I don't personally believe that morally and ethically we have the right to use living things in that manner. It seems to me that we have always tried, as humans, to find another classification to be able to treat in different terms. For many years, it was by the color of your skin or your sex. And now we have animals, and we can say that animals are in the group that we can use any way that we want to. And it really strikes a lot of people. From a lot of polling information, I can say that approximately 30 percent of our population really doesn't believe that animals should be used in research.

What's the problem with doing something like that to other living things? Is it about pain? Is it about saying that another living being isn't important?

You can evaluate it on a number of levels. You can certainly evaluate it based on pain and suffering that the animals go through. You can also evaluate it on violence in our own society. If we can just take an animal's life or use them in any way that we want to or put them through some type of torture, does that become part of the fabric of our own society, where violence loses its meaning?

How do your concerns about xenotransplantation tie into some of the concepts you just mentioned about the animals maybe suffering?

Well, certainly xenotransplantation is different than probably normal animal use. I've been at many conferences where the basic statement is that you really try and use the least amount of animals to benefit the largest number of humans. And xenotransplantation actually goes against that basic premise, because in some cases, it could be killing one animal to serve one human. As a matter of fact, what you're really saying is that animals are really nothing more than spare parts for humans.

And what's wrong with using animals for spare parts?

A lot of people would say that animals are not here to be used by humans, and that having animals as spare parts for us really puts them in a completely different category from any other living things. And the other question, is much more practical . . . is that something we actually need to do in the first place?

But many say that experiments with animals are absolutely required.

Well, you've had plenty of breakthroughs where animal use has not been done at all, and you always have to have human clinical trials, anyway, to be able to prove your own point. On the other hand, you've also had many instances where animals have been used, and because their own physiology is different than humans, the researchers have gone down the wrong path. How many times have you heard that we just found a breakthrough for curing cancer with rats and mice in our own laboratories, but nothing ever develops of that? Many times you have research that really doesn't lead anywhere, because a rat or a mouse or even a non-human primate doesn't react like we humans do.

Are there any situations in which use of animals in lab experiments is justified?

The real question is: do animals really need to be used? The procedures that we've been following, in terms of animal research, are the same procedures that have been used almost since the beginning of time. Do we need to build animal models, or do we need to use animals to be able to test things on? Maybe with the kind of intelligence we have in research, if we made creating alternatives to using animals our priority rather than using animals, we may be a lot further along in testing. There's no way of being able to tell, because we always go back to using the same procedures over and over again. "Let's build an animal model. Let's test these on animals," rather than making it a priority to develop alternatives to using animals.

What are those alternatives?

There are certainly things that are being used today, and certainly the use of computers have really developed that. There are human tissues and cells that can be used. There may be numerous other things. It's really hard to evaluate that, because it's not a priority in our society. If we said tomorrow that there would be no animal research, and a priority was going to be to build alternatives to using animals, I think we'd be shocked in the next three or four years to see how many developments would actually happen -- things that the scientists have not even thought about. But it's not a priority.

Have those scientists and others in the medical community been able to sell this idea that you have to use animal models?

The concept of using animals as models has been well established within the research community. I don't believe that they've ever really seriously considered using any other procedures, or are really making it a priority to develop procedures other than using animals. And why should they? It seems to be something that is accepted, and it seems to be something that they can develop. They can develop a number of animals to be used for that purpose. And there's plenty of money for funding.

So you're saying that they made the public believe that that's the only way?

Absolutely. Certainly, the public believes that you have to use animals for research for catastrophic diseases, and the public does buy into that theory for medical research. From almost any public poll . . .approximately 70 percent of the public believes that animals need to be used for medical research.

Why do they believe that?

You have a large machine out there that does biomedical research. You have huge dollars and big money; you have the medical profession; you have the pharmaceutical industry; and you have large government agencies. They all really service the same pool.

Do you see xenotransplantation moving across the Atlantic from the UK to the United States?

Xenotransplantation is definitely moving a little bit more into the United States from the UK. The UK seems to be slightly ahead of us in being more cautious. And the United States seems to be more dollar-driven, more profit-driven, where industry really tends to lead the show. And so this seems to me a little bit more fertile market for xenotransplantation.

Do you see more animal rights protests related to xenotransplantation in the UK than you see here?

