FDA Worries About Stem Cell Trials

Tomorrow the FDA begins a two-day hearing involving stem cell research and human trials. Monya Baker of Nature magazine's stem cell blog, The Niche, has some insights into the session. Among other things, she writes,

"The FDA is mainly worried that the animal tests used to assess safety problems aren’t good enough and that they won’t know until too late that the transplanted cells are causing harm rather than benefit."

It is a good bet that the California perspective will be heard at the meeting, both from CIRM and at least some of the state's biotech firms.

(Shortly after this item was first posted, we ran across a related posting from Biopolitical Times that carries a report about the problems with human research protection.)

Money Up Front for CIRM Lab Dough?

Looking for more on the Calfornia stem cell agency's lab grant program -- "the largest stem cell infrastructure component in the world?"

Take a look at an item by John M. Simpson of the Consumer Watchdog group, once known as the Foundation for Taxpayer and Consumer Rights.

He quotes Alan Trounson, CIRM president, on the size of the effort, which is now set at about $758 million, including matching funds.

Simpson also provides a list of the scores for each of the 12 applicants, with Stanford (my father and brother's alma mater) at 95 and UCLA (my alma mater) at 73.

Simpson reports that the agency is considering paying an entire grant up front if the recipient agrees to reduce the amount requested. That would be one way to deal with the $48 million shortfall in CIRM funding compared to the amounts requested. (See the "Millions Cut item.) However, it is also one way for grant recipients to play a little loose with the money.

CIRM Executive Salaries Take a Hit

Should the president of the California stem cell agency, with roughly 26 employees, be paid $300,000 more annually than the director of the National Institutes of Health, which has nearly 19,000 staffers?

No, according to the Consumer Watchdog of Santa Monica, Ca. Its stem cell project director, John M. Simpson, says,

"CIRM's salaries are ridiculously out of whack."

Writing on the blog of the Consumer Watchdog, a group once known as the Foundation for Taxpayer and Consumer Rights, Simpson offers as the chief support for his view the following salaries for NIH executives:

"Elias Zerhouni, Director, NIH: $191,300 (increased in January from $186,600)
John Niederhuber, Director, National Cancer Institute: $247,500
Francis Collins, Director, National Human Genome Research Institute: $300,000
Story Landis, Director, National Institute of Neurological Disorders and Strokes: $260,000"

Simpson's figures come via reporter Jim Downing of The Sacramento Bee, who obtained them from the NIH.

Simpson compares them to the $490,000 salary earned by CIRM President Alan Trounson and the $310,000 being paid to Marie Csete, recently hired as CIRM's chief scientific officer.

The salaries have recently come under increased fire because of the state's budget crisis. Salaries of public servants are always lightning rods, even in the best of times. They are far easier for the media and the public to understand than some of the financial inequities created by Prop. 13, the property tax initiative approved years ago and that now, in many ways, cripples local government in California.

The CIRM salaries are also dwarfed by the pay of some physicians within the University of California system, who earn more than $750,000 a year. And they are tiny compared to the wages earned by some of the men at UC who supervise boys running and throwing balls. Their pay can approach $2 million annually.

Nonetheless the salaries at CIRM are a perception problem, at the very least. The agency must develop a stout defense for them, which it does not seem to currently have. Otherwise, CIRM will continue to suffer attacks from critics who find the pay levels extreme.

Millions Cut from CIRM Lab Grant Requests, Millions More Approved

California's unprecedented $758 million stem cell lab construction program completed another chapter this weekend, but fell $48 million short of fulfilling the desires of 12 universities and research institutions.

All of the 12 saw their requests cut by millions as their applications cleared CIRM's Facilities Working Group during a two-day meeting in San Francisco. None was eliminated, however, and none is likely to be eliminated when the grants come up for final action by CIRM directors (the Oversight Committee) May 6 and 7.

CIRM directors have never reversed a recommendation for funding made by their working groups.

The 12 California institutions had sought $336 million from CIRM. The Facilities Working Group approved $289 million, compared to the $262 million budgeted by CIRM. The stem cell lab construction program proposed by applicants totals $832 million, including matching funds. CIRM has proposed funding that would total $758 million, including matching funds.

CIRM said in a news release that the Oversight Committee will address at its May meeting the difference between the $289 million approved this weekend and the $262 million budgeted.

