn.
Marketizing Health
Immediately after world war two, many states in the OECD embarked on
comprehensive social security and health care provision, and the creation of publiclyowned services and industries, as hedges against the massive social disruption of the
depression and war. The Keynesian welfare state was the high point of democratic
state involvement in the domain of biopolitics, providing extensive compensations for
the risk to health and welfare associated with the vagaries of a market economy. In
many cases3 the provision of universal, free health care, exemplified by the British
National Health Service, formed the centre-piece of social security and redistribution.
The crisis of Fordism and the elaboration of neo-liberal rationality saw
dramatic reversals to this inclusive, public funding approach to managing the
biological stability of the population. By the early 1980s, neoliberal administrations in
the USA and UK were reducing corporate taxation rates, shrinking public provision in
social security, health and education, and privatizing previously ‘essential’ public
infrastructure like tele-communications. In the case of health services, the post-war
consensus in favor of public, comprehensive health care provision was challenged by
neo-liberal advocates like the World Bank, which argued in a series of influential
reports (World Bank 1987, World Bank 1993) that governments should encourage the
identification of for-profit health services, and shift service provision from the public
to the private sectors. Since the mid-1980s, many countries in both the developed and
developing world has seen a decrease in public expenditure on health as a percentage
of GNP (Brugha & Zwi 2002) and/or the marketization of health services not
provided, or inadequately provided, through the public sector (Kumaranayake & Lake
2002). Population aging and the expansion of high-technology medicine places even
more pressure on states to contain health care costs through selective privatization.
Moreover, neo-liberal social policy moves more and more responsibility for the
management of health and the biological/social risks from the mutualised forms
associated with the welfare state and public funding, to individual responsibility for
self-care and self-provision, often through private forms of health consumption and
the supplementation of state-provided health care with private medical insurance
(Rose 1996, Ericson et al 2000). These developments, coupled with new
communications technology, have seen the development of global clinical and
therapeutic markets.
4
Marketization and increasing globalization in individual sub-markets within
the health care sector are beginning to generate a range of global markets for
health-related goods and services. … First there has been the increasing
exportation (sic) of particular models of provision and financing, largely
drawing on the private health system of the US. Examples include the
expansion of Health Maintenance Organizations into predominantly middleincome markets in Latin America and … South Africa. Secondly, we now see
the emergence of global markets, where buyers and sellers … circumvent
national boundaries. With the expansion of communications technology,
notably the internet, major barriers to transferring health-related goods and
services between countries are decreasing (Kumaranayake & Lake 2002).
Health consumers around the globe provide markets for ‘luxury’ medicine,
like cosmetic surgery and anti-aging therapies, reproductive services like IVF, PGD
and sex selection, for black market organs procured from third world vendors
(Schepeur- Hughes 2002) and for treatments excluded from national medical benefit
schemes on the grounds of cost or dubious efficacy. The market for these kinds of
treatments is set to expand as the populations of the developed nations grows steadily
older and live longer with more chronic disease.
To summarize, the management of the population’s biological risks is no
longer the exclusive responsibility of the nation-state or national agencies. Risk
management has demutualised and become a matter of individual prudential
assessment, entrepreneurial self-investment and selective forms of health
consumption and private insurance made available through global markets. Such
practices frequently coexist with and run parallel to (often poorly funded) public
provision; public and private hospitals, public and private cord blood banking, and
state-subsidized pharmaceuticals alongside market-price ones.
Hence the locus of biopolitics has become more complex. While national
populations still make demands on the nation-state for health provision in the name of
citizenship, other forms of social contract and rights, and other spatial distributions of
power, are more and more in play. While health consumers purchase private health
insurance and for-profit therapies and services, they also demand greater
accountability and transparency from big pharmaceutical companies for example, as
part of their consumer rights. Consumer rights have been extended dramatically by
patient advocacy and medical charity groups, who are increasingly likely to form
transnational research alliances with biotechnology and pharmaceutical companies,
exercising control over the direction and funding of research that will directly impact
on the treatments produced for their conditions (Novas, Hogle). These kinds of
public-private partnerships are responsible for some important stem cell research, for
example, a development I will investigate below. As health care provision and
medical conditions themselves become more globalized, the idea of health as a civil
right has been increasingly displaced by the idea of health as a human right. Hence the
recent global AIDS activist campaigns to make cheap HIV medications available for
people in the developing world, and the growing importance of global health
programs like the WHO Fund for HIV, malaria and tuberculosis, as forms of
biopolitical action.
