A revealing book investigates the politicization of regenerative medicine, finds Gilberto Corbellini.
The Stem Cell Hope: How Stem Cell Medicine Can Change Our Lives
- Alice Park
Scientists have a fragile power, which is easily weakened when research goals clash with emotive value systems. The controversy over stem-cell research is a good example of this. In The Stem Cell Hope, science writer Alice Park investigates the political obstructions that for nearly 15 years have curtailed the public financing of human embryonic stem (ES) cell research in the United States, despite the exciting discoveries that have attached so much promise to the field.
The book begins with the first animal cloning experiments, performed in the late 1950s and early 1960s; Martin Evans' isolation and cultivation of mouse ES cells in 1981; and the birth of Dolly the sheep, the first mammal to be cloned from an adult cell, in 1996. Park discusses the failed attempt of Harold Varmus, then director of the US National Institutes of Health (NIH), to get public financing for research on human embryos by setting up the 1994 Human Embryo Research Panel. President Bill Clinton rejected the panel's funding recommendation, and in 1996 Congress passed the Dickey–Wicker Amendment to the annual NIH budget bill, ensuring that no federal dollars could be used to support research in which human embryos were created or destroyed. The amendment has been renewed every year since.
Park recounts the obstacles that US researchers have faced to remain internationally competitive in the emerging fields of stem-cell biology and regenerative medicine. She describes how scientists and patients' associations have defended and spread the view that the suffering of living people justifies experimental studies on spare embryos that are left over from infertility treatments and will never be implanted, and so will never become human beings. We meet James Thomson, who in 1998, while working at the University of Wisconsin–Madison, became the first scientist to cultivate human ES cells, thanks to the financial support of the biotechnology company Geron. We also listen to the justifications of the president of the Wisconsin Alumni Research Foundation, which took aggressive control over the patents to Thomson's cells, issuing licences with one-sided terms that irked some scientists.
Private foundations and patients' associations helped US scientists to continue research on human ES cells.
The author interviews Jay Lefkowitz, the policy adviser who prepared President George W. Bush's televised prime-time address of 9 August 2001, in which the president authorized the use of “more than 60” existing lines of embryonic cells. Lefkowitz reveals how a division inside the White House cabinet pushed stem-cell research to the top of Bush's agenda, prompting the president to change tack after having promised during the 2000 presidential election to prohibit research using human embryos. Park does not comment on whether polls published in the weeks before the address, showing that the majority of US citizens favoured research on spare embryos, might have influenced Bush's decision.
The success of California's Proposition 71 referendum in 2004, which enacted a law supporting stem-cell research in the state, shows that organized and well-financed actions of civil commitment are possible in the United States, despite being almost unknown in the rest of the world. The proposition resulted in the creation of the California Institute for Regenerative Medicine in San Francisco — a pivotal moment in the process by which private foundations and patients' associations helped US scientists to continue their research on human ES cells and explain the field's therapeutic value to the public.
Luckily, a new protagonist emerged, with results that were promising and reproducible.
With the sad story of the downfall of Korean cloning scientist Woo Suk Hwang, who in 2009 was convicted for gross ethical violations, Park portrays well the hellish vortex that can engulf the scientist who allows himself to be manipulated by media and political pressures into touting spectacular results. The Hwang case could have been devastating for the field. Luckily, a new protagonist emerged, with results that were promising and reproducible. Japanese scientist Shinya Yamanaka restored the field's credibility with his careful work on induced pluripotent stem (iPS) cells — adult cells genetically reprogrammed to mimic natural stem cells capable of developing into any other type of cell, and which could potentially be used instead of human embryos. But because iPS cells emerged from work on human ES cells, the latter remain essential to understanding the biology of human tissue formation.
Park does not discuss how the politicization of regenerative medicine contributed to the popularity of stem-cell tourism and treatments of doubtful effectiveness. In this regard, oversight by the International Society for Stem Cell Research (http://www.isscr.org) in Deerfield, Illinois, is valuable. Bypassing sluggish governments, the society provides guidelines for how to design translational studies and informative tools to protect patients against deceptive advertisements of stem-cell therapies.
The book ends with the White House ceremony on 9 March 2009 at which President Barack Obama signed the executive order “Removing barriers to responsible scientific research involving human stem cells”. Surprisingly, Park does not mention the still-unresolved Sherley v. Sebelius litigation, which, in August 2010, resulted in the US District Court for the District of Columbia passing an injunction to block the effect of Obama's decision on the basis that it violated the Dickey–Wicker Amendment. This April, the US Court of Appeals for the District of Columbia Circuit overturned that preliminary injunction, but the case is still open to further court decisions, arousing concerns among scientists and patients.
Nevertheless, The Stem Cell Hope is an instructive report about the negative effects of politics on regenerative medicine in the United States.
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Corbellini, G. Stem cells: The clash of hype, hope and stem cells. Nature 474, 575–576 (2011). https://doi.org/10.1038/474575a