Missing the boat

Eventually, we’ll get there. We’ll be able to regenerate our own cells to replace parts of our body that have been lost to accident, disease or plain ageing.

My personal wish-list is growing longer by the day, even though I don’t expect to see the technology mature in my own lifetime. I want new unblemished skin, a new set of teeth, a less-hyperactive gastric system, eyeballs with perfect vision and a brain wired for peerless ability to learn new languages.

OK, the last three are more than just cell regeneration, there has to be some tweaking too. But that technology will arrive as well. And I have a sneaky suspicion that when we learn to regenerate-with-tweaking, a big commercial demand will come not for eyeballs or gastric systems, but for fuller breasts and awe-inspiring penises. And then at last humanity may learn a long-overdue lesson - that anything quite as pendulous as our dreams describe will be more a hindrance than a help!

* * * * *

The latest research advance came from South Korea, as reported in a February issue of Science. Hwang Woo Suk and Dr Moon Shin Yong from Seoul National University managed to grow a stem cell line from mature adult human cells.

The side articles give a bit more detail about what exactly they achieved, based on a story in Time magazine (24 Feb 2004).

One of the surprises attending this announcement was that it came from Korea. One doesn’t normally associate cutting-edge medical research with more than a handful of countries, and Korea isn’t yet one of them. In fact, we often think firstly of the US. But in the field of stem cell research, most people now believe America is ‘infertile’ soil.

As this example demonstrated, to get embryonic stem cells, one must first get embryos. Isolating those stem cells for further cultivation must necessarily involve destroying the embryos.

The American rightwing tends to believe that life begins at conception, as seen from their strident opposition to all abortion (second only in stridency to their opposition to all things gay). Destroying embryos is, to them, murder.

President George W Bush is so beholden to this fundamentalist constituency that, in August 2001, he ordered that no federal money be spent on stem cell research except involving existing stem cell lines. At the time of his decision, he said there were about 60 stem cell lines available for research. A month later, US Health Secretary Tommy Thompson told the Senate that he expected only about 25 to be viable.

While today, the NIH registry lists 78 lines, most of these have turned out to be frozen, dead, or otherwise not quite stem cells at all. Only 11 or 12 stem cell lines are regarded as viable and widely available for research. Even so, critics have pointed out that there isn’t enough genetic diversity among these 11 or 12 lines to be really useful. Federally-funded research will not get far with them.

In addition, further legislation has been proposed in the US that would make it illegal to do any research involving embryos, whether with government money or private.

Given this climate, few believe that America will play a significant future role in this area of research.

Burn victims, disfigured by scars will get new skin. Amputees may one day get a new limb. Kidney failing patients new kidneys. All will get a new lease of life.

But where dogma stands in the way, the road to the future is blocked.

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Of course, this principle doesn’t only apply to America. The only difference may be that in America their commitment to free speech means the costs of a dogmatic approach are loudly aired in the media, so we tend to think America particularly prone to this kind of obstructionism.

In Singapore, dogmatic roadblocks exist too. It’s just that we seldom have the means or, more importantly, the inclination to bring attention to it. We shrug our shoulders if we are aware of the blockage and resign ourselves to it. But there are times when we we’re not even aware that dogma is standing in the way because we ourselves have been trained to see the world in the same terms.

Take kidneys.

We know that there are never enough kidneys available for transplant. Singapore’s list of kidney failure patients grow ever longer. The longest list are Muslim patients.

In Singapore we make a distinction between Muslim and non-Muslim cases. This is because in this matter, Muslims are covered by Muslim law, and non-Muslims by civil law.

For non-Muslims, the law makes a presumption that everyone is an organ-donor unless he has specifically opted out of organ donation while alive. If he dies and he has not opted out, his organs, where possible, can be used for donation.

Muslims are governed by a different approach. The religious leaders in MUIS, the state-sponsored governing council for Islam here, have ruled that opting out is not a permissible approach. Muslims must actively opt in to be considered a potential donor. Furthermore, he must obtain the consent of 2 witnesses, one of whom must be his ‘waris’ (paternal next-of-kin) in order to validate his pledge.

The result has been a great paucity of organ donations by Muslims. It’s difficult enough persuading people to sign up while alive; it’s well nigh impossible to meet the requirement of 2 family members agreeing. All it takes is one old-fashioned member of the family objecting strongly to it and everyone else reserve his support.

Patients are grouped into the Muslim and non-Muslim waiting lists. The argument is that the community that does not pledge enough organs cannot expect to be a freeloader on another community that pledges more, especially when other communities still don’t have enough themselves.

You may think this segregation of patients is unnecessarily small-minded, but in practical terms, it will be politically difficult to sell the idea that all patients have equal chance of receiving kidneys when not all communities are not equally covered by the same organ donation law.

Whatever it is, the fact is lots of people wait years for a transplant, if ever. Lives are meanwhile blighted because they may be too ill in the meantime. Children suffer because a breadwinner is cut down in the prime of his life.

The dogmatic blockage here comes in two layers. The first one we can see. Why is a religious ruling trumping the need to save lives? Why do we allow arcane religious considerations [1] to stand in the way of needed organs? How do we in good conscience accept more suffering and death when a solution, involving no more than a simple reprioritisaion, is within grasp?

But there is a second, more subtle, layer. Why do we treat the religious leaders’ rulings as binding on all Muslims? Why don’t we let individual persons decide whether they want to be covered by civil law or Muslim religious law?

That is, let everybody be covered by civil law on an equal basis. If you’re such a devout Muslim that you must follow religious law as enunciated by your religious leaders, then opt out of organ donation. Let the decision be made on an individual basis rather than on a collective basis.

The dogma we live with, but are not even conscious of, is that Muslims are always a special case. That it is all right for the state to treat individual Muslims as bound by the decisions of their religious leaders (who appointed them, by the way?), when we don’t treat people of other religions the same way.

If a Roman Catholic person goes to her doctor and asks for birth control pills, we don’t have a law saying she must first get a letter from the Archbishop or the Pope before we can prescribe for her. Her religion is her business. How faithfully she follows it is for her to decide, not for the state to impose.

There is something racist about the way we always treat Muslims as a set by themselves. True acceptance comes when we treat others exactly the way we would treat our own. This is not to say there isn’t room for respecting differences, but that respect must be for that person’s individuality, not because we, in our minds, have assigned him into a class.

Meanwhile, kidneys fail and people die.

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I have the sneaky feeling that racism underlay the way we treated the Vietnamese boat people 25 years ago.

There weren’t many of them in Singapore; I think we managed to hold them all in just one camp, somewhere in Sembawang. That could mean there were no more than 5,000 at most at any one time.

My mother used to collect old clothes for her church, and took some of mine in the process, explaining that they were meant for the poor Vietnamese. I couldn't say no, could I? In the 1980s, my sisters also got involved with helping them, though I have no inkling what precisely they did.

Me, I must humbly admit to no involvement at all other than not being possessive about my clothes, though I can also swear to a few occasional pangs of guilt.

But even then, I used to think that Singapore wasn’t treating them right. I used to wonder why we didn’t just absorb them into our country. After all, there weren’t that many of them and we were economically able to bear the cost of integration.

All the countries in Southeast Asia were refusing to take in the boat people. All of them kept the Vietnamese interned in squalid camps while making loud noises to the UN and the West to solve the problem. But just because others were treating the refugees miserably couldn’t mean we had to act likewise.

I do remember our political leaders saying something about how Singapore was so densely populated we couldn’t take the boat people in. It never sounded convincing because there weren’t that many in our single camp.

Arguably, the government might have feared that if we let the Vietnamese who were already here stay on, it would attract a hundred thousand more from camps in Malaysia or other neighbouring countries. Thailand, Malaysia, Hong Kong and the Philippines were housing hundreds of thousands (perhaps a million altogether during the entire period) because they were nearer Vietnam and had longer coastlines.

But beneath all the excuses, I suspected the real reason was that the boat people were not Chinese enough, for our government has long held the dictum that the Chinese must dominate for Singapore to survive. Letting the Vietnamese in would undercut not just the majority, but the whole principle.

By the 1990s, the Vietnamese were all resettled elsewhere. I don’t really know where. Perhaps Australia and the US.

Yet, now the government is saying that Singapore needs an external wing to rejuvenate our moribund economy. We must tap into the growth potential of China, India and other emerging economies like Vietnam. Now, we all know how difficult it is to do business in these places. To begin with, one must know the culture and must have contacts. Very often, family connections are the simplest building blocks of business trust.

Imagine if we had taken in 100,000 Vietnamese. We would have a thriving little community here - and they’d be thriving, because everywhere the Vietnamese refugees settled, they thrived. Our new compatriots would now be giving us an inside track into investing in Vietnam.

But no, the dogma of the day wouldn’t even allow us to think of accepting the boat people. The price for that dogma today is that it is us who are missing the boat to Vietnam.

© Yawning Bread 

Footnotes

1. From what I understand, the reasoning is like this: after death, the corpse of a Muslim does not belong to him, It belongs to his waris, i.e. his paternal next-of-kin. Hence disposing of the organs in that body is for the waris to decide.
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