If Any Drug Tested on HEK-293 Is Immoral, Goodbye Modern Medicine

For years, the Church has generally encouraged vaccines while noting issues with certain ones grown on fetal cell lines. She allowed people to give prophetic witness against abortion by not taking such vaccines (I have defended the right to a prophetic stance in this case). Vaccines help both one’s own health and the health of those around you. However, in the discussion of COVID vaccines, some have taken this further. They have rejected every vaccine tested (not grown on) on fetal cell lines like HEK-293. However, if we reject a medication merely for being tested on a fetal cell line, most of a standard pharmacy would be immoral.

These people who argue against vaccines like Pfizer and Moderna which are only tested on fetal cell lines have a pretty straightforward argument. They identify “abortion as an evil which is in a horrendous class all its own, a class that excludes the normal rules of moral reasoning.” The main rule excluded is the rule that remote material cooperation can be licit. They want nothing that could in any way indicate a possible approval of abortion or drawing good from abortion. If that is the standard, that standard should be applied across the board to all drugs.

Below I will list out a sample of drugs tested on HEK-293 like the Moderna and Pfizer vaccines, point out errors in their reasoning, point to two ethical things we should do as Catholics, and conclude with a point on over-thinking remote cooperation in evil.

Medications Tested on HEK-293

To make this investigation manageable, only those tested on HEK-293 will be included as it’s most commonly used fetal cell line; and also it’s the line Pfizer and Moderna used. There are 66,000 published studies using HEK-293 and its derivative cell lines. Other drugs may be tested on Per-6, WI-38, and MRC-5, although these are used less often. If you are going to reject a vaccine for testing on HEK-293, you need to reject all of these by that same logic.

Thanks to Dr. Lisa Gilbert, MD, for pointing me in this direction and sharing her research on the topic. She summarized her findings, “I believe all the Top Twenty medications prescribed in the US are tested on HEK293.” And “Every medication I’ve researched so far appears to have some connection to HEK.” In the end, I found a single over-the-counter drug not tested on HEK-293, which Dr. Gilbert had not previously reviewed.

The List of Medications

Common over the counter medicines tested on HEK-293 cells or derivative cell lines.

1. Tylenol / Acetaminophen (1, 2)
2. Advil / Motrin / Ibuprofen (1, 2)
3. Aspirin / Acetylsalicylic Acid (ASA) (1, 2)
4. Aleve / Naproxen (1, 2)
5. Pseudoephedrine / Sudafed / / SudoGest, Suphedrine (1, 2)
6. Diphenhydramine / Benadryl (it is used so much with HEK293 that it has a page for using it and HEK293 together for further studies on the FDA site, 2)
7. Loratadine / Claritin (1, 2)
8. Dextromethorphan / Delsym / Robafen Cough / Robitussin (1, 2)
9. Guaifenesin / Mucinex (1)
10. Tums / Calcium Carbonate (1, 2)
11. Maalox / Aluminum Hydroxide and Magnesium Hydroxide (1)
12. Docusate / Colace / Ex-Lax Stool Softener (1, 2)
13. Senna Glycoside / Sennoside / Senna / Ex-Lax / Senokot (1)
14. Pepto-Bismol / Bismuth Subsalicylate (1)
15. Phenylephrine / Preparation H / Vazculep / Suphedrine PE (1, 2)
16. Mepyramine / Pyrilamine (1, 2)
17. Lidocaine / Lidoderm / Recticare (1, 2)

Common prescription drugs tested on HEK-293 cells or derivative cell lines.

1. Levothyroxine / Synthroid / Tirosint / Levoxyl (1, 2)
2. Atorvastatin / Lipitor (1, 2)
3. Amlodipine / Norvasc (1, 2)
4. Metoprolol / Toprol XL / Lopressor (1, 2)
5. Omeprazole / Prilosec OTC / Zegerid OTC / OmePPi (1, 2)
6. Losartan / Cozaar (1, it is used so much in testing the FDA has a page on using it with HEK293)
7. Albuterol / Salbutamol / ProAir / Ventolin (1, 2)
8. Sacubitril / Valsartan / Entresto (2 studies mentioned in FDA application)
9. Tenapanor / Ibsrela (1 study mentioned in FDA application, 2)
10. Enbrel / Etanercept (1, 2)
11. Azithromycin / Zithromax (1, 2)
12. Hydroxychloroquine / Plaquenil (1, 2)
13. Remdesivir / Veklury (1, 2)
14. Dapagliflozin / Farxiga / Ipragliflozin / Suglat / Enavogliflozin / Jardiance (1)
15. Ivermectin / Stromectol (1, 2)
16. Canagliflozin / Invokana / Sulisent / Prominad (1 study mentioned in FDA application)
17. Metformin / Glucophage / Riomet / Glumetza (1, 2)
18. Cerivastatin / Baycol / Lipobay / Fluvastatin / Lescol / Pitavastatin / Livalo / Pravastatin / Pravachol / Rosuvastatin / Crestor (1)
19. Simvastatin / FloLipid / Zocor (1)
20. Oxbryta / Voxelotor (1 study mentioned in FDA application)
21. Lisinopril / Qbrelis / Zestril / Prinivil (1, 2)