I do think that in the UK, the people, and society in general, seem to have a stronger feeling about animals. They really don't like to see them suffer. They don't like to see them in pain. They don't like them being used in certain ways. And legally, they have actually enacted some laws to protect that. So they're a little bit ahead of where we are in the US.

The United States seems to be a little bit behind. People's perceptions are not quite the same, and it does appear that it's a little bit [of an] easier place for xenotransplantation to flourish. You also have the media, which is quite different. In the US, you have 20 major media markets that need to be covered if you try and get the message out to the public. In the UK, it's a much smaller marketplace; it's much easier. It's much more difficult to get the animal rights message out in the United States.

What's the difference, generally, in how Americans feel about animal rights versus how British people seem to feel?

It would be hard for me to assess exactly how animal rights are seen within the UK and the US. It does appear to me that, in the UK, animal rights are more accepted. It seems to be part of the culture. I don't think that the animal rights movement comes under the same attack in the UK that it does here.

. . . I think we've had a different picture of animals -- a more frontier-type approach that's been here for a long time. Making an adjustment in terms of how people perceive animals takes a lot more work, a lot more effort, and it may take a lot more time.

And with regard to xenotransplantation, we haven't seen as many protests here. . . .

There's been very little in the way of protesting the xenotransplantation issue. . . . It's a very difficult, very complex issue, and really, the changes that might occur may be more public policy-oriented than they are protest-oriented.

Should we take that as a sign that the animal rights community doesn't see xenotransplantation as a priority?

Within the animal rights community or any other advocacy-type movement that is really concerned about health care, there are different tactics and strategies. It's possible that protest just may not be the right strategy in this particular country to deal with this issue. Forming or changing public policy may be a more effective means than getting up and putting on a protest before a biotech company.

In terms of affecting policy change, are animal rights a ground that you can even stand on, or do you approach it in other ways?

Animal rights are like any other social movement, because it really is a social movement, in the very large picture. And movements have different phases. In the US, the animal rights movement has been very young. It's maybe 30 years old, and we've probably grown out of the infancy stage of doing a lot of protest to get the public to see this particular movement. Over the past 30 years, there have really been remarkable changes in how the public perceives animals. There have been a lot of positive changes.

But as in most movements, they go through phases. And the phase of protest -- although there are plenty of places where protest makes sense -- it may be that this movement is starting to mature like many others. And you start moving into a different phase, when you're really trying to effect social change, by changing policy.

You're an animal rights person. Yet, when you go before this committee tomorrow, you're not going to argue animal rights. I'm wondering why you would argue socioeconomic issues rather than animal rights.

. . . I got very involved in xenotransplantation about six years ago, starting from an animal perspective, in terms of using animals as spare parts. And when you go through research, you start realizing that's one of many issues, and you start to develop the issues around xenotransplantation that really have increased meaning. Animal rights are one of those. But there are many other issues that revolve around xenotransplantation that the population may really look at as even more serious than the use of animals.

What are some of those issues?

You can start on a broad framework, and the broad framework is that xenotransplantation is one part of a large health care policy. And the question is: What is our health care policy? What is it that we're trying to achieve? Are we trying to save as many lives as we can? Are we trying to improve the quality of one's life? Are we trying to cure every single disease that we have out there? Are we trying to prevent illness? Are we trying to have an equitable system of delivering health care? And then xenotransplantation has to fit into that big picture. But instead, you have all these therapies that live on their own, without ever being considered in a bigger marketplace.

So if you had to name the particular reasons you don't favor xenotransplantation in addition to animal rights, what would they be?

The first major problem, and the problem that everyone seems to be struggling with, is the fact that xenotransplantation really opens us up to spreading infectious disease into the general population. So it's one of the few areas when we're looking at developing a cure for a disease where it's not just that patient that we're really worried about, it's really the general public. It's you and me and my own children who can be affected by doing a xenotransplant into a patient. There's a real -- and I mean a real -- public health risk.

What's done to the pigs in xenotransplantation that you find objectionable?

Well, take the life of these pigs. First of all, they're being bred strictly to be used as spare parts. Secondly, you have pigs that are not living even a natural life. They have no real quality of life. The young pigs are separated from their own mothers at a very young age. They're generally raised in very sterile conditions. And they're slaughtered at somewhere around six months of age. So you're really raising animals for a very particular use where they have really no quality of life at all.

