International Women's Day 2023: Interview with Professor Elena Cattaneo
“No woman or girl should feel obliged to set aside her own self-actualization.”
To mark International Women’s Day 2023, the Academy once again looks at the pressing issues of innovation, technology, equality, and the role played by women scientists. Barbara Faedda, Executive Director of the Academy, interviewed Professor Elena Cattaneo, a co-founder and director of the University of Milan’s Center for Stem Cell Research who in 2013 was appointed, by then-President Giorgio Napolitano, to be a Senator for life in the Italian Parliament.
“Scientific evidence requires people to abandon their beliefs, if the beliefs are not compatible with evidence and data."
Professor Cattaneo, stem cell therapies are promising, but successful treatments arise slowly and rarely in the face of the urgent needs of sick people. Can you explain for a general audience what is the state of this research? —Would you describe yourself as cautiously optimistic?
Professor Elena Cattaneo
It is understandable that the general public feels that the process of creating new therapies is long and slow, and that, because of this, science cannot respond to a sick person’s urgent need for a solution. This applies to any therapy, including stem cell therapies. This happens not because research is slow but because it is complex. In the sense that it is full of study, of trials, of verifications that move into unknown terrain—where no one has ever been before. It is also full of failures that require one to start all over again. Along the road to stem cell cures, however, the amount of “science” and knowledge that is gained from their study has been enormous, and it is the only serious prerequisite for serious treatment solutions to be brought to the world, to the sick, and to their families. In this regard, I would like to note that the Italian scientific community is among the best trained, internationally, in the field of stem cells. Holostem, a spin-off company of the University of Modena and Reggio Emilia, was—in 2015—the first biotech firm in the world to obtain marketing authorization for a stem cell-based drug—Holoclar. Specifically, Holostem was the first in the world to develop, manufacture, register, and distribute products for advanced therapies based on epithelial stem cell cultures for cell and gene therapy. Thanks to the Holoclar “drug,” countless patients in several European nations have been able to regain their sight and improve their quality of life. The scientific excellence behind the founding of Holostem culminated in the life-saving treatment of a Syrian child suffering from epidermolysis bullosa, a disease that makes the skin extremely delicate and prone to constant tearing, wounding, and infection. The astonishing results of the treatment of this “butterfly-child,” Hassan, are known worldwide; in 2017, his case was the cover story for the journal Nature—because of the exceptional scientific, medical, and therapeutic results of this work. While this is the potential, sometimes the research in this field struggles to attract investments because of the extreme personalization of treatments and the small number of beneficiaries; but researchers are very determined to push ahead.
So, I would say it is difficult to choose between being “optimistic” or “pessimistic” about the development and timing of the availability of new therapies. As researchers well know, failure or success—even therapeutic success—can be just around the corner. However, there are diseases such as Parkinson’s where the possibility of replacing degenerated neurons with new ones obtained from stem cells is being tested after 40 years of basic research. What is certain is that for diseases like these, or like Huntington’s, many researchers and scientists devote their entire lives to these goals.
You’re known for dismantling baseless claims from companies that offer stem cell-based remedies for serious diseases (while they present little or no scientific evidence). From your direct experience, can you explain the roles of reliable scientists and of the media in the face of people’s hopes and expectations?
Scholars can do a lot to help build, rebuild, and maintain trust with citizens by telling about the “how”s, the “why”s, the pathways, the struggles, and the results and failures of their research. This would not only help to anchor our societies in reality, eschewing attempts at simplification and unrealistic “savior” narratives, but would also help to reduce social resistance to scientific innovations. Every international survey shows that when the trust relationship between citizens and political and scientific institutions improves, there is less rejection of innovation. I am thinking, for example, of the study titled “Understanding our political nature,” conducted by the Joint Research Centre (JRC), which is the European Commission’s scientific support and advisory service. As confidence grows, the space occupied by quacks and their scams shrinks down. One should never give up verifying and explaining research outcomes or new discoveries—if only to protect them from manipulation, fads, and anti-scientific bias. In this sense, scholars should be perceived as a resource for society, who never waver in their public ethics, who cultivate the general interest in the same way and with the same importance as their own, to help the nation and the policy-makers with increased debate, results, and progress.
In 2019, the World Health Organization listed vaccine hesitancy as one of the top ten threats to global health. You say that, in this moment of skepticism toward “experts,” a public policy can only succeed if there is continuous discussion and listening among all actors: those who make decisions, those who do research to provide data and evidence (not merely opinions), and those who see the effects of those decisions on their own lives—namely, the citizens. You argue that people are more willing to accept and respect medical decisions when they understand the value, soundness, and necessity of those decisions. Scientific communication for the general public is not always easy or clear. What is your experience in this regard? What would you advise for scientists who must communicate data and analysis to non-experts?
