TO WHAT EXTENT DO THE ACHIEVEMENTS OF STEM CELL THERAPY OUTWEIGH THE CONTROVERSY AND COST SURROUNDING?

WRITTEN BY ENYA H

Completed the Extended Project Qualification Level 2

The question I am going to be looking into for my EPQ project is “To what extent is the use of stem cells in treatments and research worth the hassle they cause ” . The use of Stem cells in modern medicine for both research and treatments offer great new potentials. Adult Stem cell treatment is currently used to treat diseases such as Leukaemia and Lymphoma however with further research and developments in these treatments scientists hope to be able to develop therapies for Type 1 diabetes and repairing the heart muscle after a heart attack. With the obviously huge potential for stem cell treatments in future is it worth the backlash from different standpoints In my project I will be covering: How are stem cells used in treatment and research, what medical potential they hold, are there alternative treatments and what are the different lawful and ethical standpoints. The reason I chose to complete my EPQ on this topic is because I strongly believe that both adult and embryonic stem cell research and treatment are the future in modern medicine, regardless to my conclusion I would like to find out about the reasoning behind people who hold other beliefs on the subject and if there are ways to prevent using them when possible

What are stem cells and what are they used for?

Unlike other cells, stem cells hold the unique ability to be able to differentiate into any type of specialised cell in the body, they can divide over again, and from this point they can form new cells There are three different types of stem cell which each hold different uses, and controversies

Embryonic stem cells which are the stem cells that form and embryo, these cells are pluripotent meaning they can develop into any cell type and are obtained from earlystage embryos, induced pluripotent stem cells otherwise known as iPS cells are formed artificially in a laboratory with the use of other regular adult cells for example skin cells and they are reprogrammed to become stem cells, this type of stem cell is also pluripotent Adult stem cells are multipotent cells which means that they do not have ability to develop into any type of specialised cell however instead they can become blood or skin cells In stem cell therapies the cells are used to generate new cells in the body to replace those that may have been lost due to injury or disease Adult stem cells can be used to provide healthy blood stem cells to those who have blood conditions, and skin stem cells can be used to generate new skin for those who have suffered severe burns Adult stem cells have been used in specific scenarios such as they were pivotal in aiding someone who suffered a stroke to “restore power of speech” and “regain use of his right arm ” .

In research embryonic stem cells are used to test drugs to model disease and in new therapies injected into the body In 2010 clinical trials were conducted using embryonic stem cells were used in finding treatments for Parkinson’s disease and diabetes among other conditions. (How human embryonic stem cells sparked a revolution: accessed March 2018) The main difference between adult and embryonic stem cells is that embryonic stem stell hold the ability to grow organs, this would eliminate the extreme issues that come with long transplant lists and could prevent lots of deaths A big issue with traditional organ donation is risk of rejection, this will become very small ergo the use of immunosuppressants will become void The use of adult stem cells is more accepted the using embryonic stem cells as by using adult cells the death of an embryo is eliminated from the process of extraction, however this causes the potential of embryonic stem cells to be overlooked, the use of these cells allows illnesses that would have otherwise been terminal to be cured. However, although stem cells seem to allow for extreme medical discoveries they have also had situations where they have not worked as intended one of the most notable being with an 18-month-old boy “ was injected in the brain with stem cells and subsequently died " This shows that despite the masses of evidence supporting the use of stem cells in treatments, that they are not always safe

What are the alternatives to stem cells?

With science and modern medicine rapidly developing technology an alternative to embryonic stem cells has been formed, induced pluripotent stem cells are also pluripotent stem cells in the same way as embryonic stem cells however instead of embryos being destroyed for their use these iPS cells are derived from skin or blood cells and are reprogrammed into an embryonic-like stem cells These IPS cells are also being used by top scientists such as Professor Ian Wilmut, better known as the creator of Dolly the sheep, since the development of IPS cells has completely abandoned the use of Embryonic stem cells altogether due to the potential that the new artificial version holds so much potential (The Daily Telegraph, 17 November 2007) In (The promise of research with stem cells:Susan Solomon) Solomon advocates the use of lab made iPS cells she talks about how iPS cells can be crucial in modelling disease to eventually lead to new drug discovery In 2008 IPS cells were used to monitor the way cells deteriorate in patients with motor neurones or ALS, the cells provided the first model of disease from a living patient in living human cells; in order to see this scientists used healthy cells and used them to form diseased cells with these the disease was recapitulated and was able to provide the model necessary to take observations

This research was pivotal in discovering that the motor neurons were dying in a different way than scientists had previously thought; instead there was another type of cell sending out a toxin which contributed to the death of the motor neurons, this was something was was not previously visible without the use of a human model There is also the use of Somatic cell nuclear transfer this process involves taking the nucleus from a cell and inserting the nucleus into an egg, through this process the egg is stimulated without being fertilised and then forms an embryo Through SCNT embryonic stem cells could be extracted however this could also run into the ethical dilemma as there is still the involvement of an embryo no matter how it is obtained through SCNT and developments in medicine to enable it to be more accessible this provides a viable method for same sex couples to have biological children

What are the laws surrounding stem cell treatment?

The use of embryonic stem cell in medical research and treatment is managed under the Human Fertilisation and Embryology Act (1990), this allows the use and creation of human embryos in the form of human embryonic stem cells This act remains lawful until the embryo becomes no longer disassociated and after this point the human tissue authority’s remit begins The storage of eggs, sperm and embryos is allowed under the Human Fertilisation and Embryology Authority (HFEA) this enables licences to be granted which permit the use of human embryos in scientific research under certain conditions and the HFEA must be satisfied that the use of embryos is necessary for the research to be conducted and must be for one of the following purposes “to promote advances in the treatment of infertility to increase knowledge about the causes of congenital disease, to increase knowledge about the causes of miscarriages, to develop more effective techniques of contraception, to develop methods for detecting the presence of gene or chromosome abnormalities, to increase knowledge about the development of embryos, to increase knowledge about serious disease, to enable any such knowledge to be applied in developing treatments for serious disease. Research on embryos can only occur on embryos which have been created in vitro -embryos which have been created outside of the body- the majority of embryos used in the UK are the result of surplus from IVF treatments when the embryo is donated with the full consent of the parents What are the ethical dilemmas around the use of stem cells in treatment and research?

In order to evaluate the ethics behind the use of embryonic stem cells, you must take into account the question of “When does life begin”, In the eyes of science extracting embryotic stem cells involves the termination of “ a hatched blastocyst”-a blastocyst is a structure which forms 6 days after an egg is fertilised- .The moral issue of destructing potential new life regarding use of embryonic stem cells for medical research and treatments causes controversy in different religions when discussing this topic, in Christianity the sanctity of life, this is the belief that life is precious and should be valued, the problem emerges when opinions differ about the point when life starts under this belief the harvesting and use of embryonic stem cells interferes with the sixth commandment which reads “Thou shalt not murder” However one must take into account that in the eyes of Christianity and science life begins at conception therefore in their eyes harvesting these cells is murder and subsequently goes against the ten commandments instead they believe that these cells have the same right to protection of their lives as any other person out of respect for the sanctity of life . Since 1996 in the church of Scotland has the belief that “the human embryo must be regarded as an actual person and regarded as a person at all stages of development from the moment of conception Therefore, all treatment of a human embryo which is not for the benefit of that embryo is morally wrong and as such all research on human embryos is morally wrong ” (Pre-Conceived Ideas: A Christian Perspective of IVF and Embryology, The Church of Scotland Board of Social Responsibility, 1996, page 62) this agrees with the Christian idea that the use of these cells is completely unethical as the research conducted on them is of no help to the embryo and instead the scientist conducting the research therefore it is morally wrong The church has no issues with the use of the newer IPS cells or adult stem cells as they do not carry the destruction of potential new life

In conclusion I agree that to a large extent the achievements through stem cell related therapies and research outweighs the costs and controversies surrounding however I also agree that further research should be done using artificial IPS cells as they are able to mimic some of the uses for natural human stem cells as a result some therapies and research would not be possible to undergo as the use of artificial cells would not suffice Whilst not dismissing the ethical dilemmas surround stem cells, I do believe that the use of them is ethical whilst remaining in the guidelines of the law, Therefore with the immense amount of positives to use of stem cells I do believe that the use of them is in research and medicine. If the issues surrounding use of stem cells are one day overcome then I believe that they will be pivotal in medical breakthroughs in the future

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WHAT EXTENT DO OUR UNCONSCIOUS BIASES ALTER OUR TREATMENT OF WOMEN IN SOCIETY, HOW DO THEY SHOW THROUGH IN OUR CONVERSATIONS, AND HOW CAN WE STOP THIS NEGATIVE TREATMENT SO THAT SOCIETY CAN BECOME MORE EQUAL?

