The year just ended saw some major developments in medicine, not the least of which involved the consolidation of trends in the controversial area of stem cell research. And the big news is that this research is rapidly evolving, in ways quite different from what experts predicted just a decade ago.
Insofar as the general public is aware of stem cells, it is most likely to be of embryonic stem cells. For more than a decade these stem cells – obtained by destroying living, human embryos — have been heralded for their supposedly miraculous potential to cure any number of diseases and conditions. Celebrities such as Michael J. Fox, Kevin Kline, Mary Tyler Moore, and the late Christopher Reeve all went to Capitol Hill to promote federal funding of such ethically contentious research because, they claimed, it was the research most likely to help millions suffering from disease and disabilities. One prominent senator heralded these cells as a “veritable fountain of youth.”
But in the time since President George W. Bush first authorized limited federal funding for human embryonic stem cell research (hESCR) in 2001, and especially since President Obama lifted the Bush restrictions in 2009, something very different from these predictions and promises has occurred. Programs established for the express purpose of funding hESCR are more and more directing resources to pursuing adult stem cells and other alternatives, such as induced pluripotent stem cell (iPSC) research.
A look at the California Institute for Regenerative Medicine (CIRM) itself is instructive. Established by voter referendum in 2004, CIRM had an initial mission of giving priority funding to hESCR and Somatic Cell Nuclear Transfer (SCNT), i.e., human cloning for research. CIRM’s budget for funding stem cell research was $3 billion over 10 years.
In its first year of funding, 2007, CIRM was true to this mission. In two rounds of grants that year, CIRM funded just over 100 research projects; three involved SCNT and all of the rest went to research involving hESCs.
In 2009, CIRM revised its strategic plan to give funding priority to projects deemed most likely to actually lead to clinical trials and not just to those that involve hESCs. The resulting grants showed a startling turn. In one round of grants, hESCR projects received a total of $35 million in funding, but CIRM now seemed also to embrace the alternatives, as non-hESCR projects received almost as much –$33 million.
A subsequent round of grants that year showed an even more dramatic turn away from hESCR. Of 14 grants awarded, only four went to hESCR, totaling $71.5 million. The remaining 10 grants all went to projects involving adult stem cells, iPSCs or other non-embryonic avenues of research and totaled just over $158 million.
Even the media, which so heavily favored hESCR in their reporting and editorials, took note. “For 3 1/2 years, the agency focused on the basic groundwork needed to someday use human embryonic stem cells to replace body parts damaged by injury or disease. Such cures are still far in the future,” The Los Angeles Times reported. “Now the institute has a more immediate goal: boosting therapies that are much further along in development and more often rely on less glamorous adult stem cells.”
“In something of an irony, little of it is going to the reason the institute exists – to work with human embryonic stem cells,” the Knight Science Journalism Tracker commented.
And the New York Times characterized this round of grants as a “tacit acknowledgment that the promise of human embryonic stem cells is still far in the future.”
CIRM’s most recent round of grants, announced last August, saw funding for only four hESCR projects, for a total of $6.4 million. In marked contrast, 10 projects involving adult, induced pluripotent and other non-embryonic stem cell research received $34 million – more than five times as much. Moreover, CIRM has not funded any SCNT project since 2010.
A similar pattern can be seen in Maryland, another state that has chosen to provide considerable funding for stem cell research. The first round of state-funded grants there, in 2007, strongly favored hESCR – 11 such projects were funded, almost triple the number of the four adult stem cell research projects funded. The 11 hESCR grants totaled $5.2 million, more than double the $2.4 million awarded to the four non-embryonic projects.
Compare this to the most recent round of grants Maryland announced last May. Fully 90 percent — 28 of 31 grants – went toward non-embryonic stem cell research projects. Only one hESCR project received a grant, while one employed fetal tissue.
President Clinton’s National Bioethics Advisory Commission first endorsed federal funding of hESCR in 1999. But the endorsement was conditional — because of the ethical issues raised by the destruction of embryos it entailed, hESCR “is justifiable only if no less morally problematic alternatives are available for advancing the research.”
As the saying goes, money talks. Looking at the projects that both CIRM and Maryland have been funding over the years, what the money is saying is that those viable alternatives exist and it is with them that the real therapeutic promise of regenerative medicine lies. Science and ethics once again have shown themselves as the best partnership of all.