The only drug where I could not find any testing done on HEK-293: Simethicone / Gas-X / Infacol / Wind-eze / WindSetlers. This is a drug that never enters cells. It prevents gas bubbles in the digestive tract. I found a few experiments where it was used to prevent foaming and HEK-293 was used in another part of the experiment but none testing it as a drug on HEK-293 directly.

Notes on the List of Medications

This is a very partial list in several ways:

1. More HEK-293 studies exist for many of these drugs. I just stopped after 1 or 2 for the sake of time.
2. Many other drugs are tested on HEK293, but I focused on the top ten prescribed drugs in the USA according to this list, the top over-the-counter drugs, and the ones Dr. Gilbert sent me from her research (which often overlapped with the other categories). Just search a drug you take and “HEK293” to find the testing done on HEK-293 for it. Here’s a list including over 130 drugs are modeled/tested on HEK or its derivative HERG cells.
3. Many medicines have multiple substances from above. For example, Tylenol Cold and Flu has Acetaminophen, Dextromethorphan, Guaifenesin, and Phenylephrine, all of which are listed separately above.

Dr. Gilbert also shared some info on why HEK-293 testing is so ubiquitous.

HEK-293 This is often used in basic research, which helps to establish how diseases cause bad effects at the cellular level, such as on the cell receptors, ion channels or protein expression and folding. This knowledge allows researchers to look for or even create new medications to counteract these specific diseases more precisely, by targeting the cause and effects of diseases at the cellular and molecular level. More directly, HEK is used to test various medications and evaluate see their effects on the cells in-vitro.

This allows safety and efficacy testing to be done in the lab before medications are given to patients in clinical trials. Or HEK call lines may be used to study old medications that are already available and FDA approved. There may be new applications for these medications; knowledge of how these medications work at the cellular level will help in targeting diseases better.These medications may also have side effects or cause interactions on cells when combined with other medications. Studying this in the lab allows for side effects to be understood and mitigated. New medications in the same class can be developed that are safer or more effective. But all of these research possibilities require living cell lines and one of the most common ones chosen for such research is HEK.

The Problem with Rejecting All Tested Substances

There is a difference between the scientists performing these tests or the companies selling HEK-293 and derivatives, vs. us using medicines that have been tested on HEK-293. That is why degrees of remoteness in cooperation matter. The amount of cooperation in evil of scientists running the test and those of us taking the medicine are dramatically different. I will take a Tylenol if needed while a scientist would need a much greater good to justify their less-remote cooperation.

If we were to disallow all remote cooperation, we would need to reject all of modern society more than contemplative nuns. Only hermitic subsistence farmers or hunter-gathers making their own clothes and tools could be completely free from very remote cooperation in evil. I’ve noted before that the most logical and moral Christian response is realizing that we can’t avoid all really remote cooperation in evil. In general, we should try to avoid it. However, we should not get scrupulous about it: it is one factor in a decision but should not overwhelm every other factor or lead to excessive worry.

As noted above, those who reject vaccines tested on fetal cell lines argue that abortion is such a horrendous evil that ordinary rules of cooperation don’t apply. They would see remote cooperation in slave labor like mining raw materials for my phone as acceptable, but use different reasoning when they evil remotely cooperated in is abortion. I’ve written a whole piece on how we inevitably cooperate in many other evils. It would be within reason to be a little more cautious about remote cooperation in abortion, but you can’t use radically different moral reasoning.

Using Their Logic

Nonetheless, even within their logic, their argument fails unless they are going to reject all those medicines above and anything where any part of the production was in China. I’ve shown how all those medicines were tested on HEK-293 just like the vaccines. Every time something is produced in China, a fraction goes to the Chinese government and a fraction of that goes to their forced abortion program. With Biden rolling back the Mexico City policy, part of federal income taxes now fund abortion so I guess American-made or American-sold stuff where any federal taxes were paid would then also be immoral by that standard. (The Mexico City policy is a policy that prevents US tax dollars from being used on abortion in foreign countries.)