John M. Simpson, stem cell project director for Consumer Watchdog (formerly known as the Foundation for Taxpayer and Consumer Rights), attended the facilities meeting. In an email, he said the main question was how to cut money from the requests.

"At (CIRM President Alan) Trounson's suggestion the FWG (Facilities Working Group) score, which was on a scale of 100, was treated as a percentage, so for example, Stanford with a score of 95 will get 95% percent of its request. Using this method, they cut $47 million.

"Interestingly most of the applicants there seemed to think this could work. Some had been worried that entire programs would be cut."

Some of the cuts were rather large. UCLA saw its $30 million request cut by $8 million. The $50 million request from the San Diego stem cell consortium (UC San Diego, Scripps, Burnham and Salk) request was slashed $7 million. UC Irvine lost more than $7 million out of a $37 million request. (A full list of the applicants, the amounts requested, amounts recommended and total project cost can be found here.)

The Oversight Committee decisions on the funding will ultimately be made by only a handful of its 29 members, perhaps as few as eight or less. The reason is that about 18 of the directors have financial ties to institutions seeking the taxpayer funds. Those directors will be barred by law from even discussing the issue.

The CIRM news release touted the economic benefits of the construction program. Marie Csete, the agency's new chief scientific officer, said the grants will help to build "optimal facilities for our scientists and will extend California's leadership in stem cell science."

As far as we can tell, no mainstream news media carried reports on the weekend action. The agency continues to receive little notice from California newspapers and even less from the electronic media.

The Facilities Group met in public session, as it did on a previous round of lab grants. However, scientific reviews of the programs were conducted behind closed doors by scientific reviewers who do not publicly disclose any potential conflicts of interest.

(Editor's note: Our figures differ slightly from CIRM's. The discrepancies appear to be related to rounding.)

CIRM Bill Moves on in California Legislature

Legislation aimed at California's unprecedented $3 billion stem cell research effort this week easily cleared its first hurdle -- as expected.

The measure by Sen. Sheila Kuehl, D-Santa Monica, now moves on the state Senate Judiciary Committee, where it is likely to win approval as well. Kuehl is part of the Senate leadership and chair of the Senate Health Committee, which unanimously approved her bill, SB1565, on an 11-0 vote. Co-author of the bill is Republican George Runner of Antelope Valley, who is part of the GOP Senate leadership.

The legislation is designed to provide affordable access to therapies developed with taxpayer funds and correct problems associated with conflicts of interest at CIRM.

The legislative staff analysis of the bill said that its authors believe

"...that, given CIRM/ICOC's unique formation as a public entity, the level of public investment--$3 billion in bond funds that will amount to a General Fund expenditure of $6 billion (including interest), and the close-knit nature of the scientific community, CIRM and the ICOC should be thoroughly scrutinized by an independent body to ensure the highest level of public trust and confidence."

CIRM has opposed similar legislation in the past, but according to John M. Simpson, stem cell project director for Consumer Watchdog, the group formerly known as the Foundation for Taxpayer and Consumer Rights, CIRM is now taking a more measured stand.

Simpson, who attended the hearing earlier this week, reported:

"CIRM's Interim Director of Legislative Relations Sue North told the Senate Health Committee, 'We have no formal position on the bill and hope to resolve any differences administratively.'"

Simpson opined on the Consumer Watchdog blog that the CIRM position marked an improvement from the days when CIRM Chairman Robert Klein declared that one legislator who was also a longtime supporter of stem cell researcher was an "ongoing threat" to CIRM.

Consumer Watchdog supported the CIRM legislation but said it did not go far enough. Simpson said,

"We need a provision that allows the state attorney general to intervene if drugs or therapies funded by the stem cell agency are priced unreasonably. We've seen too many cases where companies benefit from publicly funded research and then set prices at obscene levels. They act like socialists when seeking research funding but are greedy capitalists when there are profits on the table."

Also supporting the measure were American Federation of State, County and Municipal Employees (AFSCME), the California Alliance for Retired Americans, California Nurses Association, Center for Genetics and Society, Gray Panthers, Greenlining Institute and the Pro-Choice Alliance for Responsible Research

CIRM Seeking Egg Donation Comments

The California stem cell agency has prepared a draft of guidelines for reducing risk in connection with the donation of human eggs for stem cell research and is seeking comments on them from the research community and others.

The draft can be found here. A related document concerning the history of the guidelines and their purpose can be found here.

