Talking embryos: changing public perceptions of embryo research | 91TV
Transcript
- On behalf of the Royal Society, I'd like to welcome you here to this lecture this evening.
- My name is Patricia Fara, and I'm a historian of science. So we have two audiences, the audience
- in front of me actually at the Royal Society in London. So welcome to all of you. I also know
- that there's a very large online audience as well. So welcome to all of them. For the people who are
- here, I've got a few housekeeping rules. First of all, please make sure your mobile phones are off.
- Secondly, as far as I'm aware, there's no fire alarm practice scheduled for tonight. So if the
- alarms do go off, it's for real, and you should exit through that door at the back on the right,
- the one you came in through. Please note that this event is being live streamed on the Society's
- YouTube channel and will be available to watch afterwards. Now, you don't really need me to
- tell you why we're here. We're here for the 2023 Wilkins-Bernal-Medawar Prize Lecture. This prize
- is an annual prize that's given for excellence in presenting the social function of science, the
- philosophy of science, or the history of science, and this year, the very worthy winner is Professor
- Sarah Franklin. She joins a long list of eminent previous lecturers and award holders, including
- Philip Ball, Professor June Barrow-Green, who was still up there a minute ago, and Professor
- Jim Al-Khalili, and several more. Sarah Franklin is world famous for her research into the social
- aspects of new reproductive technologies. So throughout her career, she's helped to establish
- several new fields, notably new kinship studies, the social study of new reproductive technologies,
- and the cultural analysis of bioscience, and she's worked throughout her career in
- several very prestigious places but at the moment she's Professor of Sociology at the University of
- Cambridge. She's also Director of the Reproductive Sociology Research Group, a leading research
- centre in the field, and in addition to her own research, in 2018, Sarah helped to launch the
- Q+ initiative and that aims to promote research, outreach and network building related to queer,
- trans, and sexuality studies at the University of Cambridge. So her current research into the early
- history of UK IVF illustrates Sarah's commitment to bringing together reproductive biology and
- technology as well as the history of science. So she continues, as she has done in the past,
- she continues to find new ways to look at interdisciplinary approaches to the study of these
- intersectional fields. So tonight, she's going to be giving us a talk with an absolutely wonderful,
- tantalising title, Talking Embryos, Changing Public Perceptions of Embryo Research. So with
- great pleasure, I welcome to the stage, Professor Sarah Franklin. Thank you.
- Thank you, Patricia, for that lovely introduction, and thank you to all of
- you for being here tonight on the occasion of the Wilkins-Bernal-Medawar Lecture,
- which recognises the importance of work in both the history and philosophy of science
- and also its social aspects. It's the latter topic that's the subject of tonight's lecture,
- which, if I'm not mistaken, is the first time a prize lecture has ever been presented to the Royal
- Society by a sociologist. So this is not to say, of course, that the social aspects of science have
- been neglected, as the examples set by so many of the previous lectures in this series show. Last
- year's brilliant lecture by Philip Ball emphasised this point particularly strongly when he argued
- that all science is political, all science is saturated, as he put it, with agendas. However,
- the question of how to study the social aspects of science is a somewhat different matter,
- as it involves both specific uses of evidence and distinctive modes of analysis, and these are the
- focus of tonight's lecture, which concerns the very thoroughly saturated topic of the human
- embryo and presents a series of sociological observations of how the public perceive and
- talk about embryo research. I hope by the end of tonight's lecture, you'll not only know much
- more about the busy social life of the human embryo, but also the scientific method of the
- sociologist and why it's particularly important to both science and society today. So to begin,
- what does it mean to refer to the public? This term is used in a wide variety of ways
- and even in the specific context of discussing science and its publics, it's fairly vague,
- but to be brief, we are generally speaking about everyone who is not a scientist. In other words,
- we're talking about how non-scientists view or perceive scientific research, scientific topics,
- science policy, and even scientists themselves. This has always been a complicated question,
- which at times has become intensely politicised and one of the most adversarial periods for
- science and its publics in the UK was in the 1990s when high profile controversies over
- genetically modified foods and bovine spongiform encephalitis, or mad cow disease, created such
- widespread distrust in science, it came to be seen as a national priority to restore confidence in
- scientific advice. In response to what was seen as a crisis in public attitudes toward science,
- the Blair government commissioned the Science and Society Report of 2000, led by Lord Jenkin,
- which argued for a radical shift in the relation of science to its publics, in fact, a complete
- U-turn away from the idea that the public needed to be educated and informed by scientists who knew
- more than they did about scientific facts, to the opposite view that scientists needed to learn far
