THE PROGNOSIS

The fiery debate over fetal tissue research came to Capitol Hill yesterday as Democrats and advocates clashed with Republicans and scientists linked to antiabortion groups pushing for an end to federal funding for the research.

In sometimes heated joint hearing before two subpanels of the House Oversight and Government Reform Committee, Republicans questioned expert witnesses about viable alternatives to fetal tissue used in medical research, while Democrats and their allies expressed concern that cutting off funding for the research could hamper progress in vaccine production and the search for potential cures for HIV and cancer. Opponents of the use of tissue and cells from aborted fetuses said alternatives should be used.

The debate is part of a larger examination by the Trump administration of whether and how fetal tissue should be used in scientific research, a move long vehemently opposed by social conservatives. Social conservatives “view such research as morally repugnant and unnecessary because they contend other techniques can be used — an assertion many scientists reject,” my colleagues Lenny Bernstein, Amy Goldstein and Lena H. Sun wrote this week.

"In the past three months, the Department of Health and Human Services has severed one contract with a California firm that has been a major supplier of such tissue for laboratories. At least a few researchers’ projects are in doubt," Amy reported.  

She added: "Administration officials emphasize that they have made no decisions and are merely examining whether alternative research models would suffice."

At yesterday's hearings, three expert witnesses separately acknowledged it was important to explore alternatives to fetal tissue where useful. But neuroscientist Sally Temple, the only witness for the Democrats, stressed alternatives are insufficient when it comes to all medical conditions and areas of research and "cannot fully replace fetal tissue." 

Biochemist Tara Sander Lee and cell biologist David Prentice, both associated with the Charlotte Lozier Institute, the research arm of the antiabortion group Susan B. Anthony List, said alternatives to fetal tissue are available widely and have been successful, points that were challenged by Temple,  co-founder of the Neural Stem Cell Institute and former president of the International Society for Stem Cell Research.

Sander Lee and Prentice suggested the use of adult stem cells and tissue discarded from newborns who have cardiac surgery as some potential alternatives. But Temple countered that fetal tissue has  “unique properties that these other alternatives do not."

“The consensus opinion is those alternatives are not sufficient,” Temple said. “The critical thing is it will not substitute for every application and for every disease. But scientists will use alternatives where they are available. We see the value in it... Scientists will only use it if it’s essential, and if it’s important. You cannot misrepresent the science."

Republican Reps. Mark Meadows (R-N.C.) and Jim Jordan (R-Ohio) asked pointed questions, making it clear they support an end to government funding for fetal tissue research, which Meadows decried as spent on research from “harvested baby parts.”

“Well this is pretty simple,” Jordan said. “That is as plain as it gets. Taxpayers, something they don’t like, both on the front end and back end are paying for it, and ‘we do not need the fetal body parts from aborted babies to achieve future scientific and medical achievements’ because we have alternatives that can do it,’ ” he said, quoting from the opening statement made by Sander Lee.

Prentice referred to a study by Matthew Brown of the University of Wisconsin at Madison to demonstrate the use for discarded neonatal tissue, calling it an example of “robust ethical alternatives" that don’t use fetal tissue. But during questioning, Rep. Bonnie Watson Coleman (D-N.J.) cited a letter Brown sent the subcommittee that seemingly subverted the argument from the Republicans and their witnesses.

“It is premature to make generalizable conclusions about the NeoThy replacing fetal tissue in all humanized mouse research applications,” Watson Coleman quoted from Brown’s letter. “Further, in no way does our paper … support the claim that fetal tissue research as a whole is no longer needed.”

The hearing also frequently turned to concerns about whether the federal government should fund Planned Parenthood, signaling how intertwined the debate over fetal tissue research is with the contentious abortion debate. Jordan repeatedly referred to controversial and heavily edited 2015 videos in which antiabortion activists posing as biotech company employees filmed a conversation with an official from Planned Parenthood.