In addition to general remarks, Geoff Lomax, senior officer for the CIRM Standards Working Group, is asking for comments on the following:

"The utility of the guidelines for reviewing studies proposing to obtain oocytes for research

"The consistency of the guidelines with current clinical protocols and standards of care

"General feasibility considerations with the draft guidelines."

The impact of these guidelines will go well beyond California, which is currently in the global forefront of setting standards for human embryonic stem cell research. Seeking comment at early stage and posting the information on its web site serves CIRM well, opening the door to all who are interested or who have something at stake.

Sailing Time-Out for Blogger

We are setting sail Saturday morning from Guaymas for Mazatlan and will be at sea for several days. So we will not have any fresh postings until late next week.

We have been on the hard, as the maritime term goes, for far too long, performing unpleasant but necessary boat maintenance chores. It is great to be back on the water.

'Doing It Right,' Cerberus Simpson Says

Both the California stem cell agency and the Interstate Alliance on Stem Cell Research have come in for some praise from Consumer Watchdog's John M. Simpson, who has followed California stem cell issues closely for several years.

Simpson, who was once thrown out of a meeting of the interstate group, lauded it for an early posting an agenda for its meeting April 9-10 in Washington. He also remarked that CIRM has done better recently on posting materials for some of its meetings. He particularly cited Rick Keller, senior officer for Scientific and Medical Research Facilities.

Writing on the Consumer Watchdog's blog, Simpson said,

"Public policy should always be made in public. And the public must have timely advance access to what's being discussed. That's how policy-makers actually build true support for their actions. Perhaps after a few -- sometimes less than gentle -- nudges from folks like me that message is getting across in these two cases."

Bravo on Timely Posting of Lab Grant Documents

The California stem cell agency today posted on its web site the staff analysis and other key documents in its $758 million lab grant construction program, a full week ahead of their scheduled public review.

Congratulations to CIRM and its tiny staff for the timely posting. It well serves the agency, interested parties and the public, providing ample time to review the complex documents and prepare comments, if so desired. Posting and preparing the material is no small task. The documents are large and intricate. And no one wants to make mistakes.

In addition to the staff analysis of the applications, the newly posted material includes lab planner's evaluations and applicant comments. The applications in CIRM's single largest round of grants will be evaluated at a two-day session of the Facilities Working Group in San Francisco, beginning next Friday,

CIRM Seeking IP Lawyer and Presidential Consultant

Attention IP attorneys and anybody – almost – who wants to tell the president of the California stem cell agency what to do.

CIRM is looking for a couple of people to come to its assistance on a temporary basis. The IP gig is part-time for six months for $150,000. The consultant to the president is scheduled for only four months fulltime for $80,000.

The IP position caught our eye for several reasons. One is that it lists an hourly rate of $150, rather low for a 15-year veteran of the biotech/IP field, which is the experience level that CIRM seeks. Another curiosity about the position: An hourly rate of $150 for 20 hours a week for about six months weeks amounts to $78,000, somewhat less than the $150,000 allotted for the job. The RFP also requires the winning bidder for the contract to cover his own "personal and business" expenses within that rate, except for "additional expenses, incurred at CIRM's direction."

The RFP highlights the nature of the legal work and management structure within CIRM, and not just because the agency is treading new ground on IP. The agency has a general counsel, who one might think would oversee the entire legal staff. However, virtually since its inception, CIRM has signed on with Remcho, Johansen & Purcell of San Leandro, Ca., for legal advice at a cost of more than $1 million.

While the reporting lines are not entirely clear, Remcho's James Harrison seems to be directed primarily by Robert Klein, the CIRM chair. On CIRM staff is attorney Scott Tocher, who once appeared to report to the president of the agency but now has been moved under Klein's control. Tamar Pachter, the general counsel, reports to President Alan Trounson via the chief operating officer. The new legal "temp" will report to Trounson and "coordinate" with the general counsel.

We ran the RFP by one observer who is knowledgeable about CIRM and IP work. That person confirmed that the hourly rate was at the low end and also indicated that the RFP was unclear about whether a firm or person was desired. Our observer also said,

"If the contract is not renewed, the attorney has still been paid to become one of the world's leading experts on stem cell IP, funding and commercialization. There is a good chance that this new-found expertise will lead to job opportunities with law firms, companies, non-profits, universities, etc. Even a law firm might be willing to discount its rates heavily to get this work to establish itself as a player in this field."

