Hot-button health issues during this frenetic political season include spiraling health-care costs, importation of drugs from foreign countries, and the feds' war on obesity. Rapidly heating up is the controversy over stem-cell research.
On one hand, we have John Kerry and his fellow Democrats portraying President Bush as, for ideological reasons, blocking advances in research and treatments for a range of debilitating diseases, including Parkinson's, Alzheimer's, heart failure, and some forms of cancer. Kerry's message is that, if he is elected, the United States will be catapulted to world leadership in stem-cell research, with a dazzling array of miracle cures (and salable products) to show for it. "We're going to lift the ban on stem-cell research. We're going to listen to our scientists and stand up for science. We're going to say yes to knowledge, yes to discovery, and yes to a new era of hope for all Americans," he promised in a radio address on August 7.
On the other, we have the president and many of his supporters arguing -- seemingly from the campaign's talking points -- that the Bush administration was the first to provide funding for stem-cell research. Paradoxically, many of these same people remonstrate that the prospects for cures are grossly overstated, that federal funding is not needed, and that the real potential for finding cures lies not in embryonic stem cells (ESCs) but in applications of adult stem cells (ACSs). As Laura Bush said in dismissing as "ridiculous" Senator Kerry's criticism of the administration's policies: "We don't even know that stem-cell research will provide cures for anything -- much less that it's very close" to yielding major advances.
Stem-cell research and therapy -- particularly using embryonic stem cells -- are, for many, highly emotive issues. ESCs are obtained via the destruction of early-stage embryos, and many social conservatives who object to this technology describe it using the inflammatory rhetoric of the debate over abortion, referring to "killing" and "tearing apart" babies and "culling" their cells.
Such emotion and passion often lead partisans to obfuscate and speak in a kind of code. Far better, surely, for the critics of ESC research simply to say forthrightly, "I oppose this for religious and moral reasons" -- which is clearly their right -- and to forgo the quasi-scientific rationalizations.
It is curious, and also inconsistent, that embryo wastage in other contexts has been far less controversial (and also far less political). For decades in the United States and elsewhere, as part of treatment for infertility, embryos have been created and then destroyed, discarded, or kept frozen, when procedures fail or when another embryo leads to a successful pregnancy. Why don't individuals who demand an end to embryonic stem-cell research on the grounds that it "kills potential babies" object as strenuously to the destruction of embryos or their indefinite storage at fertility clinics?
Politicians on both sides of the aisle who are trying to use stem-cell research for partisan advantage commonly misrepresent and confuse the issue.
Democrats would have us believe that miracle cures for debilitating diseases are right around the corner -- if only the Bush administration would repeal its onerous restrictions. "Some of the most pioneering cures and treatments are right at our fingertips, but because of the stem-cell ban, they remain beyond our reach," Kerry said in August.
Republicans argue that potential ESC therapies are simply a mirage and that the Democrats are cruelly manipulating and deceiving desperate patients. Some, including Laura Bush, emphasize the early nature of ESC research, that no medicines have yet been derived from ESCs, and that no clinical trials are under way. "Embryonic stem-cell research is very preliminary...The implication that cures for Alzheimer's are right around the corner is just not right, and it's really not fair to the people who are watching a loved one suffer with this disease," said the First Lady in August.
The truth lies somewhere in between. Research is indeed in its infancy: Mouse ESCs have been induced to differentiate into a variety of blood cells but not yet the relatively immature ones that researchers want. Similarly, mouse ESCs have been induced to grow into nerve cells used to treat Parkinson's disease in mice; the cells did produce the deficient chemical, dopamine, but not in amounts sufficient to reverse the disease. Nevertheless, and although successful therapies may be a decade or more away, most scientists conversant with the field believe that this technology offers enormous potential. Most technology goes through a phase in which the product or process is imperfect, often profoundly so. It is useful to recall that bone marrow transplantation was a dismal failure for about the first decade that it was used clinically.
Republicans claim that President Bush, the first American president to authorize federal spending on ESC research, is really a champion of the field.
Well, yes and no. On August 9, 2001, the president authorized federal spending on human embryonic stem-cell research -- but only on 64 cell lines then in existence (and only about 21 of which are currently available for research purposes). His supporters characterized this decision as a sound "compromise." Actually, it was a better example of arbitrariness and inconsistency.
In essence, the president argued that, although he was against the use even of early embryos (which are about the size of the period at the end of this sentence) for research because it involved the destruction of human life, federal funding was OK for research using stem-cell lines that had already been created from embryos for which "the life and death decision had already been made." But if it is morally acceptable to use cell lines from embryos created before that somehow magical date of August 9, 2001, why is it not also right to use federal funds to create new stem-cell lines from the estimated half-million unused embryos now relegated to the freezers of infertility clinics and slated for destruction? For these as well, the life-and-death decision has been made.