- more from the public about how they communicated, or didn't. In retrospect, or even at the time,
- it could be said this message was as much about how the government communicated about science
- as scientists themselves, and we'll come back to this point later. But for now, what's important
- to emphasise is that from 2000 onwards, the UK scientific community has been much more genuinely,
- positively, and successfully engaged in a two-way dialogue with the public, not just a one-way
- public education project, and this historic change has come to be known as the shift from deficit to
- dialogue. Interestingly, the Jenkin Report doesn't mention one of the most important public debates
- in British history over scientific research, which directly preceded the BSE and GM debates. This was
- the lengthy embryo research debate which reached its peak intensity in the mid-1980s, but was very
- successfully resolved by legislation in 1990, and has since come to be seen around the world as one
- of Britain's science policy triumphs. So today, I want to go back to that debate right from the
- beginning with two main aims, to illustrate what we can learn from this debate about
- public engagement with science, and to show how this question can be approached sociologically,
- and since this is a very big topic for one lecture, I'll move very quickly through five
- separate snapshots or episodes, which hopefully in the manner of a gripping Netflix miniseries, will
- keep you on the edge of your seats. So episode one is about regulating embryos. So it goes without
- saying that both the social and the scientific lives of human embryos became significantly more
- complicated in the wake of successful IVF in 1978. With the birth of Louise Brown, a myriad
- new questions about human embryos were also born, including religious, political, ethical,
- medical, anthropological, and scientific questions, as well as the very pressing practical
- and moral question of how human embryos created outside of the body should be treated in law. As
- Emily Jackson and I have argued in our forthcoming book on the past and future of Britain's landmark
- legislation governing human embryo research, one of the main reasons the UK offers such an unusual
- and valuable case study, both of changing public perceptions of human embryos and the
- factors that influence these views is that even today, following the birth of tens of
- millions of IVF babies worldwide, the UK is the only country that has ever succeeded in passing
- comprehensive legislation to regulate the use of human-assisted conception technologies such
- as IVF, as well as the field of human embryo research on which such technology depends.
- In contrast, it is precisely the intensely saturated social significance of the human
- embryo that has prevented any other country from achieving this goal, even today. Needless to say,
- when Mary Warnock was selected in 1982 to chair a committee of inquiry into Human
- Fertilisation and Embryology, no one had ever undertaken to legislate in this area before,
- and the prospects of success were minimal. For over a decade, the work of Patrick Steptoe,
- Bob Edwards, and Jean Purdy to develop human IVF had been dogged by controversy, including negative
- press coverage, criticism from fellow scientists, and widespread religious opposition. Moreover,
- Louise Brown's birth coincided with a sea change in British politics with the election of Margaret
- Thatcher and a Conservative government which favoured a return to Victorian values, which
- meant not only a renewed emphasis on traditional families and stricter moral codes related to
- sexuality and reproduction, but a significant rise in anti-abortion activism, which quickly
- came to include opposition to IVF and embryo research. We do not have a full record of how
- the Warnock committee conducted its meetings, or exactly how its 16 members reached the key
- decisions that informed the 64 recommendations they submitted to parliament in 1984. But what
- we do know from some of the documents that were recovered in 2016 is that the committee was well
- aware of the considerable public concern about embryo research in particular, and indeed saw
- this issue is the most significant obstacle to overcome in devising a basis for proposed
- legislation. As an illustration of what they knew about public perceptions of human embryo research,
- we need go no further than the first item on the agenda on November 9th, 1983, when the
- Warnock Committee exceptionally devoted an entire session to a single issue, namely whether human
- embryo research should be permitted at all and, if so, under what conditions. Item number one
- was this paper summarising correspondence from the public on this matter, and in a simple box
- diagram are neatly presented a rather sobering set of cumulative totals, which together show that
- roughly 50 times as many members of the public are opposed to embryo research than support either it
- or IVF. Although this ratio clearly reflected the highly organised nature of the Pro-Life Movement,
- including the amount of support it received from many prominent Tory MPs, these numbers must have
- very firmly underlined the scale of the challenge facing the Committee, as well as its Chair. We
- don't have any surveys of public opinion related to human embryo research in the early 1980s,
- but what we do have is a detailed account from Warnock herself, as well as her key scientific
- advisor, Dr Anne McLaren, of how they navigated and overcame such substantial opposition. In a
- nutshell, Warnock understood very clearly and established early on, three key principles
- that guided her strategy as Chair. Number one was that the subject of the human embryo is one about