The RFP for the presidential consultant seeks a scientific professional (Ph.D.) with 15 years experience. In addition to a wide range of advice, the RFP indicates the person will be asked to develop "alternative resource opportunities for increased flexibility and productivity of CIRM research and clinical applications."

Both positions were posted just last week under "CIRM RFPs" instead of the job listings on the CIRM site. The deadline for applications is April 1 with work beginning shortly thereafter. Given the short time frame, it is likely that CIRM has candidates in mind for both positions.

CIRM is also seeking to fill the IP position permanently through its job listings. Other open positions include finance officer, scientific officer, senior administrative coordinator and communications manager.

Fresh Comment

In a new comment on the "CIRM Legislation" item below, Don Reed discusses his role as vice president of public policy for the Americans for Cures Foundation and his comments on CIRM matters.

Rabble, International Meetings and CIRM

The Consumer Watchdog group says the real problem with the International Stem Cell Forum last month did not necessarily involve CIRM's reluctance to provide cost estimates.

Instead, it involves keeping the rabble out of the meeting at a luxury San Francisco hotel.

The remark comes from John M. Simpson, who was writing on the new blog of Consumer Watchdog, which was formerly known as the Foundation for Taxpayer and Consumer Rights.

Commenting on our item below, Simpson, stem cell director of the group, says,

"What really is of major concern, though, is the fact that these meetings were closed. Supposedly the reason for that is that the ISCF is administered by the UK's Medical Research Council. The ISCF chairman is Sir Leszek Borysiewicz, chief executive of the Medical Research Council (UK). Apparently the scientists on the other side of the Pond just assume the rabble ought not be let in behind the closed doors of their scientific clubs when meeting.

"CIRM did call a late afternoon telephonic news conference -- about the worst time for any working reporter on a deadline -- only to delay the announced start by half an hour. Then when reporters called in at the newly appointed time, they were kept on hold for at least 20 more minutes."

Simpson says the amount spent does not seem unreasonable, a judgment with which we concur.

CIRM Releases Cost on International Stem Cell Forum

The California stem cell agency hosted the International Stem Cell Forum in San Francisco last month, which involved representatives of the leading stem cell research organizations in the world.

CIRM ballyhooed the event with a news release, and prior to the meeting, we asked for an estimate of the cost to CIRM. The agency declined to provide an advance estimate and said that the costs would include "paying for the meeting room at the hotel where the meeting is taking place as well as the audio visual set up and possibly some things like copies. We are also paying for 2 dinners (but not alcohol)."

In response to our queries, Don Gibbons, chief communications officer for CIRM, this afternoon reported that the cost totalled $25,912.

Tribulation for Love and Harrison

Last week did not bring the best news for two California stem cell personages – CIRM Oversight Committee member Ted Love and the agency's outside counsel, James Harrison.

According to The Associated Press, Love, who is CEO of Nuvelo of San Carlos, Ca., had the unpleasant task of cutting 40 positions out of his workforce, which is 14 more than the total at CIRM. The reason? The biotech firm is dropping "its troubled blood-thinner alfimeprase after it failed another study," The AP said. The move will cost the company about $3 million during the first quarter.

Attorney Harrison lost a big one with California's official state political watchdog, the Fair Political Practices Commission.

According to reporter Aurelio Rojas of The Sacramento Bee, one of Harrison's clients, Sen. Carole Migden, D-San Francisco, agreed to pay a record $350,000 fine for "personal use of campaign funds and inaccurate disclosure of cash payments and receipts between 2003 and 2007.

Harrison, who told us that Migden is a longtime client of his firm, attributed the violations to inadequate record keeping by her former campaign officials.

The Bee also said:

"During the FPPC's months-long investigation, the agency determined Migden illegally transferred approximately $1 million of surplus campaign funds and had already spent hundreds of thousands of dollars.
"The senator was told to stop using the money but instead sued the FPPC (in federal court) in an effort to gain access to $647,000 of the money she had not spent."

That suit is scheduled for a federal court hearing April 1.

Fresh Comment

"Anonymous" has left a new comment on the item below.

CIRM Legislation Hearing Scheduled for Early April

The latest legislation to target the California stem cell agency is set for its first hearing April 2 in Sacramento before the Senate Health Committee.