I have always thought that the scientist’s role doesn’t start and end at the laboratory bench, because science in all its forms is only fully complete if it does not remain an individual fact but becomes a cognitive enterprise that has social dimensions and repercussions… an enterprise to be carried out on behalf of and at the behest of institutions and citizens. We work for those outside the university walls, and outside our research centers, who are waiting for answers, knowledge, solutions, and cures.
I am well aware that the language of science may seem like an obstacle to mass communication, but this should not be an excuse. In recent years, with the help of social media, several scholars have emerged and have won over the general public and gained millions of followers simply by recounting the subjects of their work, from physics to chemistry to virology. How did they do it? They brought science into everyday life, with examples of situations that affect us all, every day. Because no matter how difficult a formula may seem—or the name of a bacterium, or a disease—these things are part of us and our very existence. And it turns out that it is not impossible to explain why and how to study the cyclones that form on Jupiter, or the social organization of ants, or the fact that with science we can save the prized femminello siracusano (a Sicilian lemon that is disappearing), and we can read and modify the letters of our DNA. If we spark curiosity, by telling things that we perceive as familiar and interesting, we can win the attention of listeners. Thus knowledge increases and fears decrease.
I also believe that scholars should talk not only of the beauty and innovation in what they do, but also about the failures. In his book, Advice for a Young Investigator, Santiago Ramón y Cajal, a Nobel laureate in Medicine, wrote a century and a half ago that it would be “wonderfully inspiring” for young students and researchers if their teachers—in addition to celebrating the magnificence of their discoveries—recounted their origins, “without neglecting the series of mistakes and missteps that preceded them.” I very much share this thinking: not just scientific research, but indeed all of human life is subject to the risk of mistakes and failures, and the scientific method can help us deal with them in the right spirit, learning from what didn’t work so that we can start off again in another direction. Also, talking about difficulties and failures would allow us to clarify, as Cajal said, that no matter how illustrious and famous, a scientist is in the end a human being like everyone else.
Of course, it is not only scholars that have a role to play: the media too have to play their part; nowadays, fortunately, there are plenty of courses in science communication and popularization at all levels. The example that always comes to my mind is that of Rossella Panarese and Pietro Greco, two science journalists who unfortunately passed away too soon (just a few months apart, two years ago). Rossella and Pietro were able to communicate science in a way that was both rigorous and correct while also being accessible to non-expert citizens. The first step in conveying the wonder of science to all citizens is to train an adequate number of journalists and popularizers, who then know how to do this job.
You note that the global vaccine crisis is chiefly due to vaccine shortages (not vaccine refusal). Indeed, 75% of current vaccinations are concentrated in just ten countries. Vaccinating as many people as possible, world-wide, is the right thing, you have said—for both ethical and “selfish” reasons. Can you explain what you mean by that?
I believe that the experience of the Covid-19 pandemic, which forever changed our lives as individuals and as societies, taught us—or, rather, reminded us—that the health of humanity should be considered as the health of a single living organism. In a globalized world such as ours, in which one can move from one continent to another in a matter of hours and the domino effect of human relationships is continuous and almost unstoppable, it is necessary for each person to commit to protecting other people’s health, too—knowing full well that it is a necessary, though not sufficient, condition of one’s own good health. This is selfish and altruistic reasoning at the same time; indispensable to avoid falling into an extremism and an isolationism that are not only anachronistic but also very dangerous.
You are also an advocate fighting stigma (in your case, stigma against the illness that you study: Huntington’s Disease)—particularly for those living in poor communities. What people and institutions, apart from scientists, can best be engaged to counter stigma?
In 2017, together with a small group of colleagues, we organized what I believe was the largest humanitarian initiative dedicated to Huntington’s, in terms of participation. Never before, I believe, had dozens of sufferers and their families, from very poor areas of South America, been invited to leave their villages and homelands to journey to Rome and be at the center of an international event. These families, who were completely isolated from their communities because of illness, who had felt abandoned all their lives by the whole world, were welcomed and embraced by the top level of our institution of democracy—the Parliament—and the top level of our religious institution—the Catholic Church, represented by Pope Francis. “HIDDEN NO MORE!” was the cry, the message, and the civil commitment that we pursued together as a community of patients, researchers, people of faith, and policy-makers, in those extraordinary days in the heart of Rome. I believe that similar initiatives can be very helpful; both to give hope to those who experience the disease personally, and to get the rest of society to see the difficult but ever-present, close-up realities that must be taken into account. In those days that were so charged with emotion and responsibility, I also realized that the complex scientific path that guides us in the search for a therapy must not be separated from its humanitarian aspect, because one complements and celebrates the other. In this sense, the associations of patients and their families are doing a lot, learning how to network in an effort to alleviate the suffering of people who live with the disease. And, again, science can play its part in reporting and explaining to people the instinctive mental mechanisms behind marginalization and stigma. Cognitive neuroscience has made great strides in recent years, and we scholars should always keep this in mind: seeing our mistakes and our prejudices is the first step in learning to accept that we can all stumble into them, but also in understanding that these prejudices have no real basis and in finding the strength to fight them.