God never demands the impossible and this degree of vigilance required to avoid all even very remote cooperation in abortion is beyond what most people are even capable of doing. I do not know anyone who could survive in the USA while doing what was presented in the above paragraph, as you would need to build everything needed for survival directly from natural materials. The Catholic Church does not require or even recommend this. In fact, plenty of stuff in churches involves such remote cooperation in abortion as some stuff we buy is made in China, to take one example.

We theologians should not lead people into scrupulosity as I have often seen from those arguing we should not use vaccines tested on fetal cell lines.

We Should Encourage a Move from HEK-293

One thing that the ubiquity of HEK-293 brings up is that Catholics, especially those in the field, should work for other research methods. Can we start a cell line from umbilical cord blood or from other ethical sources that could replace HEK-293 as a standard way to do in vitro tests? We need to encourage the move from HEK-293 to one or more ethical lines before HEK-293 starts having issues. Fetal cell lines last a long time but do not seem to be completely immortal.

I doubt we will change testing away from HEK-293 next week but a slow move to ethical lines would be good. What is most important about its use is that once it reaches that point where it starts failing, other ethical cell lines have replaced it, so scientists don’t try to harvest cells from another abortion to replicate its characteristics. One way a non-researcher could help is to write letters like this one to companies encouraging them to switch away from fetal cell lines.

MRC-5 started to have issues, so in 2015, some scientists made Walvax-2, specifically chose to emulate MRC-5’s characteristics. If by 2010, MRC-5 was basically unused, I doubt scientists would have made Walvax-2. The abortion we most directly (but still quite remotely) cooperate in by using HEK-293 is not abortions in the past but whatever abortions cells are harvested from to replace it if it’s still in use in the future. (More on Walvax-2.)

HEK-293 Testing and Existing Medicine

As noted above, almost every common medication has been tested on HEK-293. As also noted above in a different section, avoiding remote cooperation should be one factor in decision making but not the only factor or automatically trumping all other considerations. This leads us to be able to morally use all the medications above even while noting there is some very remote cooperation in evil or appropriation going on.

It’s analogous to if I go to buy a new desk lamp and in the store, the five available are all made in China, I’m free to buy any. I might even buy one made in China over another for some other reason related to how I will use the lamp. And there is no moral obligation even to check as the cooperation is so remote.

Constantly Thinking About Remote Cooperation

A constant worry about cooperation in evil that is so remote will likely over-occupy us and actually cause moral issues where we haven’t the energy to actually seek good, not just avoid remote cooperation in evil. Morality is about both avoiding evil and doing good. Avoiding evil is to prevent obstacles to our final end, but doing good actually seeks that end of beatitude. Doing good, not avoiding evil, is the height of Christian morality.

Evil must be fully avoided in the object and the end, but circumstances are rarely going to be perfectly good. When I go to buy food, all nearby grocery stores carry products from companies that directly fund Planned Parenthood, so the circumstances are imperfect. But, that is not a reason to avoid all nearby grocery stores. (In the suburbs, unless I want to eat out every meal, I’m kind of stuck with grocery stores.) Worries about remote cooperation in evil that is several steps removed can occupy our practical reason (where we make decisions) to the point we no longer are able to focus on doing good. This would be detrimental to the Christian moral life.

In our concern for the lives of the unborn, there are two other areas we could more fruitfully apply our energy for change. We could probably achieve more for unborn humans by stopping the sale of fetal body parts from abortions now and in the future. We could probably achieve more by fighting against many practices in IVF like creating extra embryos, then freezing them indefinitely, or throwing them away. In 2016 alone, the USA had 52,686 cycles of IVF where embryos were implanted. On average, they implant two embryos but only 6.2% result in twins. Moreover, a significant portion of women decide against implantation or create more embryos than immediately needed and freeze them, often indefinitely.

Conclusion

Along with their special case for abortion listed above, those opposing a vaccine tested on fetal cell lines may be making a special case about different pharmaceuticals. If they are serious, they should at least call for not using all the pharmaceuticals above. If they insist on no vaccine tested on fetal cell lines while accepting a lot of similar or less-remote cooperation or appropriation, including the exact same thing with other medicine, then they do not seem to be doing moral theology but attempting to use it to justify a choice they already made for other reasons. That is not an honest application of moral theology.