The bill is aimed at ensuring affordable access to stem cell therapies financed by public funds in California. It would also require a study of the agency with an eye to correcting some of the difficulties it has had with such problems as conflicts of interest.

The lead author on the measure, SB1565, is Sen. Sheila Kuehl, D-Santa Monica, who is chair of the Health Committee. She is not expected to have difficulty in winning approval of her bill and sending it to the Judiciary Committee.

CIRM has not taken a position on the measure, but has opposed similar efforts in the past. Last month, one stem cell activist, Don Reed, opposed the measure, calling it "another distraction, another delay." Reed also said that CIRM is "squeaky clean" although one of its directors. John Reed (no relation to Don Reed), is under investigation by the state for violating CIRM's conflict-of-interest rules. Five other directors also violated conflict policies last year by writing letters on behalf of grant applicants.

Don Reed is vice president for public policy for Americans for Cures Foundation, which is the private, nonprofit stem cell lobbying group run by CIRM Chairman Robert Klein. It was Klein, an attorney, who advised John Reed to lobby CIRM staff on behalf of a grant to his institution.

Fresh Comment

"Anonymous" has posted a new comment on the "egg shortage" item below.

Fresh Comment

Jesse Reynolds of the Center for Genetics and Society has posted a comment on the "eggs" item below. It says in part, "Some believe that stem cell lines could be derived from embryos that are specifically created for research through cloning, or somatic cell nuclear transfer. This process requires fresh human eggs. Only perhaps a dozen labs worldwide are trying, and only three or four CIRM grants have been awarded for this purpose (to my knowledge). This line of work raises concerns beyond the moral status of the embryo." To read his entire remarks, click on the word "comments" at the end of the item.

An Egg Shortage: Is More Cash the Answer?

The California stem cell agency has embarked on a sweeping review of the human egg market and the needs of researchers, some of whom are complaining that they do not have enough raw material.

The study was set in motion after Harvard scientist Kevin Eggan (see photo on left) told the CIRM Standards Working Group last month that he and his colleagues had spent $100,000 recently advertising for donors and "pursued every option" for collecting eggs with little success.

CIRM President Alan Trounson, a renown Australian stem cell scientist, said "accessing those eggs is no trivial matter." He said scientists are seeking grants from CIRM for research that may not be feasible because of the lack of human eggs.

One answer to the question of scarcity posed during last month's session is increasing the money for women who provide eggs. However, that could be considered the politically fatal "third rail" for hESC cell research. Prop. 71, which created the California stem cell agency in 2004, was approved by voters in a campaign that appeared to promise that women would not be paid for eggs. But the language of the measure is artfully ambiguous. The initiative says that it is up to CIRM directors to set

"standards prohibiting compensation to research donors or participants, while permitting reimbursement of expenses."

Currently CIRM regulations do not allow for compensation other than reimbursement of direct expenses. One suggestion that arose during the meeting of the CIRM Standards Working Group on Feb. 28 was some sort of reimbursement of expenses for women involved in IVF treatments. However, paying for IVF treatments could be construed as cash for eggs.

Not all members of the group were comfortable with the concept of paying women for eggs.

Here is an exchange from the transcript of the Feb. 28 meeting between CIRM Oversight Committee member Jeff Sheehy and CIRM Chairman Robert Klein, who led the campaign for Prop. 71 and claims responsibility for writing it:

Sheehy:

"(Prop. 71) was approved by the voters because the voters thought there wasn't going to be compensation for egg donors when they voted for it, and they didn't know we were going to go back and change it. And so in that context I think this is an issue that would be appropriate for us to study."

Klein:

"Well, I'm in a reasonably good position, Jeff, to discuss the issue of what was presented to the voters. and --

Sheehy:

"I was your average voter, Bob. I was not one of these people that was waving the stem cell flag. I can tell you that if we were going to go out and spend $3 billion buying eggs from women, I wouldn't have voted for it."

Klein:

"Certainly I wouldn't have voted for it either, so we agree. But the key here is medical reimbursement was clearly contemplated. I have gone to James Harrison (outside counsel to CIRM and who wrote portions of Prop. 71) and discussed this issue with him...."

Alta Charo(see photo on right), professor of law and bioethics at the University of Wisconsin and a member of the CIRM standards group, noted the political sensitivity of the issue of cash for eggs. She said changing the CIRM standards worked out in 2005 could be "inviting really quite draconian responses" from unspecified parties, but presumably hostile lawmakers and regulators.

