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States, Private Funders Will Advance Stem Cell Research May 2009

States, Private Funders Will Advance Stem Cell Research

By James W. Fossett
Director, Health and Medicaid Studies, the Rockefeller Institute of Government

James W. Fossett

Last month, the Obama administration released its long-awaited plans for expansion of government-funded human embryonic stem cell (hESC) research — plans that mark only an incremental change from the previous administration’s policies. An earlier executive order had eliminated Bush era restrictions against funding for research on embryos that were not part of specifically designated stem cell “lines.” Now it has proposed extending funding to cover research on embryos donated to fertility clinics, but unused and slated for destruction.



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James W. Fossett directs the Institute’s health and Medicaid studies and is associate professor of public administration and public health at the Rockefeller College of Public Affairs and Policy, University at Albany. This piece is adapted and updated from a longer article appearing in the Yale Journal of Health Policy, Law, and Ethics, and available in its entirety here.

The limits of the administration’s proposed guidelines disappointed some scientists and patient advocates, who had called for broader access to embryos for research holding the potential to help people with diabetes, Parkinson’s disease and other illnesses. But it might be argued that substantial reasons exist for the Obama administration, and stem cell research proponents more generally, not to push for broader changes in federal stem cell policy in the short run.

Given multiple political controversies and scientific questions surrounding the research, it’s likely that states and private funders — rather than the federal government — will continue to shoulder the burden of funding and setting policy for such research. The result will be an increasingly complex patchwork of policies throughout the country that range, as they now do, from criminalization of stem cell research to active encouragement of such work inside state borders.

Perhaps the most obvious reason for not pursuing more dramatic change in federal stem cell policy is the demand for political capital and attention from other pressing problems. The Obama administration and new Congress have inherited wars in Iraq and Afghanistan, a major economic and financial crisis, and controversial anti-terrorism policies, among other difficulties. Congress and the president simply may not have the time or energy to address the complex, controversial, but non-crisis, issues associated with significantly altering the federal role in stem cell research.

Indeed, the Obama administration has sent signals that it is unlikely to seek dramatic changes in stem cell research policy. The president’s executive order rescinding the previous administration’s restrictions on hESC research endorsed no substantive position on stem cell research, and left it to the National Institutes of Health (NIH) to draft detailed rules. NIH’s proposed rules embodied policy changes already passed twice in Congress that expanded federal support for stem cell lines created from embryos intended for, but not used in, fertility treatments. The draft rules avoided controversial questions, such as the use of federal funds to support the creation of embryos for research or so-called “therapeutic cloning.”

After much-publicized conflicts with anti-abortion advocates — like the nomination of abortion rights supporter Kathleen Sebelius to Health and Human Services Secretary and moves to rescind the so-called “conscience clause” regulation that allows medical workers to refuse to provide some reproductive services – the administration may simply wish to avoid further conflict on reproductive issues. Such avoidance may be politically necessary given the administration’s interest in collaborating with religious organizations to reduce the number of abortions.

In addition, a number of issues remain scientifically and politically contentious. There is controversy over payment for embryos from which to develop stem cell lines. Researchers and advocates have increasingly complained that the lack of embryos constitutes a major barrier to research progress and that efforts to solicit donations have proved unsuccessful. Legislative efforts to allow the use of federal funds to pay egg donors, however, are likely to prove controversial. Interested parties particularly include women’s health advocacy groups, which support stem cell research, but have expressed concern about the risks associated with egg extraction procedures and the vulnerability of lower income women to significant cash offers.

Proposals to dump additional federal money into stem cell research may be similarly divisive. While the administration’s economic stimulus package contains increased funding for the National Institutes of Health (NIH) as a whole, it seems unlikely that this increase will produce anything more than incremental funding for stem cell research. Given constraints on overall research funding, opposition will come not only from traditional opponents, but also from the broader scientific community. Scientists who are having trouble supporting their own research are likely to protest if their stem cell colleagues, who already receive money from states and private foundations, now get additional support from NIH as well.

A final factor complicating the prospects for further changes in federal stem cell policy is continued scientific uncertainty around important questions. One is the availability of alternative procedures, such as the production of induced pluripotent stem cells (iPSCs) for producing hESC lines that do not require the destruction of embryos. The existence of alternatives to hESCs would make the research much less controversial, but many stem cell scientists appear unconvinced as yet that iPSCs are reliable substitutes for hESCs.

Meanwhile, with federal funding limited for stem cell research during the Bush years, states developed a wide range of policies. Five states ban hESC research, but as many as 10 have supported stem cell research in some form. Foundations and other private organizations have also donated substantial funds to stem cell research. It seems unlikely that states will diminish their stem cell programs even if stem cell supporters are successful in further expanding federal hESC funding.

Many states have legal obligations to spend research funds over a particular period, during which it may be difficult to divert funds from their intended uses. If the NIH funding picture remains tight, scientists and universities in some states may push to institutionalize or expand state stem cell programs as an alternative source of research funding.

A second factor that is likely to encourage states to persist is competition both between states and between states and several foreign countries that have begun stem cell initiatives of their own. State efforts to attract stem cell researchers through permissive rules and funding have apparently been at least partially successful. While budget shortfalls may handicap state efforts to initiate or expand stem cell programs, these programs are likely to continue, albeit on a less well-funded basis.

What seems most likely, in short, is that the immediate future will be like the recent past, with the federal government being a relatively minor player and states and private funders continuing to carry the major funding and policy development burdens. Human embryonic stem cell research will continue to be heavily supported in some states and illegal in some others, with states weighing in with funding programs of widely varying sizes. This system is less efficient and more administratively difficult than a single funding source and set of rules would be, but it is an accurate reflection of the conflicting and diverse national public and political views about hESCs, which do not show any sign of going away anytime soon.


ABOUT THE ROCKEFELLER INSTITUTE OF GOVERNMENT

The Nelson A. Rockefeller Institute of Government, the public policy research arm of the State University of New York, conducts fiscal and programmatic research on American state and local governments. It works closely with federal, state, and local government agencies nationally and in New York, and draws on the State University’s rich intellectual resources and on networks of public policy academic experts throughout the country.