California Stem Cells, 'Rapture' and a $5 Billion Bond Measure

This past weekend brought news about a "rapturous agreement among Republicans and Democrats" to support development of new therapies by financing biomedical research with billions of dollars.

The New York Times article indicated that the rapture could have something to do with the fact that many key political leaders on Capitol Hill are "aging in place."

The piece by Robert Pear also carried implications for the $3 billion California stem cell agency, which has virtually endorsed a yet-to-be-written, $5 billion bond measure to stave off its own death.

Pear wrote on Sunday:

"For the third straight year, lawmakers (in Congress) are planning to increase the budget of the National Institutes of Health by $2 billion. In the process, they have summarily rejected cuts proposed by President Trump.

"The push for additional funding reflects a fascination among legislators with advances in fields like molecular biology, genetics and regenerative medicine, even as they wage bitter battles over just how large a role the government should play in financing health care and providing coverage."

Pear continued, 

"Why is medical research so much less contentious than fundamental issues like health insurance coverage?

"Anthony J. Mazzaschi, a lobbyist at the national organization representing schools of public health, said that 'the charisma of the cure, the hope and promise of curing disease, seems to excite members of Congress,' including some in their 70s and 80s who are 'facing the prospect of disease and disability head-on.'"

The Times piece said, 

"The challenges facing patients and policymakers were illustrated this past week when a Philadelphia company said it would charge $850,000 for a new gene therapy to treat a rare inherited form of blindness. (The company, Spark Therapeutics, said it would pay rebates to certain insurers if the medicine, given in a one-time injection, did not work as promised.)"

California's stem cell agency is running out of money. It is looking at a November 2020 ballot measure to fill its shrinking coffers with $5 billion more. But such public policy decisions involve trade-offs concerning the health of Californians.

Several questions (among others) arise theoretically and otherwise:

• Would it be better to spend $5 billion to provide much needed, immediate health care to poor Californians, including mothers and children, which could provide a quicker payoff in improved health. 
• Is it better for the state to spend $20 million to help reduce infant mortality rates in Fresno and Mendocino that are nearly twice the statewide average or give the cash instead to a stem cell researcher (and his employing institution) who can also win the cash from the NIH. 
• The impetus for creation of the California stem cell agency was based on a restriction in federal funding for human embryonic stem cell research. That restriction no longer exists, but could be restored by the Trump administration. But should California spend its billions when researchers can seek funding at the federal level? 

These are sort of bottom-line policy questions that ignore the fact that bond issues generally are used for long-lived assets, such as prisons, educational buildings, highways, etc., -- not services such as health care. The bond measure that provided the stem cell agency with its only significant cash was an historic exception.

Nonetheless, in the public's eyes the stem cell agency is all about health. As the campaign that created the agency in 2004 noted, medical problems that affect nearly half of California families "could benefit from stem cell research."

The likely cost of the therapies that are being developed in the agency's clinical trials are almost never discussed in public. Yet many are likely to be as expensive as the Spark Therapeutics blindness treatment. One can only imagine the kind of opposition advertising that is likely to surface in a campaign for a $5 billion bond measure: "Vote No on Million Dollar Cures for Billionaires!" On the other hand, that pitch might seem too harsh and blow back on agency opponents.

Nonetheless, Americans believe drug costs are too high, something that will come into play during a 2020 campaign. According a recent Gallup poll, 78 percent of the people also say total health care costs are too expensive. Drug costs have become an easy litmus test for the expense of staying healthy.

The New York Times story noted the importance of age as helping to create support for spending on medical research. California is headed for a sharp increase in the numbers of seniors in the next decade. One study is even projecting a "silver tsunami" of cancer in older patients nationally. Generally, however, older voters are considered more likely to be conservative. and may not buy into more government spending. How that plays out in California is not clear when it comes to stem cell research or the hope for stem cell cures.

Hope is one of the more powerful products of the California stem agency. Ultimately that could be the deciding selling point. But the November 2020 election is 34 months away, and much is likely to change.