Do you think they're mistreated in the laboratories where they're kept?

I can't answer in terms of the mistreatment of the animals in the actual laboratories where they are raised. Very little has been made public to even comment on that. A little bit that I've seen makes it questionable of the treatment of the animals.

I don't know if you'd make a distinction between mistreatment and quality of life. Do you know anything about their quality of life?

Well, I would say the quality of life is very poor. Whether they are purposely mistreated -- and I'm not quite sure how you would define that -- what I might define as the animals being mistreated may be different than some other people. But whether they're abused or whether they're tortured or not, I really don't have an answer to that.

When we use animals that way, what are we saying about the worth of animals, about the value of animals?

I think that we're saying that really animals don't have any value -- that we are humans and we can use animals any way that they really fit our particular use, whether it's for medical research; whether it's for entertainment; whether it's for food; or whether it's for almost anything. We're saying that animals are really here just for us to use.

Can you assess what you think is wrong with that?

It's very difficult to talk about why I feel there's something wrong with the fact that people believe that animals can be used. Sometimes it's just an inherent feeling, or it's something that is hard to describe while you feel that's unfair -- why animals would be separated out and they can only be used any way that we want to.

And it does remind me of what we've done as humans with other humans, where we've put them into lower classifications by race or sex or religious beliefs -- and now we have animals. And it just seems to me that there's something inherently wrong with taking a group of living things and saying, "You're not at the same level that we are, so we can do whatever we want to, because you don't have a way to stand up for yourself."

Consider somebody who has Parkinson's disease and they are dying or they're very sick. And they get an injection of pig cells into their brain, and they say, "Hey, if somebody objects to this, let them get a fatal disease." How do you respond to that person?

It's very difficult to deal with individual cases. Obviously, I would, and most anyone else, would feel very badly for someone that has a fatal disease or something that really affects dramatically the quality of their own life. And I hear this all the time from doctors who say, "This is my patient. I'll do anything that I can to save their own life." And in some sense, that makes sense, because you should be your own advocate. A doctor should probably be your own advocate, too.

But that doesn't mean that it's the right decision. If in fact you have a patient that's doing something that he or she thinks can save them but puts the general public at risk, then they don't have that choice. That's not informed consent. I haven't given my consent because I could potentially be affected by that, or my children could be affected by that. When you're dealing with larger public health issues, that choice has to be made in a broader arena than one person or one doctor making that decision.

Do you see alternatives to xenotransplantation?

There are plenty of alternatives, and you really have to start in a much broader look. Number one, it's a simple economic model to begin with. You have supply and demand. The reason that xenotransplantation has come out is the reaction to a shortage of human donor organs. So it seems to me that, before we even get to xenotransplantation, we need to make more of an effort to increase the number of human organ donors. There are things that we can do to relax some of the rules in terms of what qualifies as an actual donor organ.

There are things we can do about better advertising, recruitment, marketing, and training in order to encourage that, and there are laws that can be developed. There are mandated choice laws that states can have. All through Europe, there is some form of presumed consent, and at the very least, programs could increase the number of human organs that we have available. The very first step should be to increase that supply before you get into something that's very, very dangerous.

On a long-term basis, the other thing that we need to do is to do something about the need. We need to decrease the need for human organ transplants. Developing more organs does nothing in our society to try and decrease the need for that. So it does seem to me that changing our priorities from trying to cure diseases to preventing illness to really looking at preventive medicine. Really putting some money into prevention, in the long run, may do more than dangerous experimental surgeries like xenotransplantation.

So what's driving the xenotransplantation? Is it financial interests?

Certainly one of the major things driving xenotransplantation is money. The United States spends the highest percentage of their gross national product on health care, by far. But yet, in many health care categories, we actually don't rate that highly. Health care in this country is very good if you are white, if you're in a middle- and high-income category, if you live in the right areas, if you have health insurance, if you have access to health care. Then it works great. But if you don't have those things, then it doesn't work so great. And we have huge categories where people not only don't have health insurance -- 42 million Americans -- but it's estimated that there are 50 million Americans that don't even have access to health care at all.

But being able to provide the services to them is not making money; it's not a business decision. There's not a commercial element to it as there is in xenotransplantation, or as there is in developing a product that can be sold out in the market and someone can make money. So the question is, is xenotransplantation about public health or is it about profits?

