Monday, July 10, 2006

Stanford University: Medical Research, Money and Conflicts of Interest

In a news story that has major implications for the California stem cell agency, the San Jose Mercury News has detailed a web of relationships that have enriched Stanford University and "fattened the personal bank accounts of many of its prestigious faculty members."

The article by reporter Paul Jacobs is a rare look inside the normally private Stanford documents designed to monitor the ties between faculty and medical companies.

The story said:
"Dozens of professors moonlight for medical firms or have founded companies based on their government-funded research.

"In the 2004-05 academic year alone, $38 million in royalties poured into the university from medical school discoveries -- roughly $10 million of which went directly to faculty researchers whose discoveries were patented.

"Critics worry that these complex financial and ethical relationships between companies and the nation's premier research universities are corrupting science and producing overly enthusiastic portraits of new treatments."
Friends and foes of the California stem cell agency have longed expressed reservations concerning the built-in and legal conflicts of interest that riddle CIRM. A measure –opposed by CIRM -- is now before the legislature to tighten oversight and force more disclosure of potential conflicts of interest.

Jacobs' thorough and even-handed story, based on six months of work, said:
"Financial conflicts can turn campus laboratories funded by taxpayer money into outposts of corporate research. They can divert researchers from work that might have a bigger impact on health toward research with bigger financial rewards. And in the worst cases, they can blind scientists to the dangers of treatments they are studying, resulting in injury or even death among volunteers."
The story noted that links between medical research and the corporate world exist at virtually every major unversity in the country.

Stanford voluntarily disclosed to the San Jose newspaper overall figures for a single year concerning its faculty's relationships. The article did not explain the university's reasoning behind the disclosure, but it was a bold decision – one that reflects well on the school but one probably opposed by significant segments within the university. The action was fundamentally good public relations. The choice is to release more information, as the school did, or suffer mightily as bits and pieces dribble out, each one making Stanford look worse and worse.

Philip Pizzo, dean of the medical school and a member of the Oversight Committee for the California stem cell agency, told Jacobs that conflicts are unavoidable but manageable. He said Stanford's "standards for dealing with conflicts are 'the most rigorous' in the country."

But, Jacobs reported, Pizzo "also says ties to industry are necessary if the university is to translate its research into practical treatments for patients."

Not everyone agrees with Pizzo on the "manageability" of conflicts. Jacobs wrote:
"'There is a focus on procedural solutions and this magical belief that disclosure is the answer as opposed to dealing with the fact that many of these things should not be allowed,' said Barbara A. Koenig, a bioethics researcher at the Mayo Clinic and former executive director of Stanford's Center for Biomedical Ethics.

"Tufts University Professor Sheldon Krimsky, author of 'Science in the Private Interest,' argues that fields such as law have stricter conflict policies than universities. A judge, for instance, isn't allowed to have any financial relationship with a party that might benefit from a ruling."
Jacobs' article also included the following segment on one of the brighter stars in stem cell research.
"...(N)o one is more up-front about his financial conflicts than Dr. Irving L. Weissman, one of the founding fathers of stem-cell biology. His lab at Stanford was the first to isolate blood-forming stem cells from animal bone marrow. Today, in addition to his own lab, he directs Stanford's Institute for Cancer/Stem Cell Biology and Medicine.

"Weissman's research has made him a multimillionaire entrepreneur.

"When he gives speeches, when he publishes papers, when he testifies before Congress, he lets everybody know what his outside financial interests are.
"After serving on the scientific advisory boards of Amgen and DNAX, he helped launch three companies, all based on his stem-cell expertise and, in varying degrees, on the research done in his medical school laboratory.

"Weissman recently recalled what led him to form the first of his companies, SyStemix.

"He describes a frustrating year trying to get the facilities he would need on campus to advance his work. He finally concluded in late 1988 that he would have to start a company. He went to (Donald) Kennedy, Stanford's president at the time.

"A biologist who is now editor in chief of Science magazine, Kennedy had reservations. 'I didn't want faculty wandering from their homes on campus into labs thinking about money in their next offshore venture,' he recalled.

"But Weissman convinced him that he could separate his work at the company from his work in the lab. A faculty committee would look at his NIH grants every year to see, Weissman said, 'if I was starting to slant my grants in favor of topics relevant to the company.' He and Kennedy agreed Stanford would not take shares in the company, avoiding a financial conflict for the university -- a policy later abandoned.

