The presentation was heavy on the pageantry of stem-cell hopes, familiar to anyone who had followed the Prop. 71 campaign. Microscopic images flickered across the screen: early-stage cardiac cells pulsing with the rhythm of the human heart, clusters of undifferentiated cells in the human embryo glowing like lights in water or stars in space. The science was fascinating. The promise was great. But for those with eyes to see, both the science and the promise had changed so much since the fall of 2004 as to be unrecognizable.
The star of the show was Tamara Alliston, a Ph.D. from UCSF's Cartilage Repair and Regeneration Center. She researches methods for regenerating cartilage using mesenchymal stem cells, which are found in various adult body parts. Her work could one day provide significant relief to those suffering from arthritis — a degenerative condition, affecting 5 million Californians and 27 million Americans, about which shockingly little is known. Since the cells are harvested from consenting adults, her work is free of ethical debates and culture politics — in fact, it falls safely within the research parameters established in 2001 by Bush.
Jake Poehls
Arnold Kriegstein, director of UCSF’s stem-cell research center.
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Alliston is among those applying for the agency's multimillion-dollar grants for "disease teams" — squads of doctors, scientists, engineers, and representatives of the biotechnology industry tasked with preparing cell therapies for specific illnesses. While her work has nothing to do with embryonic stem cells or the intractable diseases they are supposed to cure, CIRM had highlighted it for obvious reasons: It was safe and almost ready for tests in humans. "Tamara wouldn't have been on the program a year ago," says Conklin, who shared a seat with Alliston on the evening's panel of scientists. "But because of the change in direction toward anything regenerative that is potentially going to go to clinic, that opens it up in a big way."
In the realm of biomedical research, money talks — President Bush's notorious edict on stem cells, based on his belief that their extraction from human embryos was unethical, was simply a decision not to offer federal funds for research on new cell lines. And CIRM's 2009 funding priorities speak volumes about the direction of its decision-making. In its first two years of operating — legal challenges kept CIRM from starting its operations until 2007, setting back its sunset date to 2017 — the agency has distributed more than $600 million in grants for basic science and facilities. By contrast, the next round of grants will devote more than $200 million to disease teams; the goal for these teams is to prepare therapies for FDA clinical trials within four years. As little as $20 million will go to basic research.
With the drive toward making medicine from stem cells beginning in earnest, work such as Alliston's poses "an identity issue" for CIRM, says Jeff Sheehy, a member of its governing board. "If we are going to say that we're going to work with adult stem cells, we can be in the translational phase and the clinic now," says Sheehy, who is communications director for UCSF's AIDS Research Institute and represents the interests of HIV patients to the board. "While they're going to be of benefit to a great many people in California, these adult-stem-cell approaches are probably not going to have a big impact on these severe degenerative diseases that really motivated a great number of people to support Prop. 71, like Alzheimer's, Parkinson's, spinal-cord injuries."
In short, the question is whether CIRM should become an agency that pays tens of millions of dollars to alleviate arthritis while research languishes on Huntington's disease or multiple sclerosis. This approach could go a long way toward addressing the more serious safety concerns voiced by some scientists. It is also a remarkable detour, by any standard, from the ambitious medical goals that drove Prop. 71. It is difficult to overlook the irony of a situation in which state officials, seeking to deliver on the promises of a ballot initiative intended to overcome the Bush administration's supposed limits on the advance of science, turn for their salvation to research Bush never restricted in the first place. Will California voters accept such a momentous policy shift?
Former Democratic state Senator Deborah Ortiz, who was the legislature's leading advocate for government funding of stem-cell research before she was termed out of office in 2006, says the first step is for the doctors, scientists, and state officials who have benefited so much from taxpayers' goodwill to explain clearly what this shift entails — without the hype, ego, or political calculations that have played such a major role in the still-early history of stem-cell research. "I think the voters simply want honesty," she says. "A sense of being advised, as things move along, that there's a good-faith effort to make sure that things are fair and pursue the best science."
Unfortunately, even if a show of good faith were enough, there is no agreement among experts about what the best science is. Meanwhile, Roman Reed still coaches his sons from the sidelines in his wheelchair. Davis Brown still swallows pills every few hours to avoid convulsions. By the end of this summer, roughly a third of the $3 billion approved through Proposition 71 will have been distributed. There are no miracles to report yet.