And which is it?

I think it's more about profits than it is about public health. Because if it was public health, there are many other things that we would be doing to service the 42 million Americans that don't have health insurance, the 50 million Americans that don't have good access to quality health care. In many inner cities, the life expectancy may be 20 years less than the average, because they don't have access to quality health care.

How does the UK compare to the United States in terms of animal rights?

Certainly in terms of the animal rights movement, the UK is advanced over where we are in the US. It's a longstanding movement. It's been around for 100 years or so, and people in the UK, because of that, have a different perception about animals. And they certainly react differently and legally. They're a little bit ahead of where we are in this country. In the United States, the movement is really only about 30 years old. So it's really new, and although there have been a lot of changes and the perception of the way that people see animals has certainly changed, it's just not quite at the level where the UK is. But it will be there.

Does that make the United States an easier place for using transplantation?

It makes it very much easier in the United States to do things like xenotransplantation, and it's not necessarily because of the animal rights movement. That's only part of it. The other part of it is that the United States' economy is built on business, on making profits. It's built on this entrepreneurial spirit, so in the US sometimes, ethics, sometimes morality, or how people feel about issues takes a back seat to making money.

. . . There's also a different environment in the way that the whole regulatory process happens in the UK rather than in the US marketplace. A good example was back in 1996. The Institute of Medicine released a policy statement, a small book about xenotransplantation, and just right before that the same thing came out of the UK. . . . And there was a major difference in the approaches that both groups took. Certainly the UK was much more interested in terms of animal welfare issues. It became a very major item for them, because they knew that their population was very concerned. In the United States, there was almost nothing done related to animal welfare issues in terms of xenotransplantation.

. . . There's a difference between the UK and the US on regulatory issues and animal rights issues. Do you feel that there are ethical issues where the US is behind, as well?

The environment in the UK is really different than the environment in the US. Definitely there is more interest in animal rights. The regulatory process seems to be a little bit more difficult. They operate in a much more cautious manner, and the business community isn't left to thrive as easy as it is within the US.

Do we, as humans, have the right to use animals for things like xenotransplantation?

At least from my own personal point of view, I really don't believe that we have the right to use animals in xenotransplantation, or in animal research at all.

Why do you feel that way?

That's the harder part. I don't really believe that we should be using animals in medical research. I just don't believe that we have the right to do that. I'm not sure I can sit here and give you a whole long list of reasons. It's really an inherent part of who I am. From a philosophical point of view, it bothers me that we can use living things for our own use any way that we would like to do. I think we're sending the wrong message. As a father who has raised two daughters, it really bothers me that we don't have higher ethical and moral bases in terms of using animals or in some ways discriminating against different groups of people.

Is suffering tied in there at all?

The pain and suffering of animals has been the one issue that the public has really struggled with. Many polls show that the public really does not want to see animals going through pain and suffering. There was a very major poll done by the Associated Press a number of years ago, and it came out that, in almost 70 percent of the cases, people really don't feel that we have the right to make animals suffer.

Is that an issue for you as well? Do you think part of the reason that we shouldn't be using animals for experimentation is because of pain and suffering?

Well, certainly the fact that animals feel pain and they suffer should be reason enough for us not using them. But in a much bigger sense, it seems to me that we shouldn't have the right to do that as well.

Does it make sense to be using animals for testing? Are they appropriate models? Is this a thing we should be doing?

It's very debatable in terms of animals becoming appropriate models. There are many instances where certainly we've gone down the wrong path because we've used a particular model whose physiology is just different than humans. And where there's been a lot of research and there's been a lot of funds, it doesn't necessarily mean that we've gotten anywhere. As a matter of fact, we have put back research a ways. It would be more appropriate for us to spend resources on developing alternatives to using animals, on other methodologies that might actually be more appropriate.

In the case of xenotransplantation, do you think that non-human primates are inappropriate models and are just not right to use?

Non-human primates are very inappropriate models for xenotransplantation -- not just because I don't think any animal should be used -- but just the transmission of a potential infectious disease certainly seems to be not only possible, but we have some very devastating examples, HIV being the major one. That would make non-human primates absolutely the wrong model to use.