President Bush's decision to ban federal funding of ESC research (except on existing lines) was based on his belief that embryonic cell research destroys life. But there is an inherent inconsistency here as well. If harvesting stem cells from an early embryo is truly tantamount to harvesting organs from a baby, then the morally responsible policy would be to ban it entirely, not simply to deny it federal funding. But -- contrary to charges by the president's political opponents -- there is no ban, merely the prohibition on federal support of research on embryonic stem-cell lines created after August 9, 2001.
On this issue, the president has lost some of his usual political allies, including conservative Republican stalwarts Senators Orrin Hatch and Trent Lott. Congressman Dana Rohrabacher (R-CA), who has a 100 percent rating from the National Right to Life Committee, intimates that he personally confronted the dilemma of what to do with spare embryos after his wife became pregnant with triplets through in vitro fertilization. He remains conflicted about what to do with his family's unused frozen embryos but says it would be a "horrible waste" to discard them rather than use them for research.
This issue blurs many of the usual polemical lines. Despite the Catholic Church's firm objections to embryonic stem-cell research, for example, an August Wall Street Journal/NBC news poll showed that many Catholics think that President Bush s policy is either questionable (53 percent) or wrong (37 percent); a previous poll by the same organizations found that 72 percent of white Catholics favor stem-cell research.
One strategy might have satisfied most stakeholders and also provided some political cover to President Bush on this issue. When he made his August 2001 policy announcement, the president could have surrounded himself with senior representatives of various philanthropic organizations (such as the Gates, Hughes, and Moore Foundations, for example) that, if they chose to, could fill the funding void for stem-cell research left by the restrictions on federal funding. Money is fungible, after all, and these foundations are prodigious supporters of scientific and medical research, and sufficiently wealthy to pick up the slack in a single discrete scientific area. The federal government would thus have been able to claim the moral high ground (arbitrarily and artfully defined though it might be), and embryonic stem-cell research would not have been hindered.
Democrats claim that if John Kerry is elected president, he will lift all restrictions on ESC research, putting us back in the race to produce medical miracles.
Actually, it is not quite as simple as that. In the New England Journal of Medicine, Dr. George Q. Daley observed that there exists "an even more restrictive element of government policy [than presidential edict that] prohibits the use of funds for the creation of a human embryo or embryos for research purposes" -- namely, a piece of legislation known as the Dickey Amendment, passed in 1996 and renewed every year. Simply electing Senator Kerry will not, therefore, give the green light to such research. Congress bears much of the responsibility for retarding research; thus, President Bush should not be the sole target for criticism, although currently he is perceived as occupying a position of leadership on the issue.
Some commentators who clearly have a moral objection to using ESCs are now aggressively promoting the idea that adult stem cells (ASCs), rather than those from embryos, offer the greatest hope for cures. (Indeed, ASCs are already being used experimentally to treat some blood disorders, leukemias, and other conditions.) Some advocates of this position even accuse the Democrats and their allies in the media of suppressing reports of ASC successes and hyping those derived from ESC research. But why exactly would one reject ASC research if it has such great potential? (Perhaps to keep a political football in play?)
Again, there is some truth on both sides. The NIH acknowledges that ASCs have recently shown greater flexibility or "plasticity" (the ability, under the right conditions, to differentiate into a variety of cell types) and, thereby, to exhibit more therapeutic potential than demonstrated previously. But the NIH also argues that ASCs are more likely to have DNA abnormalities than embryonic ones and may be more difficult to isolate and purify, and that embryonic cells are thought to have much greater developmental potential than adult stem cells.
The NIH's answer to the controversy over adult versus embryonic stem cells is that we should "simultaneously pursue all lines of research to determine the very best sources of these cells." In other words, instead of arguing about which type is better on the basis of insufficient data, we should pursue research using both, an approach that we find sensible. Competition in medical research, as in commerce, is constructive.
Some on the right of the political spectrum argue that the private sector, not the federal government, should fund expanded ESC research.
Certainly, there is a major role for private investors and other funders, especially as the developments in the field move closer to commercial products or processes. But the reality is that, for decades in the United States, fundamental, pre-commercial scientific research of this sort has been dominated by funding from the National Institutes of Health; and if the United States is going to compete in the worldwide race to find stem-cell-based cures, NIH funding (or, as suggested above, private foundations' picking up the shortfall) will likely be necessary. If there is consensus, or near consensus, among American scientists (and there surely seems to be) that both adult and embryonic stem-cell research offer enormous potential to improve the lives and health of Americans, scientists in this country should not be held back. In the face of uncertainty, we advocate a course that offers the real possibility of palpable benefit to large numbers of actual -- not potential -- people.
We are not so naive as to expect that this continuing debate will lead to a convergence of views, but we would plead for a greater degree of candor, clarity, and consistency in discourse. Given the stakes, is that too much to ask?