- which people clearly have strong feelings and views, and these have to be respected. She also
- understood that there would never be agreement on the ethical status of the human embryo,
- and therefore that a degree of compromise would be essential in order for any legislation governing
- their use to be successfully enacted. She further understood that, however imperfect,
- any legislation would be better than none, and indeed that almost everyone agreed on this point,
- however much they disagreed on others. We will never know absolutely, she insisted, what is the
- right way to treat human embryos. What we need to seek instead is a means of determining what
- is all right for enough people to ensure there is some legislation rather than none. Warnock
- was a philosopher, but her strategy was rooted in an unusually sociological understanding of the
- relationship between law, policy, and morality. According to Warnock, the law is not only Sorry,
- I think I went ahead a bit. According to Warnock, the law is not only a limiting but an engaging
- and expressive force. Solid legal frameworks, in her view, promote social cohesion, reciprocity,
- and trust, and thus a sense of mutuality. People want laws to govern Oh, sorry, it seems to be
- going in the wrong direction. People want laws to govern IVF and embryo research, she believed,
- because such laws express the moral idea of society in the form of mutual respect and
- care. Anne McLaren, Warnock's principal scientific adviser and the only biologist on the committee,
- shared a similar but somewhat different view. For McLaren, a communist, a lifelong political
- activist, as well as a pioneering scientist who helped to develop IVF, scientific progress was
- key to human liberation. She believed IVF and embryo research were crucial to the ability to
- improve pregnancy outcomes, alleviate the distress of infertility, help to reduce childhood disease,
- and open new medical horizons. She wanted these technologies to succeed and she believed
- unequivocally that if they were clearly explained to the public, sensibly regulated and encouraged
- to develop further, that most people would be persuaded of their value and importance
- to society. Good science, McLaren believed, was a source of social betterment for all,
- a principle she saw embodied in institutions such as the NHS. Based on their shared understanding of
- both the task in front of them, and the importance of allowing IVF and embryo research to be legally
- permitted, the approach that Warnock and McLaren proposed was essentially a social contract. In
- exchange for allowing IVF and embryo research to continue, these fields would have to be strictly
- regulated and subject to the very highest degree of oversight. In turn, the benefits of
- controversial scientific work in such a sensitive and emotionally charged area could be realised,
- while continuing to respect the need to reassure the public that it was in safe hands and sensibly
- governed. In 1984, when this strategy was presented to parliament in the form of a proposal
- to establish a strict upper time limit for embryo research of 14 days, a comprehensive code of
- practice backed up by a licensing authority, and powers to enforce these regulations using
- criminal sanctions, the initial response was not encouraging. Parliamentary response was doubtful,
- while the media and many expert professional bodies expressed disquiet. Within a year,
- a proposal from the controversial conservative MP from Northern Ireland Sorry, it seems to be going
- ahead a little bit. Enoch Powell The research was very nearly banned entirely. It would be another
- five years There we go. It would be another five years until the Human Fertilisation and Embryology
- Bill was enacted, a hard-won achievement reflecting the intense lobbying of Warnock,
- McLaren, and a network of highly committed clinicians, scientists, and parliamentarians. The
- passage of the Human Fertilisation Act in 1990 was not only a world-first in regulatory terms, but a
- huge boost for the interdependent fields of IVF and embryo research, accelerating their already
- worldwide expansion and establishing Britain as the global hub of this research. IVF clinics were
- opening all over the country, and even by the late 1980s, a whole new way of seeing embryos began to
- emerge, which was in the context of widespread clinical IVF. So for our second episode, we need
- to go to seeing embryos. I conducted my doctoral research on early UK IVF between 1986 and 1988,
- for which I conducted in-depth interviews with women and couples about their experiences
- of undergoing this technique. Much of what I documented then remains the same today on a vastly
- greater scale. Embryos have many complex meanings, for those who are immersed in the topsy turvy
- world of IVF, as the following brief extract from one of the women I interviewed in 1988 reveals.
- She says, 'Yes, oh, that was so emotional, that was. I didn't believe it would, but when I went
- in there for the embryo transfer, you're lying there on the bed and they've got this screen,
- this big television, and then quickly under the microscope and she says, "Right, I'm going to
- bring them out now. Now look quickly," because she wants to put them back because obviously,
- she doesn't want to leave them there too long, and then all of a sudden, there they are and you see
- these little eggs that are dividing, and well, they're my babies because they're my embryos,
- they have divided. They've just got to grow. And they are the actual start. It's the closest you've
- got to actually being pregnant, and oh, I just burst out crying. I just couldn't believe it.
- And when they said there were three put back, you know, to me, then I was pregnant, you know,
- I was actually pregnant. And that was just marvellous.' In this emotional description of
- seeing IVF embryos, years of hope and expectation are condensed into visual form on the big IVF TV,
- as if the long and tumultuous IVF journey has at once culminated in triumph and yet only truly just
- begun. This vivid description of the briefest of glimpses reveals, and indeed confirms, the
- magnitude of expectation laced with peril that so many more people today recognise as the bright but
- tentative hope that IVF offers. There, in those three tiny embryos on the big screen, lies all the
- promise and precarity of technologically assisted conception. They are magnified both physically
- and emotionally, offering a glimpse of a miracle. These little eggs that are dividing, carriers of
- so much promise and so sensitive to light. This close up view of IVF, of its transformatively
- hopeful promises, and the intensity of the emotion it involves, has grown exponentially alongside
- the rapid expansion of the IVF industry since the 1980s. Indeed, this primal scene of the IVF couple
- and their tiny, almost progeny, had already begun to become a media trope in the 1980s,
- and accounts of their hopeful quests had a direct effect on parliamentary proceedings. In
- the same year I was completing my interviews, Lord Jellicoe, a member of both the House of Lords and
- the Medical Research Council, organised a series of visits by parliamentarians to IVF clinics. The
- former Labour life peer, Baroness Llewelyn-Davies, was one of the speakers in a debate in 1989,
- in the House of Lords, who had been very influenced by seeing herself the transformative
- impact of IVF. Describing why her visit to the Addenbrooke's IVF clinic had been decisive,
- she shared her realisation that, 'IVF has seemed almost like a miracle for desperately unhappy,
- childless couples who are unable to undertake the new process. I'm speaking today because I have
- been to visit the IVF clinic at Addenbrooke's Hospital in Cambridge. I saw one woman who was
- a senior midwife. She loves her work and is obviously dedicated to her patients,
- but until now has had the experience of delivering babies day by day while unable to have one of her
- own. She's had two failed IVF pregnancies but is now in the 25th week of her third pregnancy and
- is expecting twins, if all goes well. She has had to stay in bed in the clinic for a highly critical
- period of time just now, and probably for most of the rest of her pregnancy, but she said it's
- all worth it, without IVF, I never would have had the chance of having a child.' In this extract,
- the powerful emotions experienced during IVF are amplified in Llewelyn-Davies' account
- of directly witnessing what appears to be almost like a miracle. So powerful was this
- form of testimony that in the same debate, Lord Kennet, a more sceptical peer, objected that,
- 'The joy of those who achieve fertility or are able to achieve a baby through IVF has
- been described from all sides of the house. It is developing a very special place in this
- argument.' So moving to our third snapshot of making embryos. Within a year of that debate,
- the Human Fertilisation and Embryology Bill would be enacted, and with it the UK would become the
- undisputed world leader, not only in IVF, but in the development of the IVF platform and an entire
- alphabet soup of new translational technologies based on this ever more widely used technique.
- Since IVF is itself the offspring of agriculture and veterinary research, as well as developmental
- biology and reproductive medicine, it's no surprise that embryo research in animals quickly
- gathered pace in tandem with the expansion of its new success in man. Sheep are very good at IVF,
- and by 1996, Ian Wilmut had perfected a new and highly unusual technique of combining somatic
- cell nuclear transfer with cell culture and mastery of the cell cycle to create Dolly,
- the alleged first cloned higher vertebrate. Dolly Mania subsequently took the world by storm, and
- following her birth in 1997, a new image of the embryo appeared. This was the easily reproducible
- and instantly recognisable digital screen image of the micro manipulated cell. Technically, it is
- an embryo in the making, and that is exactly its visual message. Embryos now belong to the world of
- made things, almost indistinguishable from images of intracytoplasmic sperm injection, or ICSI,
- images of microinjection have, over the past three decades, become ubiquitous in depictions not only
- of IVF and assisted conception, but all the many new avenues of research based on the IVF platform,
- as well as wholly unrelated issues, areas such as tissue engineering, synthetic biology,
- regenerative medicine, and of course, cloning. To the general public and in the mainstream media,
- the image of microinjection is now effectively both a symbol and a shorthand for the remaking
- of the human and of life itself that Philip Ball discussed so comprehensively in his lecture last
- year. Indeed, this now iconic image has become the primary visual signifier, not only of the
- ability to retool reproductive cells, as it were, but to transform reproductivity itself into a
- toolkit for making new things like stem cells and embryo models. Indeed, images of micro injection
- are now the go-to strapline image for accounts of anything new that is repro or bio, and likewise,
- the micro engineered handmade egg cell or embryo depicts a new set of human fertility horizons,
- including new hopes, new possibilities, and new risks from IVF and related procedures. No longer
- a strictly literal image, microinjection has become a figurative condensation of the retooling
- of reproductivity and the links between human fertility and bioscience. Self-evidently, this
- new visual shorthand for the remaking of life is yet another way in which the legacies of IVF have
- become not only routine and normal, but generic, legible, familiar, and everyday. So moving right