You are a scientist but also a senator of the Italian Republic: how do politics and ideology threaten the practice of scientific research, in your view?
I realize that politics is often a victim of the need to feed its own consensus. For too many years, Italian politics has felt that it can do without evidence in decision-making, or that it can give it scant attention, omitting its most unpopular aspects. Sometimes scientific evidence can indeed be inconvenient, and ignoring it—to pander to public fears and moods—can produce consensus in the short term. Many ideological narratives are successful because they propose simple solutions (even if they are wrong and untethered from factual data), while scientific evidence requires people to abandon their beliefs, if they are not compatible with evidence and data.
But the costs of ignoring reality in policy decisions can be high, both economically and ethically. I could (to stick with an Italian example) point to the bans on animal experimentation that are periodically threatened in our country, and which would prevent our researchers—ours alone, in all of Europe—from continuing to explore remedies for very serious diseases. I could also point to the ban on the study of genetically modified organisms in the open field, a ban that has stood for almost 25 years, across all the successive administrations and governments, and that has hindered Italian research in this area, and which in 2012 led to the burning of the beautiful orchard of genetically improved plants that Professor Eddo Rugini was cultivating, for scientific research, at the University of Tuscia. I could also point to the hypocrisy with which we import thousands of tons of GMO corn and soybeans annually (as livestock feed), while we prevent our own entrepreneurs from growing them. I could point to the arrogance of those who rejected the scientific explanation that the desiccation of olive trees in Apulia was caused by the Xylella bacterium. We could have limited its effects to the zone around the town of Gallipoli, where the bacterium initially appeared, and then eradicated only the plants within a hundred-meter radius around the outbreak—following established international methods and experience—thus preventing the infection from spreading. Instead, some politicians and courts disavowed the science and fed a “fantasy” narrative, which caused the pathogen to spread over hundreds of kilometers, and which led to the destruction of millions of olive trees, businesses, and jobs, and the loss of a distinctive product of great economic significance as well as the erasure of a unique landscape. Proving once again that atrocious decisions always have consequences, and they are tragic.
I could also point to the esoteric practice of “biodynamics,” which the Italian Parliament, in a proposed law, came close to equating in all respects with organic farming. This sparked a mobilization of many scholars, scientific societies, and citizens, and I joined in for the parliamentary work and the public debate; thanks to these people, the law was then modified at the last moment to avoid the equalization of these two practices. And I could point to one more thing, back in the period when I had just been appointed Senator for life: the case of the unproven “Stamina method,” a scam passed off by certain self-proclaimed Italian researchers as a “stem cell” cure, which was then backed by many Italian politicians—who failed to consider that Italy actually had some of the world’s leading stem cell experts. Experts such as Michele De Luca and the late Paolo Bianco; with these two, and others, I publicly fought that scam, as recalled in a 2014 Nature article that I wrote with medical historian Gilberto Corbellini. Lastly, I could point to another hypocritical ban in our country, the ban on deriving stem cells from supernumerary embryos—while we can still freely import the same type of stem cells derived abroad. So many small acts of ideological subjugation—they add up to create an environment that is hostile to science and research.
Has your entry into the Italian parliament permitted you to achieve new goals, beyond your laboratory?
My appointment as senator for life in 2013 by Giorgio Napolitano, the President of the Republic, was totally unexpected, and it has allowed me to observe our democracy from a privileged viewpoint. Looking at issues (including scientific issues) from the position of someone who determines the public policies that govern a country allows one to understand them much more deeply, and to see them in all their facets. This new point of view, which makes clear the complexity of the democratic decision-making process, only confirms my conviction that “evidence-based policy making” can help legislators to take full responsibility for their choices, justifying the decisions they make on the basis of the most recent empirical evidence available.
Women scientists have historically been disregarded; now they are frequently in the spotlight. Do you have a specific message for young women—in America, in Italy, and all over the world—who intend to pursue a scientific career, or wish to reinforce their original decision to do scientific research?
I would advise any young woman to not give up her aspirations, but to do everything possible to follow what she perceives as her talent or predisposition. I think that every woman has to work out her own strategy, to create her own networks and find a partner who is willing to cooperate (while also being a cooperative partner herself)—and I would say that this applies to males as well, nowadays; the really important thing is that no woman or girl should feel obliged to set herself aside, to set aside her own self-actualization, in the name of a cliché that says women are always ready to put others’ needs first, by giving up on their own goals.
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