Del. Eleanor Holmes Norton (D-D.C.) chided her Republican colleagues for “once again raising the long-settled issue of selling fetal tissue from abortions for profit.” She referred to the select congressional committee that conducted an investigation following the release of the videos, and claimed “they found no credible evidence of wrongdoing. So to have this raised again and again no matter what the evidence is just too bad.”  

Rep. Judy Chu (D-Calif.) criticized her colleagues for attempting to “undermine” what is known about fetal tissue research.  

“Efforts by this administration and my colleagues on the other side of the aisle to undermine the integrity of the existing framework around fetal tissue procurement are motivated by extreme ideology,” Chu said. “That’s all it is. Perhaps even worse, they do great harm, extreme harm, to science.”

After the hearing, Rep. Diana DeGette (D-Colo.),  likely incoming chair of the House Energy and Commerce subcommittee on Oversight and Investigations, chided the “shameless and embarrassing” attacks and said she would "hold a serious and substantive hearing" in the new Congress:

Meanwhile, Susan B. Anthony List praised the Republican leaders for their “#ProLife, pro-science leadership”:

SBA List president Marjorie Dannenfelser: 

AHH, OOF and OUCH

AHH: A U.S. appeals court limited a previous ruling blocking the Trump administration from enforcing new rules allowing more employers to opt out of providing insurance that covers birth control on religious or moral grounds.

Two federal judges in Pennsylvania and in California granted nationwide injunctions against draft rules from the administration to expand religious and moral exemptions to the Obama-era mandate in the Affordable Care Act that required employers to provide no-cost birth control. The Trump administration appealed both rulings.

The U.S. Court of Appeals for the 9th Circuit on Thursday upheld the injunction issued in California but limited the scope, ruling it “should not apply nationwide, but only within the five states that sued over the policy,” Reuters’s Dan Levine reports. The case was brought by California’s attorney general, alongside the attorneys general in Delaware, Maryland, New York and Virginia.

 “Despite the 9th Circuit ruling, a nationwide injunction issued by the Philadelphia judge is still in effect while that case is under appeal at the 3rd Circuit,” Dan writes.

Meanwhile, the Trump administration in November announced a new pair of federal rules on birth control that are expected to spark a fresh set of legal challenges, as The Health 202 has written.

In a statement, Planned Parenthood president Leana Wen praised the  rulings as a “win for reproductive health. “The Trump-Pence administration should follow science and evidence, and stop trying to roll back access to health care and reproductive rights. At Planned Parenthood, we won’t stop fighting for our patients’ access to care – no matter what,” she said.

OOF: The National Institutes of Health announced it would examine all of its current scientific research projects that receive private donations, a move to prevent similar issues leading to the suspension of a study on moderate drinking.

The agency earlier this year halted a 10-year, $100 million study of moderate drinking that was being funded mostly by the alcohol industry. “In a report issued on Thursday, N.I.H. officials said its 27 institutes must evaluate all current research projects that receive private donor support for conflicts of interest of the kind that compromised the alcohol trial,” the New York Times’s Roni Caryn Rabin reports. “The institute directors are to report their findings to Dr. Francis Collins, director of N.I.H., early next year.”

“The report also called for N.I.H. officials to examine the motives of private donors offering gifts, determining whether donations are given unconditionally or with the expectation of desired results from scientific research,” Roni adds.

The report also noted the discredited alcohol study left a mark on the agency’s reputation for unbiased research.

“It’s one of these moments you hope will not happen,” Collins said, per the Times. “You’ve got to learn from them and put in place appropriate steps so it does not happen again.”

OUCH: The number of gun deaths spiked to nearly 40,000 in the United States last year, marking a record, according to the Centers for Disease Control and Prevention.

CNN’s Jacqueline Howard reported that CNN replicated the analysis conducted by the advocacy group Educational Fund to Stop Gun violence and “found that 39,773 people died by guns in 2017, which is an increase of more than 10,000 deaths from the 28,874 in 1999. The age-adjusted rate of firearm deaths per 100,000 people rose from 10.3 per 100,000 in 1999 to 12 per 100,000 in 2017.”

