California: new leader in stem cells?

Next Tuesday, California voters could overthrow three years of cautiously crafted national policy on perhaps the most controversial area of modern science. By approving Proposition 71, they would authorize the state to spend $3 billion on stem-cell research, trumping the Bush administration's go-slow approach and potentially setting the nation on a new course.

Although the research is in its infancy, understanding how stem cells work could revolutionize medical science - promising treatments for diseases it has been unable to cure, say many scientists. With its $3 billion bond, California would instantly become a leader in the field, attracting businesses and biologists from across the world.

But the concerns are broad, touching on issues as varied as fiscal responsibility and Christian morality, women's health and medical ethics. Audacious even by California's standards, the decision could have a transforming impact on science and society, both bringing the nation closer to long-sought cures and to the edge of cloning's slippery slope.

"This is unprecedented even for California," says George Annas, a bioethicist at the Boston University School for Public Health.

If Prop. 71 were passed, California would borrow $3 billion over 30 years to fund stem-cell research in the state. Almost overnight, it would tilt America's struggling stem-cell establishment toward the California coast and recast the national conversation about such research. "It creates a reality on the ground and ends the debate in a very real way," says Jeffrey Kahn, director of the Center for Bioethics at the University of Minnesota in Minneapolis.

This would be particularly true if Mr. Bush remains in office. Troubled that stem-cell research involves the destruction of embryos, the president decided in 2001 to limit federal funding. Since then, scientists say, America has fallen behind. "By all objective measures, we're well behind the rest of the world, but by all objective measures we have the strongest scientific community in the world," says Susan Fisher, who works with stem cells at the University of California in San Francisco (UCSF). "[Prop. 71] allows us to do the fundamental work that is needed in an exciting area of science."

Indeed, few scientific disciplines evoke more anticipation than stem cells. Stem cells are primal cells that can develop into any organ or tissue in the body. If scientists can discover how they do this, they could theoretically grow new tissues and devise new treatments. What they have lacked so far is the money to get started. While a handful of universities including UCSF have dedicated millions to stem-cell research, most medical advances are also fueled by large sums of federal money. Prop. 71 would help fill the gap, encouraging students, universities, and biotechnology firms that might have otherwise gone into areas where more money is available.

"You'll get an intellectual migration, especially of graduate students and postdocs," says Arthur Caplan, a bioethicist at the University of Pennsylvania School of Medicine in Philadelphia.

The promise of new jobs and new treatments has so far been persuasive in some quarters. Gov. Arnold Schwarzenegger (R) endorsed the initiative last week, and a Field Poll released earlier this month showed that 46 percent of likely voters here favored the measure; 39 percent opposed it.

Yet the initiative has also brought together a peculiar coalition that disagrees on particulars but has united against Prop. 71 in general. At best, they say, it is a $6 billion gamble that is not certain to yield any medical treatments. At worst, it could be a financial and ethical catastrophe.

For a state in perpetual budget crisis - with the lowest credit rating of any of the 50 states - the financial argument is perhaps the most obvious. By the time the bond is paid, it will have cost the state an additional $3 billion in interest - bringing the total to $6 billion. "[Prop. 71] might be commendable, but it is wildly irresponsible," says state Sen. Tom McClintock (R).

Even backers of the proposition are wary of saying that the $3 billion will lead to quick cures. Rather, they say, stem-cell science is at such an early stage that it needs the money to lay the groundwork for discoveries to come. "We will need these findings before the therapies can come," says Dr. Fisher. More deeply, some scientists wonder if California can handle a role usually filled by the federal government. Prop. 71 will establish an institute to regulate stem cell research, but whether it will be impartial or have the know-how and authority remains to be seen.

The biggest question is human cloning. Cloning a human in order to give birth to a cloned baby is illegal. But cloning a human in order to do research on an embryo and create new stem-cell lines is legal. At this point it's not an issue. Stem-cell scientists work on animal embryos or use the "spare embryos" not used by fertility clinics. But Prop. 71 specifically allows for human therapeutic cloning, and this will be crucial to any future treatments, researchers say.

Some worry that rogue researchers could try to clone a human for birth, but the more realistic concern is how scientists will get the eggs needed for therapeutic cloning. To treat the patients they hope to treat, scientists would need tens of millions of eggs, and the side-effects on women of those egg-gathering procedures are unknown. "Where are [these eggs] going to come from?" asks Marcy Darnovsky of the Center for Genetics and Society in Oakland. "It's an individual choice [whether to donate eggs], but we also have to look at the public interest."