What about transplanting a pig organ to a non-human primate as a substitute for a human being? Can you compare that to a human? Is that an appropriate model in that sense?

The testing that's going on right now is using genetically altered pigs, and transplanting them into a non-human primate. So I'm not even sure what that means in terms of the results that you're going to end up getting from it. And not only that, you're now causing suffering and killing two animals, rather than just one.

Who stands to make money off xenotransplantation?

Certainly, money is there to be made in the xenotransplantation marketplace if, in fact, it actually works. Right now, it does seem that you have large pharmaceutical companies interested. You certainly have a lot of venture capital money out there. You have some government grants going out there, which really do support university research.

A lot of people could benefit greatly . . . in a financial sense, by xenotransplantation actually working, along with surgeons that are performing transplant surgery. There's a lot of money out there to be made, and the estimates are all over the place. In terms of how large this particular industry could actually be, you have the money that could be made out of the actual surgery. You also have money to be made by selling the animal parts. And then you have huge dollars that could be made by the selling of drugs that the recipients will have to take for the rest of their lives.

How would that money be made? What are the things behind that?

I don't think that you have biotech companies getting into this field if they don't think that there's a commercial application where they can make money. You certainly have the selling of the actual animal organ itself. You have medical transplant centers that are selling this particular service, and then maybe even the biggest industry of all is really the drugs that recipients are going to have to take for the rest of their lives. Every single new recipient of an animal organ is going to be on drugs, and that just continues to skyrocket over the years. So the actual revenue can be gigantic. . . . I've seen estimates as low as $5 billion a year that could be the industry supported by xenotransplantation, and that estimate could go up to almost anything. Fifteen billion dollars or twenty billion dollars a year could be the actual revenue that comes in from xenotransplantation and its affiliated products.

Does this lead to conflicts of interest?

There are conflicts of interest almost everywhere when you look at xenotransplantation. You have very major conflicts of interest of whether it's really public health or it's really making profits. Companies are in business to make money; that's their number one priority. So public health comes second to that.

What about the cost to the consumer? Do you have a sense of what it will cost to get a pig heart?

Let me give you some estimates in terms of cost. The Institute of Medicine in 1996 tried to estimate what the actual cost of xenotransplantation would be in terms of health care. And they estimated the cost at $20 billion a year.

Last year I went through and tried to use my own figures, just based on published figures that are out there, to try and estimate what I thought the actual cost would be. I came up close to $35 billion a year. How is that paid for? How are we going to support a $20 billion-a-year industry, a $35 billion-a-year industry? It has to be supported by Medicaid, by Medicare, and by private health insurance.

And the cost of that is very interesting, because the cost comes in a number of ways. The major one is that premiums go up. You now have very expensive new surgical techniques, and the only way it's going to be paid for is if premiums go up. And the other way it can be paid for is that you get rid of certain other coverage to be able to support xenotransplantation. So the cost to all of us could be frightening.

Do you have a figure on how much per organ and per procedure?

I don't really know yet in terms of the price per organ. I have heard prices going from as little as maybe $10,000 to as much as possibly $50,000. The actual transplant surgery itself, putting all of the costs together, depends on whether it's heart or kidneys or liver or so forth. I've seen estimates for the transplantation surgery itself, for all of the costs, going anywhere from maybe $125,000, to maybe as high as $400,000 or $450,000 dollars.

Do you think this is actually going to happen? Or is this hype?

When I first got involved in looking at xenotransplantation, it was 1994, and it looked to me that the estimates at that point were that, within 18 months, we would be looking at some whole organ animal-to-human transplants. It's now the year 2001. And we haven't seen it yet.

There are so many problems with it in terms of whether it will even work in the first place -- despite the infectious disease risk, which doesn't seem to go away -- that it's now becoming slightly more questionable as to whether whole organ transplants will actually happen. And the interesting thing is that other medical alternatives are starting to advance at the same time that xenotransplantation is still being discussed, talked about, and still being considered.

Do you think that maybe other things, like stem cell transplants, will overtake xenotransplantation?

At the very best, if xenotransplantation actually worked, beginning with whole organ transplants -- which is very debatable with what's out there right now -- there would only be a temporary solution, because it does appear to me that there are much better potential alternatives. There's tissue engineering, and all of the stem cell research that's out there. I was just reading an article about artificial organs, and that it's really been expanding and developing a lot faster than people think. So there may be other medical procedures besides some surgical techniques that continue to be developed.

