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Facts on Stem Cells

By Ruth R. Faden and John D. Gearhart
Monday, August 23, 2004; Page A15

This summer marks the third anniversary of President Bush's announcement of his policy on stem cell research. In the intervening years, the subject has become a polarizing flash point for American politics and a focal point for the presidential campaign. For many of Sen. John Kerry's supporters, the Bush administration's stem cell policy is a leading symbol of everything that is wrong with the current domestic agenda. For Bush supporters, his stance on stem cells is a leading symbol of all that is right.

Translating science into political symbols and slogans comes at a price. There is hype on both sides. In the rush to put a human face on a complicated biomedical challenge, supporters of both stem cell research and Kerry sometimes seem to suggest that but for the administration's policy, stem cell cures for dread diseases would already be in hand. Even under the most supportive policies, however, considerable research needs to be done before the therapeutic promise of stem cells is fully understood and its benefits are realized. In no cases are cures guaranteed, and even in the most promising areas, reliable cures are years, in some cases as much as five to 10 years, away.

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That said, and despite the hype to the contrary, there is no question that the current policy is substantially retarding progress in stem cell research. In an Aug. 4 op-ed in The Post, Anne Applebaum argues that our national debate on stem cells should begin with the facts. We agree. Here are some facts:

• As much as we might wish it to be otherwise, no non-embryonic sources of stem cells -- not stem cells from cord blood or from any "adult" sources -- have been shown to have anything like the potential to lead us to viable treatments for such diseases as juvenile diabetes, Parkinson's and spinal cord injury that stem cells derived from very early embryos do. The science here is unequivocal: Access to embryonic stem cell lines is essential to rapid progress in stem cell research.

• The embryonic stem cell lines the president approved for federal funding three years ago, all of which were derived before August 2001, are clearly inadequate to advance stem cell science, let alone to take that science from the bench to the bedside. There are too few of them, no more than 21. All of the approved stem cell lines were prepared using mouse cells and thus pose a risk of contaminating human subjects with mouse viruses. This is a needless risk; since 2001 we have developed techniques for establishing embryonic stem cell lines without using mouse cells. Even if the approved lines were safe for use in humans, many patients who would be appropriate and willing participants in the first human trials would have difficulty receiving grafts based on these lines because of problems of genetic matching. There are just too few lines to even begin to accommodate the genetic diversity in our population.

• Under the current policy, it is not possible to use federal funding to generate or study stem cells derived from embryos with genetic defects or disease genes. Such cell lines would be invaluable in helping to determine the molecular basis of disease and in seeking ways to correct problems or ameliorate their consequences.

• Restricting federal funding to just the approved lines is retarding progress for financial as well as scientific reasons. The $25 million allocated by the Bush administration for embryonic stem cell research in 2003 is a tiny fraction of the National Institutes of Health budget of $18.3 billion for extramural research. To put this in perspective, in that same year the government spent almost eight times as much ($190.7 million) on research with less promising "adult" stem cells. There are formidable scientific and medical challenges to attaining our goal of providing cell-based therapies that are safe and effective. It will take the efforts of many scientists and clinicians in a variety of disciplines to bring this technology to the clinic. The results of laboratory investigations on human embryonic stem cells are highly encouraging and consistent with meeting this goal. Private funding of stem cell research is important and is increasingly forthcoming, but in these early stages, federal funding is paramount and essential.

• We are losing ground to other countries with less restrictive policies on embryonic stem cells. This month British government officials announced the first license to use cloning techniques to generate a human embryo to produce stem cells that might be used for the treatment of disease. Other nations are investing heavily -- hundreds of millions of dollars -- in embryonic stem cell research. The United States stands to lose substantially in the global economy of intellectual property and biotechnology. More important, patients everywhere stand to lose. As much as other countries invest, they cannot fill the gap. They are not as well positioned scientifically as the United States to advance stem cell research. Losing ground to other countries also means losing oversight of critical points in the research cycle, over the ethical treatment of human subjects and embryos, and over quality control.

Hype and symbols will not advance our national debate about stem cell research. Facts and frankness will. So let's be frank.

The controversy about stem cells, and the choice between Kerry and Bush on stem cell policy, is not about science; it really is about values -- moral values.

The science is clear. The only way to ensure that we realize the promise of stem cell research as quickly as possible is to permit federal funding to be used to create new embryonic stem cell lines and to support research with new lines. President Bush's values are also clear. He believes that the destruction of embryos can never be morally justified, no matter how much human suffering might be alleviated, even if the embryos are only still a clump of cells not visible to the human eye and even if the embryos will be destroyed in any event in fertility clinics where they are no longer needed.

We believe that most Americans have different moral values from the president's. While we recognize and respect embryos as early forms of human life, we do not believe that embryos in a dish have the same moral status as children and adults. We believe that the obligation to relieve human suffering binds us all and justifies the instrumental use of early embryonic life. And we believe that it is possible to draw morally relevant lines and to enforce them as a matter of national policy.

Hype and symbols aside, the choice is clear.

Ruth R. Faden, Wagley professor of biomedical ethics at Johns Hopkins University, directs its Berman Bioethics Institute. John D. Gearhart is C. Michael Armstrong professor at Johns Hopkins Medicine.

© 2004 The Washington Post Company