We should all apply moral theology in the mind of the Church. I hope I have done that. I hope others can do that too. If they do, they may not agree with me 100%, but I think they will come to similar conclusions on this issue.

Note: Please support me on Patreon so I can write more on Catholic moral theology and bioethics in line with the Church.

Update (September 2021)

This post continues to get a lot of views and has generated some critiques. I want to point readers to some foollow-up articles here.

How Remote the Cooperation Is

The point of this article is not to reject all modern medicine but to point to how impossible it is to avoid all super-remote cooperation in evil and to point to the lack of moral obligation in this regard.

This was written as a follow-up to “12 Things Less-Remote Cooperation in Evil Than COVID Vaccines” which pointed to things like Chinese-made goods, electronics, bananas, etc. A response to that was to argue for some uniqueness in cooperating in the evil of abortion vs. other evils. Catholic theology makes no such distinction between grave evils: an innocent person killed for who they are be that an unwanted unborn child or Uyghur is equally immoral to cooperate in. However, a large point of this piece was to say even if abortion is some kind of special evil we must avoid cooperation in (which it isn’t), then you can’t avoid such cooperation without essentially leaving modern society.

I also wrote a further follow-up pointing to how remote our cooperation in abortion is with COVID vaccines. After running the math (see link for this), I find that buying a $30 item made in China contributes more to abortion than all 2 billion doses of Moderna & Pfizer vaccines. Yet few of us would give much thought to where the $30 item we bought was made. I don’t think we need to avoid buying such things made in China, a fortiori [all the more] we don’t need to avoid vaccines or other medicines.

Different Types of Medicines

A number of different people made the same basic argument in reply to this piece explicitly. Their argument is that testing done on say Tylenol is different as it was not for approval or for initial development.

I wrote “Anti-Vaccine Catholics Break Moral Theology Principles” and “Missing the Point about Remote Cooperation / Appropriation” in reply to these. The first is longer and more in-depth; the second is more developed in a few smaller points.

I grant there is a bit of a distinction, but not as much as they seem to imply. The distinction is based on each use for a chemical, not the chemical in the abstract. These chemicals existed and their development / approval is for a specific medical use, not abstract. Thus, almost all proposed COVID treatments – both approved ones, and alternative ones like hydroxychloroquine and ivermectin that may not have had HEK-293 testing for their other uses – have the same super-minor and unimportant moral issue with being tested on HEK-293 as noted above.

Second, as cooperation in evil is related to double-effect, we need to consider the effect of using a drug when considering how much cooperation. I can accept a lot more cooperation in a vaccine that might save my life or the life of someone around me than I can if just taking a Tylenol to eliminate a headache and focus better for the next few hours. The cooperation in HEK-293 testing is less in Tylenol used for such a headache, but the end being sought is a lesser good as well.

Finally, this argument of avoiding COVID vaccines due to remote cooperation while living in modern society requires about 5 levels of nested special cases when nowhere else in moral theology do you have nested special cases. (Special cases exist, and exemptions exist but these exceptions just bring it back to not being a special case, so aren’t nested.)

Finally, I use categories and tags on this blog: you can find all my writings on vaccines with the vaccine tag. As I am a moral theologian who has taken enough immunology to understand it but not to be an expert on the topic, most of these focus on moral theology, not science.

October 2021: Timeline

I made a timeline about how people are responding above. Above I made it very clear that I was responding to Bishops Schneider and Strickland in late 2021. (When a theological or ethical position is taken by a number of Catholics but only two bishops, I think it’s reasonable to take those bishops’ statements as representative of the argument.) From the second paragraph above: “They identify ‘abortion as an evil which is in a horrendous class all its own, a class that excludes the normal rules of moral reasoning.’” However, many changed the criteria from any connection whatever to the specific connection of pre-approval testing. I don’t see this as disproving this article. Instead, it seems to show this article showed their prior criteria was unsustainable so they needed to change them. I sincerely ask how these people can consistently apply these criteria: it would seem that posting to social media that you aren’t vaccinating due to the super remote connection with abortion would in many cases be more closely connected to abortion than the vaccine you are objecting to. (This is the EarthHour conundrum where turning off lights and lighting candles increases greenhouse gases so your symbolic action does the opposite of what it’s meant to symbolize.) The overarching argument – a reductio ad absurdum – that you can’t consistently reject vaccines based on this super remote connection and live in modern society still stands unchanged by their change in criteria. Here’s the timeline that most critiques are still missing.