This is going to sound weird, but remember stem cells? I know that they’re still an active and important area of research and all, but I’m referring more to the period of political enthusiasm about fifteen years ago. Elected officials at the gubernatorial and national level all had positions on stem cell research, and there were some pretty extravagant promises thrown around. That legacy lives on in the form of countless dubious “stem-cell therapies” that are available to you if you’re willing to pay cash to be injected with something-or-other.
The San Francisco Chronicle has taken a look back at the state of California’s efforts in the area, which were (fittingly) some of the largest and most expensive. That was Proposition 71, in 2004, a ballot measure to create the California Institute for Regenerative Medicine and funding it with three billion dollars. What’s happened? What you’d have expected, if you knew the field at all (or were familiar with basic research in general). None of the bigger promises made during the campaign to fund the CIRM have come true. No approved therapies have come out of the work yet – and that’s one of the class of promises that were most egregious, in California and elsewhere. Just imagine the time it takes from discovery to approval for something like this, and then factor in that the needed discovery hadn’t even been made yet. But if you don’t know anything much about stem cells, or regulatory approvals, or medicine in general, the idea of get-out-of-that-wheelchair cures being just around the corner becomes more plausible.
It’s not like the CIRM money has all been wasted, of course. There’s been a lot of basic research done, and there certainly has been a lot that needed to be done. The amount of brush to be cleared in human developmental cell biology is just monumental. A quick thought the way that all of your body, all the bodies of every human being, comes each from their own single cell will make that clear. If you want stem cell therapies to regenerate organs – as who doesn’t – then you’re asking for a thorough understanding of that process. You may well be asking to do even more than it can tell us how to do.
California’s voters are now going to decide whether to renew the CIRM itself and its funding, and (as that article makes clear) a big argument is how to measure the progress so far. If you measure it against what was known and what had been accomplished then versus what’s been done since, you can make a case, for sure. If you measure it against the promises made at the time, though, things look bad. And that informs how you’re going to campaign for renewal: do you point at what’s been done and make the argument that it’s been a success, or do you promise them miracle cures again, because now they just have to be around the corner after all this work, eh?
The article goes into great detail about how the three billion has been spent (and pretty much all of it has, or has been committed). And I have to say, I don’t see how you could have done a more reasonable job of it. The splits between basic and applied/translational research, between industry and academia, between embryonic and adult stem cell work, etc., all look perfectly defensible to me. The money has not been thrown away – it’s just been thrown at a huge and difficult problem, the sort of problem that can soak up three billion dollars with no sign of difficulty. The problem, I believe, is that the proponents of the measure oversold it, and how those promises are coming back around in contact with biomedical reality.The initiative’s main advocate (Silicon Valley’s Robert Klein) was essential to getting the entire CIRM underway, but he’s also been involved in some unrealistic expectations (and doesn’t seem to have much time for critics). Adding to the problem is the legal status of the CIRM itself, which has some critics saying that it’s not accountable enough to the legislature or the public.
So if you want to see the conflict between politics, science, and funding played out right in front of you, here’s the place. There’s a lot to learn about public attitudes towards biomedical research, too, not all of them pleasant things to take on board. The question is whether there’s going to be another funding initiative on the ballot in 2020, and if it will pass if so. This argument will be getting larger and louder.