- along to episode four, the national embryo supply. From the very start of clinical IVF,
- and often in debates about its ethical legitimacy, the question of so-called surplus IVF embryos,
- those that are either unusable or spare, has often been raised. This question took on a new meaning
- in the context of the successful development of human embryonic stem cell technologies,
- which emerged around the millennium and garnered extensive publicity, both because they offered a
- new paradigm for therapeutic approaches to rare and common diseases, but also because
- they represented yet another landmark in the ability to control and indeed reverse,
- basic processes of cellular regeneration. Here in the UK, where human embryonic stem cell
- research was both legal and well regulated, management of what came to be known as the
- national embryo supply quickly became a priority topic for both the Medical Research Council and
- the UK Stem Cell Bank. A new system of embryo transfer facilitated the provision of donated
- eggs and embryos to stem cell laboratories, and a network of human embryonic stem cell coordinators,
- known as HESCO, was established to help manage and administer a new interface
- between IVF clinics and stem cell laboratories. At the same time, new stem cell labs began to
- be built directly adjacent to IVF surgeries, which were connected through a hatch or a hole
- in the wall. As part of the effort to devise ethically robust guidelines for embryo donation,
- I did some research between 2003 and 2005 on IVF patients' perceptions of stem cell research, and
- their attitudes towards donating embryos to this type of research. The study was very preliminary,
- with only 88 patients participating in a survey conducted by seven clinics,
- but the results were nonetheless revealing. An unexpectedly high proportion of patients surveyed,
- 70 per cent, were willing to donate embryos to stem cell research. This willingness to donate,
- moreover, seemed directly related to both their knowledge and understanding of stem
- cells as well as their confidence in national regulation of the research in this field. So
- to give you just two brief snapshots from this study. As you can see in this graph,
- how striking the findings are when you compare the purple column on the far right,
- showing how many of the 70 per cent of patients who were willing to donate embryos to research
- also had high levels of confidence in regulation. We can see here again in this second bar chart
- from 2005 that although greater knowledge of stem cell research is also correlated to willingness to
- donate, the correspondence is weaker, showing that both confidence in regulation and direct knowledge
- of stem cell research do appear to be positively correlated to willingness to donate embryos to
- science, and findings such as these, from what we call exploratory factor finding studies, which are
- small scale and by definition tentative, are extremely helpful but fairly rare. This is
- unfortunate, as they're relatively inexpensive to carry out and frequently yield both unexpected and
- counterintuitive findings that can very easily be used to develop more in-depth and robust studies,
- in particular, of how people's perceptions of factors like regulation influence their
- choices and behaviour. Here is another glimpse from 2005 of why people did and did not want to
- donate embryos to stem cell research, and what you can see here is that the vast majority of them,
- by a ratio of nearly 3:1, simply wanted to help, to help other patients, to help research,
- or to help find new treatments. This is what is known as generalised reciprocal altruism,
- and we're most likely to see this pattern where there are high levels of trust in both science
- and regulation, backed up by a willingness of scientists to communicate effectively about their
- work. Which brings us to embryo models. I'm going to move very quickly from 2005 to 2023 to look
- at one final snapshot in the evolution of public perceptions of human embryo research here in the
- UK, before we conclude with what I think are the key takeaways from this rapid fire review. Let's
- begin with the headline news in June of 2023 that scientists had created new synthetic embryos Maybe
- that was a little bit too dangerous for them to do that. Yikes! Okay, who's hacking it now? Oh,
- well, I'm sure we'll get some digital reproduction of the synthetic embryo in a minute. Scientists
- have created new synthetic embryos, more commonly known as embryo models. Yes,
- it seems to be having a life of its own now. All right. Well, we'll let that get sorted out. Which
- closely replicate the function of normal embryos but fall somewhat outside of existing regulations,
- and next, let's look at Here we go. Great. The findings from the recent public dialogue project
- sponsored by the Human Developmental Biology Initiative conducted last autumn in partnership
- with UKRI and Sciencewise on public perceptions of embryo research, 70 members of the public were
- recruited to take part in a series of online and in-person webinars and workshops with regulators,
- scientists, patients, and ethicists over a two-week period to consider how to regulate embryo
- models, and in particular, whether to keep the so-called 14-day rule that establishes the current
- upper time limit for such research in the UK. The findings of this dialogue project, while again
- tentative and indicative rather than conclusive or statistically representative, are nonetheless
- quite striking. For example, just as in our stem cell research two decades earlier, the study found
- that although most people had only a vague or no idea of what an embryo model was at the start of
- the dialogue, they quickly became fascinated by the prospect such research can offer,
- what the research involved, and why the 14-day limit has begun to be questioned. Similarly,
- most participants knew little or nothing about the HFEA or regulation in this area, but the more
- they learned, the greater their confidence grew in terms of their support for future research.
- Another striking finding is that one of the chief motivations to support human embryo modelling and
- to extend the 14-day rule, is the possibility of improving IVF success rates. This suggests
- that IVF failure has become not only a subject of increasing public concern, but a high-profile
- policy issue that is seen to be in need of greater investment and is now feeding back into public
- perceptions of embryo research. As we found in 2005, in our HESCO study where a significant
- majority of patients expressed a desire to know more about the actual research processes and goals
- of stem cell science, the desire by members of the public for more and more detailed communication
- from scientists about their work comes across very strongly in this recent study. Key messages from
- the HDBI report are that while public confidence in both the UK science and scientists is high,
- the desire for more and better communication and dialogue with the scientific community is also a
- prominent concern. So much so that requests were made to integrate this issue more fully within
- the national curriculum, to initiate a national conversation on the topic, and to create more
- opportunities to hear from scientists about their research. So to come to our conclusion. So here
- we are. It's 2024. We're nearly at the end of our miniseries. We can now look back over close
- to half a century of fascinating and rapidly evolving debate about human embryo research.
- Sociologically speaking, and as someone who has studied and written about the impact of human IVF
- on our understandings of ourselves, each other, our biology, and our world since the mid-1980s,
- I see five main lessons we can learn about how the public perceive and understand human embryos,
- and why studying this sociologically matters to both science and society more generally. The
- first of these is that good science communication and robust regulation can significantly increase
- the capacity for good science to deliver public benefits. Indeed, as the success of the Warnock
- approach has confirmed, very strict regulation can enable and enhance a more permissive, secure,
- and productive climate for innovative research in the life sciences in both the short and the longer
- term. However, this also crucially involves the ability to build consensus. The Warnock
- Committee's generally sociological outlook on how to devise regulation, which formed the basis
- for the 1994 Act, was not only a rare example of highly successful science policy strategy,
- it has also been a remarkably enduring one. In an influential 2019 article praising what they
- call the Warnock Consensus, the science policy scholars, Sheila Jasanoff and Ingrid Metzler,
- claim that, quote, 'The Warnock Consensus has enabled controversial bioinnovation to
- proceed markedly more smoothly in the UK than in other Western nations. One by one, the HFEA
- approved an array of practices and entities, derivation of human embryonic stem cells from
- surplus IVF embryos, production of embryos for research through somatic cell nuclear transfer,
- genetic testing of in-vitro embryos to ensure compatibility for treating sick siblings,
- human admixed embryos, in which animal egg cells are used to reprogramme human somatic cells,
- and mitochondrial donation. All of these innovations were subjected to extensive
- public consultation. Nevertheless, or perhaps precisely for this reason, none produced the
- public uproar or political deadlock that characterised comparable debates in Germany
- and the United States.' In tracing the evolution of public perceptions of human research embryos,
- I have further suggested that it is a specific image of the micro-manipulated reproductive cell
- that has reinforced and normalised the idea of technological assistance to human fertility,
- and that this regenerative image has itself come to provide a visual grammar or frame shift for
- understanding embryo research as offering a key avenue forward for better health, fertility,
- and medicine. As we saw in one woman's account of her own IVF embryo, and further in the key
- role of IVF as a hope technology in Parliament, where such testimonies were merged with those
- of parliamentarians who visited IVF clinics to see for themselves the difference it could make,
- there's an important dialectic at work here, which I refer to as being after IVF. This has
- two senses that are intertwined. We are after IVF in the simple historical sense that it has
- now become a naturalised, normalised, and familiar part of our world. We all know people who have had
- children through this technique, who are children born of this technique, or whose lives have been
- changed because they were able to have access to IVF or not. We also, of course, know and have
- read accounts of people or have seen TV miniseries or Hollywood films depicting characters who have
- failed at IVF, and thus the public has become more aware that the quest for a miracle baby
- can lead to a particularly devastating failure, recapitulating as it does the very same kinds of
- grief and despair it was intended to alleviate to begin with. In this sense, we are after IVF
- in the sense that our perceptions of its failures have shaped our world as well as its successes,
- and very interestingly, both this after IVF effect and the beneficial legacy of the Warnock social
- contract are consensus are evident in the HDBI public dialogue findings, where the suffering
- of those who have failed in their pursuit of IVF plays a particularly prominent role. It
- would appear in public perceptions of the hope that IVF models are seen to offer that they too,
- like the initial transfer that enabled IVF to begin with, have become linked in the imagination
- of a future. The very same sociological awareness that permeates the Warnock Consensus, that a duty
- of mutuality requires a degree of compromise and even of risk in order to protect the potential
- for science to bring greater benefits, appears to be at work in this perception too, and if
- this is the case that recent research on public perceptions of controversial embryo research
- suggests a cumulative effect of willingness to accept controversial research, because innovative
- new techniques have repeatedly been subject to extensive consultation and are governed under
- very strict rules, then we can add some other cumulative lessons too. An important finding in
- 2005, which wasn't explored further, but could be, is the relationship of public confidence
- and regulation and the desire to learn more about areas of scientific research, like human embryonic
- stem cell propagation. This also features very strongly in the HDBI Embryo Models Project,
- where participants asked in detail for wider public dialogue. Indeed, asked for a national
- conversation, suggesting it would be helpful to hold dialogue with a greater number of people,
- facilitate different modes of dialogue, use the dialogue process as a way of raising the profile
- of this research, having a national conversation, engaging civil society in the conversation,
- including community and faith groups, continuing to work with scientists, and engaging those who
- are likely to oppose the change as much as those who would favour it. Research I was involved in,
- in 2009, close to a decade following the Science and Society Report from the House of Lords,
- confirmed that the professional scientific community here in the UK is generally very
- supportive of what has come to be known as the turn to dialogue in UK science. Many recent
- projects, like the HDBI Dialogue Project, have equally strongly confirmed public support for,
- and interest in public conversations about controversial areas of innovation in bioscience,
- such as embryo models. Both of these patterns suggest that the effects of the Warnock consensus
- may be even wider than Sheila Jasanoff and Ingrid Metzler suggest. Indeed, that the
- principles underlying this unique consensus are far more generalisable to other areas of science.
- It similarly might be claimed that the debate about IVF and embryo research in the 1980s,
- and the resulting highly successful science policy, has had a more lasting effect on
- public perceptions of science than controversies over GM food or government mishandling of advice
- over contaminated beef in the context of the BSE crisis. We can't know the answer to such
- a broad causal or historical question but what we can certainly consider is whether the recent
- government handling of the COVID-19 pandemic, and in particular its handling of scientific advice,
- has adequately heeded these historical lessons. In their recently published account of what can
- be learned from the UK Government handling of the COVID pandemic, Susan Michie and her colleagues,
- including Philip Ball, suggest that the politicisation of scientific advice led both to
- an under-acknowledgement of degrees of scientific uncertainty and an overconfident account of its
- direct application. They argue the resulting gaps in transparency and conflicts between scientific
- advisors and ministerial offices weakened public compliance with the best advice available. While
- acknowledging the extreme conditions of the pandemic, Michie and her colleagues are right
- to emphasise that expertise from the social and behavioural sciences can offer a more nuanced view
- of how science and wider culture interact that is essential to the process of improving transparency
- and thus efficacy of science policy. We can go further to argue that thinking sociologically
- is as important to effective science policy as science itself. To be fair, and as Mary Warnock
- and Anne McLaren clearly demonstrated, you don't need to be a social scientist to appreciate that
- how people feel about subjects such as embryos or vaccinations or genetically modified soybeans
- matters as much as what they know, and that trust is earned, not simply given. Mary Warnock was a
- headteacher as well as a prominent university academic, and she nonetheless described Anne
- McLaren as the very best teacher she herself had ever had. Together, Warnock and McLaren
- offered a masterclass in public dialogue and persuasion, as well as strategic policy
- design. They enabled what Emily Jackson and I have described as a sociological approach to biological
- translation in which dialogue, conversation, acknowledgement of uncertainty and willingness
- to compromise are understood as expressions of mutual obligation. They further demonstrated that
- putting this principle at the heart of science can produce lasting benefits for us all. Thank
- you very much. [Applause]
- That was absolutely wonderful. Very, very thought provoking and a very positive story
- that you've told. So we've got a few minutes for some questions. There's two ways to ask
- questions. If you're online, go to Yes, it's on the screen behind me. Go to Slido.com and enter
- the code # WBM0905. I should at some stage, but not yet be able to read questions from
- this iPad. If you're in the audience in the room, there'll be people from the Royal Society roving
- around with microphones. So if you'd like to ask a question and I can see someone does there, could
- you take over the microphone so she can ask her question? There's nothing on the iPad screen.
- I had a question about how potentially this approach can be applied to issues like
- biosecurity concerns, about, for example, viruses and experimentations in labs,
- and what the public perception of that is like, and how do we respond to it in terms of policy?
