It wasn鈥檛 what President George W. Bush had in mind. In 2001, Bush restricted the use of federal funding for embryonic stem cell research, giving conservatives what looked like a major victory in the nation鈥檚 culture wars.
Three years later California thumbed its nose at the ban by starting its own multi-billion dollar stem cell program, and several states followed suit. Even though the restrictions were lifted in 2009, the insurgent movement survived and grew. Today at least seven states offer stem cell research听 funding or other incentives to local scientists and industry.
These initiatives have not yet produced the eagerly anticipated 鈥渃ures鈥� for conditions such as melanoma or Parkinson鈥檚 disease. But early public disappointment has yielded to the realization that years of research lie ahead before treatments can routinely enter the marketplace.
Still, as an engine for generating economic development and jobs, and as a mechanism for enhancing local scientific prestige, stem cell research for many states appears to be worth the investment.
鈥淲e want to show what we have,鈥� said Dan Gincel, executive director of the Maryland Stem Cell Research Fund. He pointed to a sophisticated science community and easy access to the National Institutes of Health and the Food and Drug Administration.
The Maryland fund during the past eight years has used between $9 million and $12 million annually in state-appropriated funds to write grants to 鈥渋ncentivize the industry,鈥� Gincel said. The money must be spent in Maryland, and grantees must be Maryland-based researchers, institutions or firms. 鈥淲e鈥檙e still in the early stages of the technology鈥攎ostly basic research,鈥� Gincel said.
And although the political and social tumult that retarded embryonic stem cell research early in the century still smolders, as the current debate over funding for Planned Parenthood can attest, the use of stem cells from adults has blunted much of the controversy.
鈥淭here was no extreme pushback,鈥� said pediatrician Jakub Tolar, head of the University of Minnesota鈥檚 Stem Cell Institute and co-chairman of Regenerative Medicine Minnesota, a $50 million stem cell research program created last year by the state鈥檚 Republican-controlled legislature and signed into law by its Democratic governor. 鈥淢y experience is that most parents or people with a particular condition could not care less about the politics.鈥�
听are unspecialized cells that develop and grow into the tissue- or organ-specific cells that make up the body of a living organism, everything from muscle and bone, to lungs and brain. Stem cells have many uses, but public attention for several years has focused on 鈥渃ell-based therapies,鈥� also known as 鈥渞egenerative medicine,鈥� in which stem cells are induced to form a particular type of adult cell to rebuild damaged or diseased parts of the body: a heart wall scarred by heart attacks; an injured spinal cord; burn damage; the effects of diabetes or Parkinson鈥檚 disease.
Controversy arose early in the century over the use of embryonic stem cells, which can differentiate into any cells in the body, but which are obtained by destroying unneeded human embryos created through in vitro fertilization. Anti-abortion groups and religious conservatives opposed embryonic stem cell research, and Bush in 2001 created after his order because of concerns over the sanctity of life.
Three years later California voters approved ballot Proposition 71, creating the (CIRM)听to make grants and loans for stem cell research, funding it with a $3 billion bond issue鈥攚hich is generating a total of $6 billion with interest and is expected to last until 2020.
鈥淲ithout George Bush, this agency would not exist,鈥� said David Jensen, publisher of California Stem Cell Report, a blog focused on the California institute. 鈥淭he campaign raised expectations that therapies were right around the corner. The federal government wasn鈥檛 funding it, and the voters said that since we want to save lives, we鈥檒l fund it.鈥�
The institute in the past decade has become one of the most important and perhaps the biggest nonfederal dedicated stem cell research center in the world, spending about $180 million per year. Different parts of the National Institutes of Health spent a combined $1.4 billion on stem cell research in 2014.
Over the years the California institute has endured sharp criticism for failing to deliver cures and spending around 90 percent of its funds on basic research while ignoring drug development.
An Institute of Medicine study in 2012 also warned of cronyism, noting that the vast majority of CIRM grants were going to academic institutions whose members sat on the board of directors. Early critics also questioned whether usurping a federal research agenda was the best use of California鈥檚 tax dollars.
Much of this was dictated by Proposition 71 itself. The law mandates who sits on the board. It also provides the money, and the institute must spend it. In a California-centric program, supporters say, conflicts of interest are endemic, and board members frequently recuse themselves during the grant process.
C. Randal Mills, chosen in 2014 as the institute鈥檚 new president and chief executive officer, said the organization is adjusting to 鈥渁 world that has changed significantly鈥� since 2004 by moving away from simply funding good ideas in isolation to what he describes as a 鈥渟ystem-based agency.鈥�
Last year the institute had 10 programs in clinical trials, but expects to have 20 by the end of this year.
鈥淲e鈥檙e setting up continuous paths to move basic research to clinical trials,鈥� he added. 鈥淚t鈥檚 like a train moving down a track, where each grant is the link to the next step down the line.鈥� 听
In 2009, President Barack Obama on embryonic stem cell research,听but by that time researchers were already using adult stem cells extensively and had learned to cells into embryonic-like induced pluripotent stem cells.
Despite the improved national climate, states, both for economic and scientific reasons, have continued to fund their own programs. NIH lists initiatives in six states, not counting Minnesota, and other reports have suggested that as many as 15 states either have dedicated programs or fund stem cell research or did so in the past.
Yet in a discipline that is just beginning to enter a translational phase, it is hard to evaluate the effectiveness of individual programs: 鈥淚t鈥檚 a huge field, and it鈥檚 still early,鈥� said Heather Rooke, scientific director for the International Society for Stem Cell Research. 鈥淪tates will continue to do basic research, and California has certainly already had important influence driving the research to the clinic.鈥�
Results will take time, agreed Minnesota鈥檚 Tolar, but it is worth the trouble: 鈥淲e started on drugs a hundred years ago. Then we went to monoclonal antibodies鈥攂iologicals,鈥� he said. 鈥淲e are now getting ready to use cells as a third way of doing medicine. We are at a historical sweet spot.鈥