There may be some drug therapy developing that might be useful in the future. It seems to me that more alternatives that we're looking at are developing a lot faster to make xenotransplantation, with all its dangers, look like the kind of procedure that we should put aside right now.

So what's keeping xenotransplantation in the present? Is it the medical profession?

What's keeping xenotransplantation going is a combination of factors. You have the biotech industry, and you have the pharmaceutical companies that have made a really large investment. You have medical centers. You have transplant centers. You have transplant surgeons that have invested a lot of time and money to figuring out a puzzle that they don't want to give up. They really want to make this work. And you have a regulatory process that's devoted huge amounts of time to putting forth guidelines and getting into intellectual discussions in terms of whether we should do things this way or that way, and how to protect the public by these great surveillance systems , which, by their very nature, can't work.

Have the doctors been able to persuade people that transplantation is a good thing?

The medical profession has a high degree of credibility to the public. So if you have the medical profession coming out and saying that xenotransplantation would be safe -- which is the major issue -- I think the public tends to believe that.

Does xenotransplantation make financial sense?

Well, it depends on how you want to spend your money as to whether xenotransplantation makes any sense at all. What we're really trying to do is to save lives and improve our own quality of life health-wise. With expensive medical procedures, there may not be a good cost-benefit model to say that this works, that if we're going to spend X amount of dollars, that we're really getting a benefit out of it that makes it worthwhile. It seems to me that there are many other areas where we can spend those dollars. After all, we have finite health care dollars to spend. And we need to do a better job of spending that, so that you get the best bang for your buck.

It's a matter of prioritizing how you spend money?

It's really important, when we're dealing with health care dollars, to be able to set priorities in terms of what we're trying to do and where that money can be best used. And xenotransplantation is so expensive, and it will only benefit a certain group of people, that it may not be worth the dollars spent. Those same dollars may be better spent or may save more lives or improve the quality of more people's lives if it's spent in different arenas, and certainly spent better in the arena of preventing illness, rather than trying to cure diseases.

Why should we not use animals? What's wrong with using animals?

The use of animals for xenotransplantation is unethical. It's a financial dilemma, and it is a public health catastrophe. We're going to be using animals for spare parts for humans when there are other alternatives that are safer, that are less costly, and that will benefit more people. And besides, we're getting into a technology that has serious -- and I mean really serious -- long-term public health problems. The possibility of letting loose an infectious disease into the general population is real, and we have no way to try and stop it from happening. If a disease gets out into the population, we'll have some enormous problems with it. . . . Surveillance techniques are being developed where, if you have a xenotransplantation recipient, their contacts and their family members all have to be tested and protected in the future. But there isn't any possibility of trying to enforce that.

HIV is a really good example that has been out in the marketplace for a long time. Prevention is common knowledge. But in the San Francisco Bay area, you have an increase in the number of victims of HIV, despite all of these surveillance techniques that are out there. So just think of a new disease that we may not even know about being unleashed into the general population, and what kind of methodology that we have available to us to try and control it. And it's frightening. It's absolutely frightening.

Using animals for xenotransplantation is incredibly dangerous. It's frightening to me to think that we're going to use an animal that can put possibly an infectious disease out into the general public . . . where we know there's a transmission of disease or a transmission of viruses from animals to humans that may cause disease. I can't understand why we would be even looking at this type of experiment.

What do you say to these people, to doctors, who say there haven't been any major medical breakthroughs without experimenting on animals?

I don't really believe that animals need to be used in research. In many cases, it's taken us down the wrong path, because the physiology of animals has been different than humans. And even more so, it's kept us from developing other techniques and other methods to be able to test medical research, because we're so tied into the animal model. A really good example today is xenotransplantation, in terms of using cells to transplant cells. It seems to me that we have the technology to be using human cells rather than fighting to develop pig cells.

But do you think we have to use animals for experimentation to make progress?

I don't think that we have to use animals to make progress. I think that we have to get out of that box of the same kind of technology, and start to develop new methods. I'm sure that, with the kind of intellect we have in the medical community, freeing people to look at medical research in a little bit different manner may actually provide technologies and methods well beyond animals. And they could actually be better models and better methods to be able to test new research concepts.