5
Postfordism and the Life Sciences Industries
The second effect of the reformulation of capital and political rationality for
contemporary biopolitics relates to the explosion in life sciences innovation and the
creation of a biological knowledge economy. Corporations seeking to retool from
unprofitable mass production to post-fordist ‘flexible accumulation’ have turned,
since the late 1970s, to new techno-scientific practices as possible sources of value
and new material bases for profitability. This is particularly true of what Etzkowitz
and Webster (1995) term the ‘enabling technologies,’ particularly information,
communications and bioscience technologies, developed out of the basic
communications engineering and biological research projects within the university
sectors in the 1950s and 1960s. Today, these enabling technologies ‘underpin a wide
range of industrial sectors without being unique to any one’ (p. 495), and form the
basis for competitiveness for a growing number of sectors.
In the wake of the dot com crash in 1998, the commercialization of biology is
widely regarded as the best hope for a new wave of science-based profitability
(OECD 2004). Commentators note that the creation of a globally oriented
biotechnology sector and of biological processes as sites for capital investment has
not involved the withdrawal of the state per se, as the tenets of neo-liberalism might
dictate. Rather it has involved a reorientation of state-market relations, where the state
provides broad innovation frameworks, research funding and regulatory and
legislative initiatives to foster investment and entrepreneurship, as well as brokering
bioethical regulation to reassure the anxieties of certain citizen constituencies
(Löfgren and Benner 2005). In particular the bio-industries have emerged from
public-private partnerships between commercial investors and academic researchers,
often fostered through public sector research funding and through policy initiatives
like the Bayh-Dole acts in the US and the EU’s VALUE program (update this) that
foster the development of university-based intellectual property portfolios (Etzkowitz
& Webster 1995). Löfgren and Benner (2005) argue that this complex state role in
fostering the biosciences suggests not the deregulation and dismantling of the
Keynesian welfare state per se, but rather a transition to a Schumpeterian
‘competition state’ (Jessop 2002), which directly supports capital accumulation
through complex and often indirect forms of orchestration and network development,
and makes economic growth rather than social security a primary source of
legitimacy.
In the life sciences industries (pharmacology, agribusiness, medical
biotechnology) public-private partnerships have produced an explosion of innovation,
organized around new sets of genetic and cellular techniques to manipulate life. As
Rose (2001) notes, commercial innovation in the life sciences is organized around the
reformulation of biological processes along particular lines.
It is not just that such companies seek to ‘apply’ or ‘market’ scientific
discoveries,
they shape the very direction, organization, problem space and solution effects
of the biology itself. For life at the molecular level is only knowable through
complex and expensive apparatus: electron microscopes, ultracentrifuges,
electrophoresis, spectroscopy, x-ray diffraction, isotopes and scintillation
counters and their links with the information-processing capacities of
computers, and now, with the information dissemination capacities of the
Internet. Hence, the politics of the life sciences – the politics of life itself – has
been shaped by those who controlled the human, technical and financial
6
resources necessary to fund such endeavors. ….Now all life processes seem to
consist in intelligible chains of events that can be ‘reverse engineered’ and
then reconstructed in the lab, and modified so that they unfold in different
ways (Rose 2001: 15-16).
Today biotechnology firms like Geron and ES Cell International and
agribusiness firms like Monsanto reengineer living processes as their core business.
Like emerging patient markets, they also operate on a global scale. ‘The purveyors
and consumers of [Life Sciences] research are internationally mobile, taking
advantage of transportation and communications technologies to operate
transnationally and seek out national environments that are most hospitable to their
chosen enterprises’ (Cahill, 1999: 5).
