The $3 Billion Question: Kids, Scientists and CIRM

Two California newspapers today offered quite different views of the world – one bleak and the other filled with hope. They implicitly captured the framework that will determine the fate of the state's $3 billion stem cell research effort.

In the simplest terms, it could boil down to school kids vs. stem cell researchers. Or it could be framed as school kids vs. the health of millions or in some other way that is more favorable to the California stem cell agency. And there could lie the fate of a measure – perhaps as early as 2012 – asking the people of California to pony up another $4 billion or so to pay for hundreds of more stem cell experiments.

But first, CIRM will have to overcome emotions generated by stories like those in The Sacramento Bee today. Reporters Diana Lambert and Melody Gutierrez wrote,

“Last year, public school districts started the year with fewer teachers, bigger classes and reduced resources.

“This year, it's worse.”

Classes with 30 or more students are common, libraries are closing, buses are being eliminated, counselors are vanishing. Music, art and shop are luxuries at some schools. And the kids are going to school fewer days.

In marked contrast came the Los Angeles Times story. Rachel Bernstein wrote about research funded by the California stem cell agency that could offer a “cure” for HIV. The “cure” is many years – if ever – down the road, but the preliminary work has generated a wave of hope for many thousands of persons.

Central to both stories is California's $19 billion budget crisis, which is not going to vanish any time soon. Given the shortage of cash, the question becomes whether the state should use its dwindling resources to finance stem cell research, which will not have a genuine payoff for many years and is also being funded by the federal government. Or should the state educate its children, improve its hard-pressed undergraduate university system, aid the poor and disabled and provide health care that is urgently needed by those who cannot afford it.

These are not questions for the stem cell agency today. It already has voter approval to borrow $3 billion via state bonds at a total cost of $6-$7 billion. But they are questions for the voters in a few years. In the past five years, the agency has already awarded $1.3 billion and is moving rapidly into ever larger rounds of grants. CIRM Chairman Robert Klein is acutely aware that, in political and scientific terms, the need for more cash is just around the corner. He is pushing hard for CIRM grants that will hopefully generate tangible results that will win endorsements and voter approval of another bond measure. Last week, he gained approval for a $600,000 Institute of Medicine study of CIRM that he expects will be key to the success of a bond measure. It is expected to be completed in time for the general election in the fall of 2012, a presidential year.

Currently, the California stem cell agency is all but invisible to state's beleaguered public. Stem cell research is not on their list of concerns, which deal with holding or finding a job, paying the mortgage and such simple matters as getting the kids to class when the school bus is cancelled.

Building support for another bond measure means generating thousands of stories like the one in the Times. The public must perceive CIRM as a positive force that will improve their lives and the lives of their loved ones. A tall task, but winning an election is like winning a war. It requires an intense, sharply focused drive that overruns all who stand in the way.

The California stem cell agency is not likely to emerge victorious if the election is framed as children vs. stem cell researchers.  If CIRM is to prevail, it must build a squeaky clean image – one that generates real hope but is based on meaningful results that are publicly impressive. That politically salubrious perception is not yet cemented in the minds of the California public.

It is unclear whether the Institute of Medicine study will do just that. Unclear as well is whether the study will address the fundamental question of whether the borrowing billions for research is the best way for the state to spend its money. Probably not is our guess. That would mean assessing the state's overall needs and prioritizing them.

At CIRM, however, discussion of the institute's study is couched often in a political context, which raises other issues. During the next two years at the agency, where will the scientific judgment end and the politics begin? It is natural for any organism, including a state agency, to want to perpetuate itself for good and not-so-good reasons. Politics, as well, is always part of the governmental process, which includes CIRM. However, its directors and the staff must tread carefully.

The campaign to win approval of a $4 billion bond measure is already drawing considerable attention within CIRM. The effort will need more soon. A baseline public opinion poll would be standard at this point to measure initial voter perception of CIRM and to identify ways in which the public could be influenced. That and other electioneering moves, however, are not suitable for a state agency.

Klein has said he will step down from the CIRM chairmanship in December. So far, however, he has given no indication that he will let go of California stem cell issues. He could well remain on the board. He has his own, personal stem cell lobbying organization(Americans for Cures), which grew out of the 2004 campaign for Prop. 71 that he directed. CIRM also could create a nonprofit entity that could take up tasks that are not appropriate for a state agency. Perhaps he might find a home in one or both of those organizations.

Whatever path Klein follows, if he chooses to lead the drive for more CIRM funding, he will face a formidable task. Unless something changes dramatically, winning approval of a $4 billion bond measure in two years seems an unlikely event given the current hardscrabble condition of the Golden State.