- Yes, thanks for that. That's a great question, because that goes to the question of how far could
- you generalise from this example. I really think that's a very timely question because we noticed,
- for example, when the news of the embryo models came last June, there weren't what you might
- call the sort of Franken headlines, you know, Franken embryos, you know, scientists create
- embryos without eggs and sperm. It was a little bit more mundane almost, the representation
- of it, like, oh, there's these new embryos and they can do pretty much what human embryos do,
- but it's not really clear how to regulate them, you know. Even today on the cover of Metro,
- I don't know if you noticed, there was a story about gene therapy for a child who was cured of
- deafness or may have at least been somewhat cured of deafness. Again, the presentation was really
- not what we would have been maybe expecting a bit more in the 1980s or even the 1990s,
- or even 2010 of slightly more anxiety about gene modification of the human,
- what are scientists doing, kind of thing. So I do think that although it's very difficult to study,
- that this case of how embryos have come to be understood as a very normal, almost, part of
- scientific research and part of almost a human kinship with the future, has huge implications,
- really, for other areas of science. But similarly the question of how the communication is organised
- and handled requires just this very simple point, requires more conversation, more dialogue,
- and probably more systematic analysis of that, and it's very pedestrian in that sense,
- but I do think that will become much more important. It will become much more important
- if the science is to reach as many people as it could, potentially, because the science,
- the message from the science, has to be received in order for it to be effective.
- Could you take the microphone to this woman in the front row, second row?
- Thanks. You were saying at the beginning that we are the only country that's created this effective
- legislation. So I was wondering if the rest of the world could be characterised as the Wild West for
- a minute? Is there a likelihood that something that is unregulated could rebound back into the
- way the public think of our research, and that the whole thing could unravel because of that,
- and therefore, what is being done to try to emulate the UK legislation across the world?
- Yes. I mean, that's a really great question because that enables the question of how UK
- legislation affects other parts of the world to be addressed, and in this case, there's a
- very interesting case study, the 14-day rule was emulated by many other countries, and the one rule
- that was passed in many countries was the 14-day upper time limit and all the countries who haven't
- necessarily passed that into law have more or less followed that as a default global standard.
- So I think the existence of a fairly strong consensus within the scientific community to agree
- to voluntarily follow certain basic guidelines, like the 14-day rule, is a very important
- historical precedent. It's an important historical precedent because it means that that can be the
- way that other areas are developed and it means that the benefits of that can be used as an
- argument for why that should be so. So probably, you could very generally say there's a bit more
- anxiety about data than genes right now. People are slightly more worried about what's being done
- with their data than what's being done with their genes, and part of the reason for that is because
- the data has been commercialised so extensively and privatised so extensively, and there isn't
- really any way to know exactly what's being done with the data. A lot of the controversies about
- data have been to do with the fact that it's actually not possible to know what's being done.
- To the extent that happens in, say, the fertility sector, where there's increasing privatisation of
- fertility services and of data about embryos and so forth, we would probably be very concerned.
- So not even just the Wild West, but the Wild Bank, you know, because the wild financial
- pursuit of areas like fertility, because that would be predicted to very significantly weaken
- public trust in general in this area and in the ability to regulate this area.
- Thank you for giving such full answers to those two questions. I'm on very strict
- instructions about the timetable, so I'm afraid we're going to have to stop there, but don't go
- away because there's one very important thing to do. So on behalf of the Royal We have to go
- through the official presentation. So on behalf of the Royal Society, it gives me great pleasure to
- award you this scroll.
- And also this medal, and these together make up the Wilkins-Bernal-Medawar Award. Thank you
- for your contributions, your lecture tonight, and your general contributions to the social,
- cultural, and historical and philosophical aspects of science. So thank you very much for
- a wonderful talk, and I'm sure you'll all agree with me that that was a wonderful talk and that
- Sarah is the most worthwhile recipient of this great honour. So thank you very much. [Applause]
Professor Sarah Franklin, winner of the 2023 Wilkins-Bernal-Medawar Medal, joins us to discuss her research into public perceptions of IVF and embryo research.
Professor Sarah Franklin was one of the first social scientists to conduct in depth qualitative research into public perceptions of IVF and embryo research in the 1980s, and she has continued to research this subject for over 4 decades.
This lecture will closely examine the evolution of public debate over embryo research during that period and will identify specific causal factors that have shifted public opinion, focussing on how we might characterise these changes sociologically. In turn, the lecture will argue for a closer relationship between translational biological research and the social sciences, and further, that the interdisciplinary study of IVF offers a unique opportunity to achieve this goal.
The Wilkins-Bernal-Medawar Medal and Lecture 2023 is awarded to Professor Sarah Franklin for her research into, and advocacy for, the social aspects of new reproductive technologies.
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About the Royal Society
91TV is a Fellowship of many of the world's most eminent scientists and is the oldest scientific academy in continuous existence.
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