Biopower, the Competition State and Biotechnology
This shift from a Keynesian welfare state and a Fordist economy to a
competition state fostering flexible accumulation, a globally oriented economy and
commercialized bioscience suggests some major shifts in the rationalities of
biopower. Most OECD nation-states still provide some forms of inclusive health care
and social health insurance. Nevertheless, the onus for the management of biological
risks has shifted substantially from state and non-state medical institutions that foster
vitality through meso-level strategies directed at communities and families (eugenic
policies, childhood vaccination, family planning, hygiene, community nursing) to
private individuals who are held responsible for their own health and self-care. This
responsibilisation of individuals for the management of their own biological risks
delivers sub-sections of national populations to the transnational therapeutic and
health insurance industries, in their search for private health supplementation of often
residual and disorganized forms of public health care provision.
It is also evident that the competition state supports the biotechnological
desire to optimize organism vitality through the identification of points of microbiological leverage – single nucleotide polymorphisms, proteomics, telomeres – that
may one day provide new kinds of mastery of in vivo processes at the level of the
individual patient. The hope is that such micro-level interventions will provide both
new forms of economic prosperity and downstream therapeutic applications that can
be used both within national public health services and marketed transnationally to
other national and private purchasers. However, as Rabinow and Rose (2003) observe
of genomic medicine, the translation of in vitro vitality into in vivo health is
speculative and highly uncertain.
the most central unknown is whether the new forms of knowledge linked to
molecular biology in general, and to genomics in particular, can actually
generate the kinds of diagnostic and therapeutic tools that its advocates hope
for. The stakes here are high, economically, medically and ethically. They lie
in the presumed capacity of genomics to identify precisely some central
processes involved in illness that control the manufacture of proteins, and in
doing so, open these to precise intervention in order to produce therapeutic
effect. It is not just some abstract knowledge gain that gives genomics its
potential as far as scientists, health care systems and the pharmaceutical
companies are concerned but its capacity to generate therapeutic targets and
manufactured molecules addressed to those targets; in other words to ground a
new kind of ‘know how’ of life itself (Rabinow and Rose 2003: 29).
7
In other words, the terrain of contemporary biopolitics has moved away from
regulating and minimizing the biological risks of national populations, local
communities and families, to the level of neoliberal, individual agency and microbiological processes. At the same time, these micro-processes and individuals are
globally aggregated through the biotechnology industries and transnational health
markets. Furthermore, the rationalities of marketization and financial investment
interpenetrate the strategies of biological vitality and risk-management today, and
must be accounted for. Finally, many people living with chronic medical conditions
have refused the neo-liberalization of illness. Patient groups and medical charities,
often transnationally structured via global communications, are beginning to play an
important role in the funding and shaping of biological research, and in the broader
state shaping of innovation and regulatory policy. In the next section I will focus on
human embryonic stem cells as exemplars of this micro-global biopolitics.
Stem Cell Technology
Human embryonic stem cell research, a very recent innovation4, has attracted
extensive state support from a handful of nations interested in gaining an international
competitive edge in the area. Salter notes that,
Although the number of states that have pursued this option is as yet small, the
beginnings of an international investment competition are clearly evident. For
example, in 2003 the UK made a £45 million allocation for stem cell science
and in 2004 the European Commission signaled its intention to fund up to 30
million euros of research in the area. On a grander scale, the Singapore
government announced plans to spend $300 million on Biopolis, a science
park focusing on stem-cell technology, and perhaps most significantly, in
November 2004 California announced its ten year $3 billion commitment to
embryonic stem cell science through the creation of a Centre for Regenerative
Medicine (Salter 2005: 4).
This public research funding is primarily intended to advance basic stem cell science
to the point where pharmaceutical company and venture capital partners will invest in
commercialization of therapeutic products, a step most have been unwilling to take to
date due to the uncertainty and controversy of the technology (Salter 2005). States
interested in fostering stem cell industries have taken a lead in developing regulatory
frameworks to assuage public anxieties about the destruction of embryos and ensure
that research takes place under conditions of acceptable ethical governance. The stem
cell research area has also attracted significant fund-raising activity from medical
charities and patient advocacy groups. In the USA, where federal funding for stem
cell research is limited due to the Bush administration’s ‘culture of life’ position,
some for-profit firms are funded by private patient organizations and foundations. For
example, the Juvenile Diabetes Research Foundation funds Athersys and several other
companies, and the Christopher Reeve Foundation funds several spinal cord
companies (Hogle 2004).
State and private funding for stem cell research is caught up in the hope that,
unlike the disappointing lack of therapeutic applications for genomics, stem cell
technologies may have real and significant clinical effects and commercial
applications. This hope is clearly stated in the ‘California Stem Cell Research and
Cures Act’, passed into legislation 3 November 2004, which claims that stem cell
8
research has the potential to cure or alleviate diseases ranging from Cancer, Diabetes,
Heart Disease, Alzheimer's, Parkinson's, Spinal Cord injuries, Blindness, Lou
Gehrig's Disease, HIV/AIDS, Mental Health disorders, Multiple Sclerosis,
Huntington's Disease and more than 70 other diseases and injuries, and to reduce the
State’s health care costs5.
This extraordinarily optimistic list of conditions suggests that stem cells are
understood as key points of in vitro leverage, where a range of complex biological
processes and human illnesses can be addressed through one key technology. They
are attractive for both public and private commercial and charitable investment
because they promise a high degree of what I have termed elsewhere ‘biovalue’
(Waldby 2000, 2002, Waldby and Mitchell 2006), a simultaneous surplus of
biological vitality, clinical use-value and commercial profit. The search for biovalue
is precisely the search for new forms of post-fordist material productivity through the
mastery and capitalization of living processes (Cooper forthcoming). As Rose (2001)
notes above, the life sciences are concerned with the micro-manipulation of existing
biological processes, the reordering of pathways, the acceleration or arrest of temporal
sequences, the recombination of properties. Re-engineered biological entities are
treated as intellectual property under most national innovation frameworks, possible
sites for investment capital. Eventually, advocates hope, this mastery of in vitro
micro-biological processes will be translated into globally marketable in vivo
diagnostics or therapies.
This desire for biological leverage finds purchase in stem cell technologies
because of their flexibility and pluripotency. The creation of a viable stem cell line
from a human embryo opens out an entire field of possibilities for limitless tissue
generation and engraftment. First, it involves the mobilization of biological vitality
that would otherwise be disposed of. Embryos for stem cell research are generally
speaking, ‘spare’ embryos; those left over from IVF procedures and donated by the
couple. If not donated for medical research they are disposed of. The advocates of
stem cell research understand this as the rehabilitation of extraordinary value from
needless waste. The political controversies around embryonic stem cell research
highlight two conflicting ideas about the life of the embryo, and about the idea of life
more generally. For opponents of stem cell research, the life of the embryo is
biographical, the beginning point of a human narrative that should be allowed to run
its social course6. For advocates of stem cell research the life of the embryo is a form
of raw biological vitality. From this point of view the embryo is not killed. Rather its
vitality is technically diverted and reorganized in the interests of the disabled and the
aging.
The creation of immortalized stem cell lines involves complex spatial and
temporal interventions into the processes of ontogenesis, made more complex by the
fact that the lines themselves can be sub-divided, banked and globally distributed.
Pluripotent stem cells are embryonic cells at the first stage of differentiation, after the
cells that form the placenta and supporting tissues for fetal development have divided
off. They are pluripotent in the sense that they are capable of giving rise to most of the
tissues that comprise an organism. In uterine embryonic development the stem cells
that form the embryonic tissue cluster, the blastocyst, eventually divide and
differentiate into the cells, tissues and organs that constitute the infant human body.
To create a stem cell line the blastocyst is disaggregated into individual stem cells.
These cells are then immortalized; that is they are induced to continuously clone
themselves in their undifferentiated state. Cells that are immortalized will continue to
divide and multiply indefinitely.
9
Immortalization involves the arrest of developmental biological temporality;
cells are maintained and expanded at a particular point in their developmental
trajectory, the moment of pluripotency. In the Thomson (1998) study that established
the first human embryonic stem cell lines, cells were cultured for four to five months
without differentiation. That is, one stem cell multiplied to produce two stem cells,
without differentiating into more specialized tissues. These cell lines were later
induced to differentiate into the main groups of embryonic tissue layers. Subsequent
experiments have induced stem cell lines to differentiate into the precursors of several
mature tissue types, including neurons. So immortalization permits the arrest,
immobilization and deployment of undifferentiated cells at specific points in their
development, and the reactivation of differentiating activity on command. It also
expands stem cell biomass to usable levels, so that the single ‘spare’ embryo, with its
200 cells, forms the starting point for significant amounts of tissue.
Stem cell lines are also bankable tissue. They can be frozen, stored and grown
again once thawed. As with all forms of tissue banking, this allows another dimension
of temporal mastery (Waldby and Mitchell 2006). Cryopreservation is a way to
preserve the potential of the stem cells. Embryonic stem cells are valuable because
they partake of the generative capacity of the prenatal body in both its maternal and
fetal aspects, its striking ability to produce and renew organised tissue. Banking these
tissues removes them from the flow of historical and biological time, and preserves
them so that their potential can be realised at a later date. Banking turns the generative
capacities of the prenatal body into regenerative capacities, able to revitalize the sick
or aging postnatal body.
As immortalized, bankable cell lines human embryonic stem cells also permit
complex spatial multiplication. Any given line may be used to strike another, which
can in turn be dispersed to multiple researchers around the world. They may maintain
the line for an unspecifiable period, and use it for research projects as diverse as
spinal injury, diabetes, organ regeneration or Parkinson’s disease. Each cell line
perpetuates the donor couple’s joint genetic material, and as an immortalized line, this
genetic material could be viable long after both members of a couple die. It is
immortalized but they are not. So a donated embryo may be the starting point for an
unknowable, infinitely branching network of cell lines, propagating the donor’s DNA,
with no specific destination and no time horizon.
To summarize, stem cell lines promise a remarkable productivity, if their
promise is realized; from single cells culled from an otherwise wasted embryo, to
globally distributed, infinitely multipliable cell lines which can be scaled up to
produce clinical levels of transplantable tissue. Once inside the body, the tissue does
not act like a passive transplant, the simple movement of effective tissue from one
body to another as in an organ transplant, but rather it actively engrafts itself,
regenerating lost or faulty tissue in the damaged site. The promise of stem cell
technology is that the generative ingenuity and energy of the embryo can be
transposed into a therapy.
Stem Cell Biopolitics
For advocates of stem cell technology, this in vitro tissue economy7 promises
to provide a technical, microbiological solution to at least two biopolitical problems
currently addressed through population-level socio-medical interventions. These are,
the problem of guaranteeing the supply of human tissues for transplantation, and the
problem of population aging.
10
In the case of tissue transplantation, stem cells and the field of regenerative
medicine more generally, offer an alternative to the post war gift-based, nationally
organised, social economy of tissue regeneration closely associated with the ethos of
the national welfare state. As I have argued in detail elsewhere (Waldby and Mitchell
2006) the system of gifting tissues (blood, organs, bone marrow etc) from bodies with
a surplus to those with a deficit, is a form of tissue regeneration which recapitulates
the norms of mutuality, collective risk-management and mitigation of market forces
associated with the biopolitical and social security ethos of the Keynesian State. This
redistributive economy is now proving unequal to the ever-increasing demand for
human tissues. Blood donation has, since the HIV and Hepatitis C contamination
scandals of the 1980s, been is decline throughout the developed world, and blood
supplies are habitually at dangerously low levels everywhere (European Commission
1995, Finucane Slovic and Mertz 2000, Sullivan et al. 2002). While rates of organ
donation have increased slightly in many developed countries over the last ten years,
the demand for organs has far outstripped supply (World Health Organization 2003).
Embryonic stem cell technologies, while still dependant on an initial gift, promise
limitless quantities of tissue and an eventual independence of the tissue supply from
gift-based economies8.
In the case of aging populations, the demographic changes associated with
longer life span, increasing levels of chronic disease and decreased fertility rates
currently confront most of the OECD nations with a series of extremely difficult
issues regarding the reproduction of the working population. By 2020, approximately
twenty percent of the population in the G8 nations will be over sixty-five (Neilson
2003), and they will live longer than previous generations. As Neilson points out, this
shift in the demographic profile of the industrial democracies presents a set of
intractable policy problems to governments.