"Today, Weissman sits on the boards of directors and scientific advisory boards of two other companies he co-founded -- StemCells Inc. and Cellerant Therapeutics. His method of handling his conflicts, primarily through disclosure, has become the standard at Stanford and other medical schools.

"'The way I usually do it is, I say, `I have stock and I'm a director of this or that, so you might think I'm biased. I don't think I'm biased, but there could be unconscious bias, so you judge,' he said.

"'You ought to be able to do whatever experiment along this line with transparency so everybody knows at every step of the way what your involvements are, what your bias might be, so you can move it forward,' he said, referring to scientific progress. 'But I think it's morally reprehensible not to move it forward.'"

California AG Moving Against CIRM Foes

California Attorney General Bill Lockyer is expected today to attempt to kill off the latest effort to halt work by the California stem cell agency.

The likely action was reported by the California Politics Today web site. Basically the attorney general's reasoning is that the effort to halt funding of grants to the University of California has already been decided in Alameda County Superior Court.

The latest anti-CIRM effort has received virtually no attention in media. Marc Strassman, who runs the California Politics Today site, has been alone on the story, as far as we can tell. His site includes audio interviews with some of the principals.

Friday, July 07, 2006

Stem Cell Research and Bringing Camels into the Tent

"You’re at a point where you can change the world." -- Michael Amos of the Advanced Technology Program at the National Institute of Standards and Technology.

Just one of the comments emerging from the search by the California stem cell agency for a plan on how to give away $3 billion.

Amos' comment was contained in a freshly posted document on the CIRM's Strategic Planning Web site. The 31-page report is a concise summary of the May 25 scientific conference and is filled with provocative and wide-ranging ideas, including reflections on the political impact of research that produces negative results.

A presentation, however, by Jonathan Shestack, a CIRM Oversight Committee member and co-founder of Cure Autism Now, caught our eye. He discussed the importance of sharing and how his organization was surprised by the lack of communication in the autism field. He also discussed the need to become an informational resource that benefits all research in a particular field.

Here are some excerpts from Shestack's comments as summarized by CIRM:
"The most important thing anyone said to us was that we had to 'become the data.' At that point we couldn't rely on people sharing data or raw materials. It was sort of an education to us that people didn't routinely share data."

"We realized we couldn’t rely on making people share so we had to become the central resource and that's what we did, and it's been the best return on investment."

"We were really sort of bootstrapping the field, but we have to guard against becoming institutional and what we hate the most. And that's the biggest danger CIRM has."

"Nothing good ever came to CAN (Shestack's group) without us giving things away. The more CAN gave things away and didn't worry about ownership or getting credit or getting cited, the better it was for us, not as an institution, but to the field. I have this deep feeling that the more you give it away the better it will be."

"What is true and does pertain to CIRM is how to bring many people together. We have complicated problems with different issues and it's a constant struggle to keep people in the tent. We started with the assumption that we would never be able to close the flaps of the tent and say we've everything. We're constantly trying to bring more and more people into the tent."
CIRM President Zach Hall spoke to the issue of what some might call managing expectations.
"Someone today said if you don’t have lot of failures you not being adventurous enough. I have commented on the gap between the political and scientific cultures in California. People have to understand that not all science succeeds. If you are too successful you're not adventurous enough on setting those goals. That's a balance we'll have to strike. It is an education matter in the end. It is also a policy matter and we'll discuss at a later session how to balance innovation and results and how to get the singles and not just the home runs to push things forward."
It is hard to overemphasize Hall's point. The public and advocacy groups want and are conditioned to expect instant solutions and cures. Indeed, American society is oriented in that direction. Without laying the groundwork as soon as possible and educating the public, CIRM could become ensnared in a few years in an unpleasant trap when critics begin to demand: "Show us the beef." At the same time, CIRM must demonstrate that is fulfilling the promise of Prop. 71. Juggling those two goals is a difficult task but one that CIRM must master.

UC Irvine Looking for CIRM Grant

Leverage is everything. That is one $10 million lesson that a bond fund manager is delivering to the California stem cell agency.

Bill Gross, founder of PIMCO, agreed to donate that much to UC Irvine for its stem cell research program. Two million will go immediately for staff and equipment. But the remaining $8 million is conditioned on matching funds.

A UCI spokesman says the school is looking for a grant from CIRM to achieve that goal.

Here are links to stories on the grant: Los Angeles Times, The Associated Press, Orange County Register. Here is the press release from UC Irvine.

Wednesday, July 05, 2006

WARF Smacks Stem Cell Watchdog

WARF says California is trying overtake Wisconsin as the national leader in stem cell research by using its patents unfairly and illegally.

The organization took that position in an op-ed piece in the Wisconsin State Journal last week. It was written by Carl Gulbrandsen, managing director, and Elizabeth Donley, general counsel.

They wrote:
"In a guest column on (June 26)Monday, John (M.) Simpson of the California-based Foundation for Taxpayer and Consumer Rights argued that the Wisconsin Alumni Research Foundation is impeding life-saving research.

"Nothing could be further from the truth."
Among the evidence they cited for their position was an analysis of ESC research articles published worldwide between 2002 and 2005 that showed that 67 percent of those articles cited Wisconsin's stem cell lines. What that also shows is dominant market share – not as strong as Microsoft's but very strong. (Now there's an interesting question: How is WARF like Microsoft?)

They continued:
"In short, California wants to benefit from stem-cell science by using patents and licenses created using Wisconsin's patent rights to overtake Wisconsin as the national leader in stem-cell research. That is an understandable goal. California also want to do so without recognizing the contributions of Wisconsin's scientists, which may be understandable, but is not fair or legal."
Simpson authored another op-ed piece in The Sacramento Bee, which is nearly identical to his earlier piece in Wisconsin. However, it carried this additional paragraph.
"Earlier this spring, Dr. Robert Goldstein, chief scientific officer for the Juvenile Diabetes Research Foundation, told a CIRM committee meeting that the patents are 'a major inhibition to productive scientific research.' Because of WARF's claims, Goldstein said, his foundation has funded scientists in other countries 'to create new and better stem cell lines, and that process … is currently flourishing.' U.S. companies interested in conducting stem cell research report they have had difficulty getting funding because of the WARF patent demands."
The Bee has a feature that allows its readers to comment online on op-ed pieces. Concerning Simpson's piece, one said,
"I hereby patent humanity! Anyone being born after today must send me 1 dollar, including any judges."
Obviously nobody should steal another's property, but in this case WARF may have difficulty in communicating its message to the public.

Upcoming CIRM Events

Monday July 10 -- Meeting of the Strategic Planning Advisory Committee in San Francisco at CIRM headquarters. A progress report is planned as well as discussion of technologies for stem cell research. Plans for the July 13 scientific conference and the July 25 commercial sector meeting are also on the agenda. No remote access is available.


Thursday July 13 – "The Scientific Challenge: From Basic Science to Clinic," daylong strategic planning conference in San Francisco. Five speakers scheduled on the agenda. No remote access is available.


Friday July 14 -- Intellectual Property Task Force meeting in Sacramento. Only one topic is on the agenda: consideration of public comments on the IP policy for nonprofits. That policy was approved last February by the Oversight Committee but is now going through the formal state adoption process. Remote access to the meeting is available at UC Irvine.

Monday, July 03, 2006

Stem Cell Legal: Fishing for Another Judgment

The folks who have failed in their legal attempts to exterminate the California stem cell agency are trying another tack.

This time they want to halt funding of CIRM grants to the University of California on the grounds that such funding amounts to an illegal conflict of interest because nine members of the 29-member body approving the grants had ties to UC.

The action in Sacramento County Superior Court is just a retread of the CIRM foes' earlier attempt in Alameda County Superior Court, a move that was rejected by a judge in a very brief trial and is now on appeal.

While providing lip service to legal arguments, the CIRM foes have made it clear that their primary motivation for their action is their religious opposition to embryonic stem cell research. They have also made it clear that if they cannot prevail legally, the next best thing is to force the agency and now the University of California and the state Controller to waste time and money on frivolous lawsuits.

We would have more tolerance for their legal positions if we had not witnessed their performance in last February's trial. They were unprepared and appeared to have failed to do basic research that could have bolstered their position.

We should note that litigation in America serves a variety of purposes aside from settling legal disputes. One is to stimulate media and public attention. Another is to stimulate the constituencies of the organizations involved in the legal action. Those are important objectives for the CIRM foes.

The Web site California Politics Today, run by Marc Strassman, was the first to report the latest lawsuit. Here are links to his two stories on the subject (the first one and the follow the next day). Here is a link to the legal filing.

Other than Strassman's piece, we have not seen any other coverage of the latest lawsuit.

Business To CIRM: We Need More Money

The California stem cell agency's plans for sharing the swag from research by nonprofits is drawing fire from the for-profit sector.