WRITTEN BY VERITY T

This EPQ essay is titled ‘To what extent do our unconscious biases alter our treatment of women in society, how do they show through in our conversations, and how can we stop this negative treatment so that society can become more equal?’. It is, in my opinion, extremely relevant to today’s society because as a race, women make up 50% of the populus and in order to have a progressive society, all voices should be heard, and people empowered equally. There is a need to reduce conscious bias and expose unconscious bias in connection with women. Without these biases being addressed, events such as the overturning of Roe v Wade and the rise to notoriety of people like Andrew Tate will continue to both restrict women ’ s rights and demean their status in society

I have chosen to expand the title to include the following sub-questions ‘What are our unconscious biases and what is the evidence proving that we have them? How does conversational mansplaining impact aspects of life? How can we combat conversational sexism?’, in order to focus on specific aspects of bias. I chose to write about this subject after meeting the author Mary Ann Sieghart during a signing of her book ‘The Authority Gap’, which discusses why women are still taken less seriously than men Her research shows that women are expected to be less expert than men.

Men and women are still less willing to be influenced by women ’ s views and we still resist the idea of women having authority She claims that ‘the authority gap is the mother of all gender gaps That gap is both huge and unmerited’. Unconscious bias was immediately apparent when my mother asked the author to sign the book to both my brother and I, identifying my twin brother first Sieghart instead signed the book to Verity and Hayden Having read the book I wanted to understand the impact of not addressing intentional or unintentional consequences of bias for the future for women of my generation and beyond

1 Unconscious bias is the main subject of this essay, so it is important that it is understood. The brain unconsciously develops a template, categorising the world into compartments – or stereotypes – so that it doesn’t have to process too much information This internalised template is called heuristics by psychologists, and when people interact with others or the media, they constantly check the information they process against this ‘template’ This template is created by the adoption or acceptance of particular stereotypes which become an influencing factor in a person ’ s interactions with the world For example, women are more easily associated with the home and men with working, or when there is news about a successful footballer, it is automatically assumed they are a man As Sieghart succinctly explains: ‘Instead of treating each person as an individual, we map them on to our assumptions about what they should be like or what we expect them to be like, based on the stereotypes we ’ ve been brought up with and are surrounded by ’ (The Authority Gap, accessed 2022 ‘Introduction’) It is possible to actively disagree with these biases when they are conscious, but the truth is, most automatically view the world through this ‘template’ which they have developed through experiences and making judgements, much as my mother did at the book signing

There are many examples of unconscious bias as they relate to female stereotypical characteristics and norms. A well-known example is the following riddle: A father and son are in a car accident The father dies, and the boy is taken to hospital The surgeon sees the boy, and announces, “I cannot operate on this boy, he is my son!” (The Authority Gap, accessed 2022 ‘Women do it too’) Why can’t the surgeon operate? Could the father who dies be the boy’s stepfather or adoptive father? No, the simple answer is that the surgeon is the boy’s mother, which even for women is not a conclusion they immediately draw.

Professor Mahzarin Rustum Banaji, an American psychologist whose speciality is bias and a pioneer in terms of developing the IAT (Implicit Association Test), shared this experiment and became increasingly aware that even personal experience could lead to unconscious bias prevailing Exactly how potent unconscious bias is shows through, when people who have mothers who are surgeons don’t get the answer to the riddle correct! Further IAT analysis can demonstrate unconscious biases when sharing words, and seeing which gender you associate them with When the IAT has produced these results inferring gender bias, critics have suggested that ‘the measure is quite sensitive to the social context in which it's taken’ and that associations may be primed by the stimuli, which sounds perfectly plausible. What those associations mean and what they indicate is an open question ‘To equate it with automatic preferences for different social groups is much less plausible " , (APA accessed 2022, ‘IAT: Fad or fabulous?) However neither of these assertions or criticisms refute unconscious bias’s existence, and if we return to the riddle, the unconscious bias here suggests that people don’t think of women as surgeons, a historically male dominated area of medicine There are some roles in society which even today have a gender connotation

I suspect the outcome of the riddle would be different if the boy were taken to the hospital requiring treatment from a nurse Or even if it were a pregnant woman travelling to hospital requiring a midwife, I believe with this example we would see the unconscious bias working in reverse

2 Unconscious bias plays a role in politics, justice, careers, and all other aspects of life

It can start early in a child’s life and develop into a number of characteristics known as mansplaining For women, this has the impact of affecting their confidence, having their intelligence challenged, and men using interruptions to assert dominance. Heuristics are mainly developed as children; so childhood is especially important for learning how to view the world A study was undertaken by Lin Bian of Stanford University, published by the American Psychological Association (APA) on 6- and 7-year-old children The children had the opportunity to participate in a game for ‘really, really smart children’ and a game for ‘children who try really, really hard’ (Princetown University, accessed 2023, ‘Evidence of bias against girls and women ’ and The Authority Gap, accessed 2022, ‘The Confidence Trick’) The results demonstrated that girls were much less likely to choose the smart game If they did choose this game they were shown photos of children they had never seen before and asked to pick teammates The odds of picking a girl instead of a boy dropped by 51%, meaning that even at an early age, children are beginning to value girls less as intellectuals because they are interpreting them as less smart than boys Without correction, this has been shown to cause issues in confidence as these children develop into young people Unconscious bias also affects a person ’ s confidence later in life, especially in situations where their intelligence is questioned To demonstrate this, I created and conducted a survey, entitled ‘Unconscious bias in conversation’, for a mixed gender group of teachers, aged 25-65 I chose the teaching profession because all have to achieve and demonstrate an equal standard of intelligence Within the group there were acceptable variances of length of teaching experience, but all were teaching to a secondary school level The questions were posed through Microsoft Forms, with an unlimited time to respond The survey data was presented back to me in a graphical and numerical format (Microsoft forms, accessed 2022, ‘Unconscious bias in conversation’). Of the 18 respondents, 56% of them said that unconscious bias had depleted their confidence in some way When asked if their expertise had been questioned due to their gender, none of the men answered yes – all the confirmatory responses were from women One of the respondents stated that ‘Having studied engineering in university, there were certainly many comments directed at me that assumed I was not clever enough because of my gender ’ This evidences that throughout a woman ’ s lifecycle, the question of ‘smart?’ never goes away, regardless of that person ’ s qualifications, especially when entering a historically maledominated career path

One of the most referenced studies to do with gender-related unconscious bias was completed in 1975, on a Californian college campus (web.stanford.edu, accessed 2022, ‘Sex Roles, Interruptions and silences in conversation’) 20 same sex partners and 11 mixed-sex partners conversed, and these conversations were recorded and measured for the number of interruptions

The results showed that the interruptions between same sex couples were generally the same, but with a man and a woman in conversation, 96% of the interruptions were done by men. Either consciously or unconsciously, the men dominated the conversation and the women accepted this state What’s interesting is that a similar study was conducted in 2014 at George Washington University (only general conversation, no partners), which saw men interrupt women 33% more than men interrupting other men (Wordpress org, accessed 2022, ‘Women, interrupted’ and web stanford edu, accessed 2022, ‘Sex Roles, Interruptions and silences in conversation’) The earlier study showed men exerting their aptitude to interrupt 63% more of the time It’s a fair conclusion to draw that in a generation, women ’ s contributions to conversation are deemed worthier, or men ’ s unconscious bias has changed to the effect that conversation is now considered a two-way exercise, regardless of gender

The use of interruptions is commonly recognised in some areas as a tool to dominate an argument, with politics and law being a couple of these areas Interruptions in this context are an acceptable tool of discourse or advocacy, however when used to extreme it has many negative connotations. What becomes increasingly difficult to determine from a conscious/unconscious perspective is when in debates For example, a debate between Donald Trump and Hilary Clinton during the run up to the US Presidential elections sees Trump interrupting Clinton 35 times in just 90 minutes He made 24 interjections and 11 sustained interruptions when Clinton was speaking, whilst Clinton interjected eight times and made three sustained interruptions. (Independent, accessed 2023, ‘The chart that shows how many times Donald Trump interrupted Hillary Clinton’ and Wordpress org, accessed 2022, ‘Woman, interrupted’) It could be suggested that Trump was simply more argumentative than Clinton wanted to be, but this and later evidence says otherwise ‘"It's certainly not groundbreaking news that the early victories by the women on The Apprentice were, to a very large extent, dependent on their sex appeal " (In his 2004 book How to Get Rich ) (Independent, accessed 2023, ‘Donald Trump: all the sexist things he said’) This quote highlights his conscious bias and suggests unconscious bias on the part of others In 2019, Sonia Sotomayor was the most interrupted supreme court justice in the USA (The Guardian, accessed 2022, ‘Bravo, supreme court: we do need rules to stop men interrupting women’). Sotomayor discussed her experience of this in 2021, after the US supreme court introduced rules which focus on the male attorneys and justices interrupting their female colleagues It’s unfortunate that it took so long for such a regulation to exist, because it is clear that ‘manterrupting’ and conversational mansplaining is involved in all aspects of women ’ s lives: career, justice, and politics

3. There are a variety of opinions from different backgrounds on how to combat unconscious bias, or whether trying to will result in effective and positive change However, the general truth is, as long as it is acknowledged, improvements in tackling conversational sexism can be made Unconscious bias is being recognised and becoming more observable as evidenced by this essay so far and within professions and industries which are adopting diversity and inclusion practices Actively correcting biases as they are triggered is important

According to Mary Ann Sieghart, the most important thing to do is consciously question the bias as it comes to light, and correct the assumptions For example, ‘if we find a competent woman unlikeable, we can ask ourselves why Is it her problem or ours?’ (The Authority Gap accessed 2022, ‘No need to despair!’)

The results of my survey suggest that a mechanism to combat unconscious bias is spreading awareness of the issue, and this in turn will shine a light on the areas for improvement In 2022, I attended the Hay festival to hear Hillary Clinton speak. During her interview, she highlighted that the majority of the time, the American media were more interested in what she was wearing than what political statements she had to make By discussing this on her speaking tour, she was hoping to highlight the inequality faced as a high-ranking female politician in America and both the conscious and unconscious biases she faced My survey specifically asked two questions: ‘How can we combat sexism in conversation?’, and ‘Do you have any suggestions on ways to tackle unconscious bias?’ Responses included suggestions for highlighting the bias and questioning the intent, such as asking, ‘did you mean to say that out loud?’ or ‘I don’t understand the joke, can you explain it?’ (Microsoft surveys – my personal survey, accessed 2022, ‘Unconscious bias in conversation’) By addressing the issue as it’s occurring, the recipient of the comment can qualify the intention and potentially alleviate the discomfort caused if deliberate ‘Opening up a dialogue rather than accusations can get people to challenge their own misconceptions or biases’ is another suggestion One commentator in my survey noted ‘Each generation needs to be better than the last ’ This implies that change in bias is an improving feature but one slow to resolve. Early education and workplaces are the areas in which these improvements can be best achieved, however, training programmes that present themselves as unconscious bias correction have been heavily criticised The training may take the form of implicit association tests, roleplay, or workshops which suggest strategies for overcoming bias However, Fatima Tresh, a social and organisation psychologist who works for the UK diversity consultancy, told the BBC in an interview, that many companies had scrapped the programmes because they had little impact on behaviours She also stated that ‘“it is unhelpful if we ’ re just looking for other tick-box solutions to diversity and inclusion challenges.”’ (BBC, accessed 2023, ‘The complicated battle over unconscious-bias training’) In 2020, this training was shown to have almost no effect on the way women in administration were represented However, this source also states that ‘ awareness raising is the most common achievement ’ Therefore, this confirms that acknowledging your own unconscious bias already makes a difference.

Unconscious or implicit bias was first coined as a phrase by psychologists Mahzarin Banaji and Anthony Greenwald in 1995 in their article ‘Implicit social cognition’, but as early as 1975 in the study of ‘Sex Roles, Interruptions and silences in conversation’, it was apparent

Even today I have a real-life example which concludes that conversational mansplaining has an impact, but that it can be combatted by correcting a bias and redirecting the praise In this example, my mother who is a single parent had organised an event which was also attended by my uncle At the end of the day two male attendees sought out my uncle to congratulate him for the event’s success without giving a thought to my mother, who had previously introduced herself to both men My uncle then proceeded to correct them and redirect the praise to my mother explaining that she was the sole organiser of the event

Authors such as Mary Ann Sieghart are achieving acclaim in writing about unconscious bias, demonstrating as I have just done that these biases do significantly alter our treatment of women, which is especially prevalent and obvious when analysing conversations It would appear that, as a nation, the UK are more willing to embrace diversity and become more inclusive However, when legislation presents an opportunity to make addressing unconscious bias obligatory, this is overturned. (BBC, accessed 2023, ‘'Unconscious bias training' to be scrapped by ministers’) In conclusion, improving the outcomes resultant from unconscious bias will require a discernible and generational change

Men and women are still less willing to be influenced by women ’ s views and we still resist the idea of women having authority She (Mary Ann Sieghart) claims that ‘the authority gap is the mother of all gender gaps