With portentous consequences for the ratio of working-age taxpayers
to nonworking retirees, these changes in age profile threaten the
economic viability of the world’s wealthiest and most powerful nationstates, tearing at the fabric of their once liberal notions of citizenship,
constitutionalism, and social contracturalism …. population aging
places a glacier-like pressure on the nation-state, slowly but surely
eroding its centralized apparatuses for managing the production and
reproduction of life (Neilson 2003: 163).
Aging populations place large burdens on welfare and pension provision at a
time when governments in developed nations are under threat of financial discipline
and electoral opprobrium if they increase tax rates. Embryonic stem cell technology
and other forms of regenerative medicine offer the possibility that the aging body of
the citizen may yet be able to extend working, tax-paying life. Stem cell technology
presents a case study of the ways that commercial in vitro vitality has become a site
for population biopolitics, relocating the agency of biopolitical processes away from
population level intercorporeal and anatomical level to the cellular and molecular
level. As Cooper (forthcoming) notes, aging is today conceptualized in biology as an
intra-cellular process, and stem cell lines, with their ability to replicate indefinitely,
seem to overcome the problem of cell senescence (cessation of division) which
afflicts cells at a certain point. The health problems associated with aging degenerative conditions like Parkinson’s disease, Alzheimer’s disease and heart
disease – are, in part at least, conditions of poorly regenerating tissue. These
11
conditions are the focus of a significant amount of the global stem cell research effort,
as health systems devote an increasing proportion of their budgets to the long-term
management of such conditions (Chief Medical Officer’s Expert Group 2000). ESC
technology offers the prospect of regenerating the tissues within aging bodies, and
hence of rejuvenating aging populations and extending the viable life of the work
force. If successful, it promises to redistribute regenerative capacities of the
pluripotent embryo from the beginnings of life to the end. It potentially displaces
social security based biopolitics (pensions, nursing homes) with the promise of
biological security and continued economic productivity.
Conclusion
•
•
•
•
•
•
Some aspects of biopolitics concerned with state-citizen relations, but new
terrains and new forms of rights to health (consumer rights, human rights)
opened up by deterritorialized life, commercialization, and globalization.
Competition state deregulates and marketizes aspects of its population’s
biology security by encouraging commercial research to address security as
individual therapy pursued through micro-biological processes– ideally aged
and disability pension replaced by stem cell technology - but outcome of this
strategy uncertain.
Some aspects of biopolitics concerned with new marginal entities - embryos,
animals - search for new material sources of vitality politicises more forms of
life.
The material strategies of micro-biopolitics inflected through the demands of
the new knowledge economies and the competition state, and the technical
ability to deterritorialize vital processes – patentability, technical mastery to
replace (ideally) social security, global marketability as/more important than
national health service applications.
The production of biovalue a new aim of biopolitics, displacing and
relativising endogenous population vitality. Populations appear as donors of
raw materials and markets for vitalised biology, rather than the primary site of
its generation.
Neo-liberalization of patienthood countered by patient groups global collective
action and research shaping in PPPs – patients attempt to shape the relations
between in vivo basic and commercial research and the clinical applications
and strategies related to their deterritorialized health communities, rather than
national populations – including north-south alliances.
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Notes
1
Including child labour laws, the establishment of safety standards for the preparation and storage of
food etc.
2
Not available in English translation at time of writing.
3
The USA being the exception here
4
The first human embryonic stem cell lines were created in 1998, by the research teams of James
Thomson at the University of Wisconsin and John Gearhart at Johns Hopkins University.
5
http://www.yeson71.com/initiative.php accessed February 3, 2005.
Thanks to Simon Cohen for this point. This position, being one dictated by in principle opposition to
embryo research of any kind, tends to ignore the fact that ‘spare’ IVF embryos have no possibility of a
biography, as they are not introduced into a uterus where they can become viable pregnancies.
6
7
For an extended treatment of the idea of a tissue economy, see Waldby and Mitchell 2006.
8
Once a sufficient range of tissue type ESC lines are established (estimates vary about how many this
should be), in theory no more embryos would need to be donated, as lines can be struck from one
another. Of course it remains to be seen if this proposed tissue economy will ever be realised.
15