What went unsaid during the Feb. 28 meeting was the fact that some have long regarded the supply of human eggs as insufficient for human embryonic stem cell research. But now that hESC research is enjoying a resurgence, the scarcity is becoming more acutely felt.

The session also did not include a direct discussion of another reality: If eggs are scarce and demand is high, somebody is going to make a business of it. It will be an unregulated business somewhere else in the world. It goes almost without saying that embryonic stem cell research is a global endeavor, a point that Klein made on Feb. 28.

The CIRM Standards meeting ended with a move to investigate the entire subject further. Bernie Lo of the University of California, San Francisco and chairman of the group, indicated the review would include availability of eggs and their numbers, researchers' perceptions of the problem, possible reimbursement of IVF treatment, use of eggs by CIRM researchers from other areas where compensation restrictions are not so tight and the grandfathering of cell lines that were derived before CIRM regulations were adopted.

The standards group will consider the staff review of the matter at some later date. We have asked CIRM when that is likely to occur.

Needless to say, this subject is complex. We have only briefly touched on a handful of issues discussed during the Feb. 28 meeting. We recommend a close read of the transcript. Most of the pertinent discussion begins on page 91.

Below are some excerpts from the transcript.

Snippets From the CIRM Egg Debate

Here are some excerpts from the transcript of the Feb. 28 meeting of the CIRM Standards Working Group concerning human egg availability.

CIRM President Alan Trounson:

"Accessing those number of eggs is no trivial matter, no matter what the opportunities are. In that circumstance the demand for the oocytes may be way beyond what we can possibly deliver in an outcome. And it may take us five years to do that. If we gave a three-year grant, that would be nonsense because the chance of deriving a cell line might be extremely low.

"That's why we've come because we have these applications sitting in our portfolio which we're questioning about how do we move forward on this, or do we sort of take them off the table and let the other ones proceed. I think it's important for you to understand that it's real-time now. We have to actually know exactly what is appropriate to do."

CIRM Chairman Robert Klein:

"From a legal point of view, I'm very concerned with the use of words here. I don't know anyone that's suggesting you make a $10,000 payment to somebody. If somebody has real cost, and they can document those costs, and they can get reimbursed for part of those costs. What's being addressed here is reimbursement for part of the cost, not a $20,000 payment to someone."

CIRM Oversight committee member Jeff Sheehy:

"If they did not think that they could get the eggs, they should not have submitted the applications. They have submitted applications, so they must believe that they can get the eggs."

Alta Charo, a member of the Standards Working Group and University of Wisconsin professor:

"Prop 71, which itself had this written in to some extent as a political matter, drove the National Academy guidelines which felt like they were already basically having to follow the California lead on the altruistic model here."

Trounson:

"I don't think it drives it forward. That's the problem."

Charo:

"Now we're in a situation, I think, where it's particularly touchy to try and revisit the compromise, putting aside whether or not it's even legally possible given the language of Prop. 71."

Kevin Eggan, Harvard stem cell researcher and member of the CIRM Standards Working Group:

"I have spent countless hours stomping around to different disease advocacy groups, tea circles, knitting circles, trying to find anyone and everyone who would donate their oocytes for our experiments, even out of the goodness of their heart because they had someone that they cared about who was affected by these diseases that we might in the very long term provide hope for.

"We spent more than $100,000 in advertising in the Boston Globe, in the Boston Herald, in the Boston area papers, in the suburbs of Boston. We have literally pursued every option. We've pursued trying to recruit donors from other parts of the United States to come to Boston to donate their oocytes for research. This will not work. In a country where women know that they can be compensated for doing the exact same thing, they simply will not, and in the face of the difficulties, I should add, it's not like they're not doing it solely because of the money, they're doing it because of the money and because it's a very difficult thing to do oocyte donation. And those two things collaborate together to create an environment in which women will not do this in a meaningful way which will allow the research to go forward.

"It was a very reasonable compromise to say we need to give up compensation because we can't afford to be assailed both from the right and the left on this position, but now we know that that compromise position is a failure. So what do we do about that? I think the fact of the matter is that it might as well be against the law if we can't do it. That's one sort of null hypothesis for years. So how to proceed in the face of that? I agree it's risky; but if we don't take the risk, then the outcome will be the same as if we take the risk ..."