“CDC statisticians confirmed with CNN on Thursday that these numbers are correct and they show gun deaths have reached a record high going back to at least 1979, which was the year firearm deaths started to be coded in mortality data,” Jacqueline reported.

STATE SCAN

— The state of Florida is set to lead the country in the number of enrollees in health plans through the federal ACA exchange, the Tampa Bay Times’s Justine Griffin reports.

Thus far, more than 999,000 people signed up for health-care plans in the state, according to the most recent data released this week from the Centers for Medicare and Medicaid Services. And that number could grow before the end of the enrollment period for 2019 plans on Saturday.

It’s also not the first time Florida has outpaced the rest of the country in enrollment. “Last year, more than 1.7 million people in Florida were insured through Obamacare, the most in the nation,” Justine wrote.

Health 202 author Paige Winfield Cunningham wrote this week about the dismal ACA enrollment results even as plan offerings are up.

“Despite the challenges, local advocates have been ‘busier than ever’ this enrollment period, said Melanie Hall, executive director of the Family Health Care Foundation, which helps people sign up on the federal exchange,” Justine reports. “A large number of people who ‘auto-enroll’ by selecting the same plan as the previous year aren't counted in the weekly enrollment reports until the very end of the sign-up period, advocates say. Florida will likely get a big boost at that time.”

OPIOID OPTICS

— A new analysis from the American Medical Association praised efforts in Pennsylvania to address the ongoing opioid crisis, calling the state a “national model in many ways.”

The report, from the AMA, the Pennsylvania Medical Society and consulting firm Manatt Health, cited progress made in the state in increasing access to overdose antidote naloxone, providing “comprehensive care” to pain patients and increasing access to care for substance use disorder.

“The report, the first of four analyzing different states' responses to the epidemic, commended Pennsylvania for making ‘considerable progress’ on access to addiction treatment,” the Pittsburgh Post-Gazette’s Julian Routh reports.

“The report cited the state's efforts to combine medical oversight on opioid therapy with access to other pain medications and alternative therapies. The report also recognized the state insurance department's efforts to review health insurance benefit packages, policies and obligations to enforce mental health and parity laws, which require that psychiatric care is covered just as thoroughly as physical care.”

In a conference call with reporters, Dr. Patrice Harris, president-elect of the AMA and chair of the organization’s Opioid Task Force, said: “We believe the work being done in Pennsylvania can certainly serve as a national model in many ways.”

— And here are a few more good reads from The Post and beyond: 

TRUMP TEMPERATURE
National Security
Guatemalan child entered illegally with her father as part of a large group crossing into New Mexico.
Nick Miroff and Robert Moore
HEALTH ON THE HILL
PowerPost
The measure — Congress’s first major policy change since the start of the #MeToo movement — was approved unanimously after nearly seven months of negotiations.
Elise Viebeck
INDUSTRY RX
California and New York regulators approved health insurer Cigna Corp.'s acquisition of pharmacy benefit manager Express Scripts, bringing the $67 billion deal a step nearer to closing.
Modern Healthcare
MEDICAL MISSIVES
One source of the latest nationwide E. coli outbreak linked to romaine lettuce has been traced to the sediment of an irrigation reservoir on a Californian produce farm.
Wall Street Journal
Women who recently gave birth may have an increased risk of breast cancer that lasts about 20 years. But for most, the overall risk is still small.
The New York Times
Answer Sheet
"It’s a staggering truth: Most dollars that have been spent on autism research in the United States over the last four decades are not helping children with autism."
Valerie Strauss
A year after a 12-year-old’s suicide attempt left Marisa Harris dead, her parents still fear for the boy’s mental health
Jessica Contrera
DAYBOOK

Today

  • Medicaid and CHIP Payment and Access Commission holds a public meeting.
SUGAR RUSH

— First lady Melania Trump visited and read to patients at a children's hospital in Washington:

— Trump says he's interviewing 5 'terrific' people for chief of staff: