Big in­vest­ment, too lit­tle over­sight

San Francisco Chronicle - - FROM THE COVER -

Like Mys­pace, the Martha Ste­wart pros­e­cu­tion and Amer­i­can demo­cratic norms, spend­ing gobs of state money on stem cell re­search might sound like an ar­ti­fact of the Aughts. And yet 16 years af­ter vot­ers agreed to bor­row $3 bil­lion to ex­plore a promis­ing new area of med­i­cal re­search, stem cells are back on the Cal­i­for­nia bal­lot.

The state’s vot­ers passed Propo­si­tion 71, which cre­ated the Cal­i­for­nia In­sti­tute for Re­gen­er­a­tive Medicine, in a fit of hope that stem cells could treat an ar­ray of dis­eases and in­juries. Pres­i­dent Ge­orge W. Bush’s or­der lim­it­ing fed­er­ally funded em­bry­onic stem cell re­search on re­li­gious grounds added ur­gency and pol­i­tics to the cause. Celebri­ties such as Michael J. Fox and Christo­pher Reeve urged Cal­i­for­ni­ans to step into the breach for them and count­less oth­ers with in­cur­able, of­ten heart­rend­ing con­di­tions.

Now the Oak­land­based agency’s back­ers want vot­ers to ap­prove an ad­di­tional $5.5 bil­lion un­der Propo­si­tion 14 to sus­tain not just a lim­it­less pos­si­bil­ity but also the more mun­dane and com­plex re­al­ity of the in­sti­tute’s ex­pe­ri­ence. Es­pe­cially in a field as nascent as stem cells, science is slow, in­cre­men­tal and un­pre­dictable, largely in­com­pat­i­ble with the leaps for­ward touted in 2004. While the unique state of the science and pol­i­tics drew broad sup­port for Prop. 71 — in­clud­ing The Chron­i­cle’s — we shouldn’t make a habit of set­ting science pol­icy and bud­gets by state plebiscite.

Stem cells en­com­pass early em­bry­onic and cer­tain ma­ture cells that can pro­duce a range of tis­sues, hence their as­sumed po­ten­tial to re­pair the rav­ages of dis­ease and in­jury. The field’s staunch­est ad­vo­cates are mo­ti­vated by the pos­si­bil­ity of treat­ing what af­flicts them and their loved ones.

While state funds helped sup­port the re­search that led to two ap­proved can­cer drugs and a host of prospec­tive ther­a­pies in var­i­ous stages of de­vel­op­ment, far­reach­ing break­throughs at­trib­uted to the stem cell agency have been scarce so far, as a Chron­i­cle in­ves­ti­ga­tion found. More than half the orig­i­nal fund­ing went to build­ings and other in­fra­struc­ture, ed­u­ca­tion and train­ing, and the sort of ba­sic re­search that, while sci­en­tif­i­cally valu­able, is a long way from med­i­cal ap­pli­ca­tion. There’s noth­ing in­her­ently wrong with that, but it is at odds with the vi­sion of dra­matic ad­vance­ments put to vot­ers.

The in­sti­tute’s over­sight raises more ques­tions. Its top ben­e­fi­cia­ries, among them Stan­ford and the Univer­sity of Cal­i­for­nia sys­tem, have been rep­re­sented on CIRM’S board. While mem­bers re­cuse them­selves from fi­nal fund­ing de­ci­sions af­fect­ing their in­sti­tu­tions, the ap­pear­ance of ram­pant con­flicts is in­escapable. Mean­while, the in­sti­tute is in­su­lated from out­side over­sight by a pro­vi­sion that pre­vents the Leg­is­la­ture from im­pos­ing changes with­out a steep 70% su­per­ma­jor­ity.

The case for Cal­i­for­nia as a ma­jor pa­tron of stem cell re­search was also di­min­ished by Pres­i­dent Barack Obama’s re­ver­sal of the Bush lim­its on re­search more than a decade ago. One anal­y­sis found that fed­eral fund­ing sup­ported more than three times as many clin­i­cal tri­als in the field as Cal­i­for­nia did.

CIRM’S orig­i­nal fund­ing will cost the state about $6 bil­lion with in­ter­est, to which the cur­rent pro­posal would add $7.8 bil­lion. While both ini­tia­tives pro­vide for re­cov­er­ing in­come from ap­proved ther­a­pies, the fis­cal ben­e­fits are a mat­ter of spec­u­la­tion. And with the pan­demic, wild­fires and more stretch­ing the state’s re­sources, stem cell re­search looks like an even more un­likely gam­ble for a govern­ment with more press­ing pri­or­i­ties.

As The Chron­i­cle also found, along­side the le­git­i­mate but halt­ing progress to­ward ef­fec­tive ther­a­pies to which Cal­i­for­nia has con­trib­uted, a whole in­dus­try of op­por­tunis­tic quacks hawk­ing stem cell snake oil has flour­ished across and be­yond the state. That’s not the in­sti­tute’s fault, but it is a byprod­uct of the ag­gres­sive pro­mo­tion of the­o­ret­i­cal med­i­cal treat­ments di­rectly to the pub­lic — and another rea­son to vote no on Prop. 14.

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