Outlook

September 16, 2005

Stem cells: Should Washington be involved?

Among the heavyweight issues on the Senate's post-recess agenda is a bill that would lift federally imposed funding restrictions on human embryonic stem cell research, one of the most promising areas in regenerative medicine. Passed by the House in May, the "Stem Cell Research Enhancement Act of 2005" has a politically diverse group of Senate all-stars behind it. The bill, of course, also got a pre-recess boost from Majority Leader Bill Frist, Capitol Hill's best-known physician-legislator.

In his July 29th speech on the Senate floor, the pro-life Frist explained how his support for the position set out in 2001 by President Bush-which for moral reasons limited federal funding to pre-existing cell lines-had evolved. Said Frist: "While . . . research is still at a very early stage, the limitations put in place in 2001 will, over time, slow our ability to bring potential new treatments for certain diseases. Therefore, I believe the President's policy should be modified." Frist called for a less restrictive federal policy, but one that stayed "within ethical bounds."

Like-minded senators cheered the endorsement-a few speculating that it might prove the tipping point for a number of wavering Republicans. Outside groups also applauded it. In an Aug. 12 letter to Frist, AMA top executive Michael D. Maves, an otolaryngologist, praised the majority leader for his "thorough and thoughtful approach."

But are they correct? Would, in fact, such research move forward as easily without federal funding?

Currently, four states-California, Connecticut, Illinois, and New Jersey-have targeted funds specifically for human embryonic stem cell research. (Four other states-Indiana, Massachusetts, Ohio, and Virginia-are at various stages with other forms of stem cell research.) California has, far and away, the deepest pockets, allocating up to $3 billion over the next decade for its Institute for Regenerative Medicine. By comparison, in fiscal year 2004, the National Institutes of Health spent a total of only $552.5 million on all phases of stem cell research-human and nonhuman, embryonic and nonembryonic.

But such federal-state comparisons are misleading, say those who fully expect new and expanded federal funding if and when Congress lifts the current restrictions. Such funding, they say, will make other revenue sources pale by comparison.

Advocates cite other reasons for a national rather than a state-by-state focus. "The Feds are in a better position to make sure that whatever research is done is well coordinated," says Mark S. Frankel of the American Association for the Advancement of Science. Leaving things up to the states, Frankel worries, will create a culture of scientific haves and have-nots-with the best minds migrating to where the best funding is. It will also create confusion, he says, as different parts of the country adopt different ethical standards.

These seem like good reasons for keeping Washington in the picture. And it's a good bet they're among the very ones that Dr. Frist thought about before he came out for legislation that the leader of his own party has promised to veto.