The national Biotech Industry Organization has complained in a letter to CIRM
:"These provisions substantially reduce or eliminate the incentives to commercialize patented stem cell-related technologies and products even in spite of the generous funding provided by Proposition 71."
Reporter Steve Johnson of the San Jose Mercury News reported the complaints from private sector, which were obtained from CIRM after the Mercury News filed a request under the public records act. Also registering complaints were the California Healthcare Institute, a biomedical industry group, and several biotech firms including Applied Biosystems of Foster City, Ca.

On the other hand, the California Council of Churches complained that the nonprofits would receive too great of a share of income from inventions from state-financed research.

Johnson's story also makes it clear once again that CIRM's initial approval of regulations is far from the final action. After the Oversight Committee approves them, they must go through the official state administrative proceedings allowing for additional comments and changes. That is the current stage for the nonprofit research rules, which were approved by the Oversight Committee last February.

Friday, June 30, 2006

Stanford Bioethicist Says More Monitoring Needed on California Stem Cell Research

Stanford bioethicist David Magnus says that the research rules of the California stem cell agency "lack adequate monitoring mechanisms."

His views were reported briefly in a recent piece in the Technology Review by writer Emily Singer in an article entitled "Lack of Human Eggs Could Hamper US Cloning Efforts."

Singer wrote:

"Unlike other types of human research, there are no U.S. federal guidelines governing how these experiments should be carried out. President Bush severely limited federal funding for embryonic stem cell research in 2001, including all research involving the creation of new stem cell lines. This has meant that the National Institutes of Health, the nation's largest source of biomedical funding, has not played its normal regulatory role, and individual states and research institutions have had to pick up the slack. "If there were agreed-upon national standards, it would probably speed up much of this protocol approval process," says Arnold Kriegstein, director of UCSF's stem cell program.

"Both Massachusetts and California, the latter via the California Institute of Regenerative Medicine, have recently enacted rules governing embryonic stem cell research. Both sets of guidelines prohibit paying egg donors, but do allow compensation for direct expenses, such as childcare and transportation. California takes it one step further, allowing women to be paid for time off work. It's unclear if Massachusetts law permits this practice.

"David Magnus, a bioethicist at Stanford University, says these regulatory systems lack adequate monitoring mechanisms, though. 'I think it would be an advantage to think about ways to make sure researchers are doing what they say they are going to do,' says Magnus. 'I would guess that we won't see problem with the first few institutions, which have been very careful. Problems would more likely occur down the road, when [nuclear transfer research] starts to become routine.'"
We asked Magnus for further comment on his statement. He responded:
"I made a general point and said that the CIRM rules are similar to most of our research participant protection system, which focuses on informed consent documents, protocols, etc. and very little on monitoring. We could, for example, do quality control activities that other industries have, such as taping some informed consent sessions to determine if that actual consent process does what it is supposed to do (the studies of this sort that have been done have found some problems that could be eliminated). We could also build in studies of the informed consent process into a lot of the research that gets conducted. At this point the CIRM guidelines are actually completely silent on issues that will arise in clinical trials."
Magnus also has more to say about informed consent procedures in the transcript of the June meeting of the ESC advisory committee for the California Department of Health. The group is formulating rules for ESC research in California that is not funded by CIRM.

Magnus cited informed consent procedures involving gene transfer research. He said,
"If you think of gene transfer research as a comparable, cutting-edge research, that’s a good analog to what we are talking about. There’s a lot of empirical studies about how that’s done, and the IRB’s are clearly not doing a good job. Because if you look at informed consent forms that went through IRBs, they’re full of misleading language.....There are maybe two or three studies published in the past year or two about informed consent forms and how awful they are. And that does not even count how - what actually happened in the actual consent process verbally where there’s not as much data, but what has been collected was terrible."


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Protection of Egg Donors Heading for Governor's Desk

Legislation aimed at protecting women who donate eggs for stem cell research in California – except for research financed by CIRM – cleared a state legislative committee and appears headed for the governor's desk.

The measure – SB1260 by Sen. Deborah Ortiz, D-Sacramento – was approved on a 12-0 vote earlier this week. It now goes to the Assembly Appropriations Committee, where it is likely to be sent on to the Assembly floor.

Ortiz' office issued the following statement:
"'Stem cell research holds great promise for chronic and life-threatening diseases that affect more than 100 million Americans,' Ortiz said. 'We all want biomedical research to move forward, but we must ensure that women who provide eggs for research are fully educated about potential reproductive health risks.'

"SB 1260 ensures that women who are considering donating eggs for stem cell research are fully informed of potential risks and provide written and oral consent before taking fertility or ovarian stimulation drugs and undergoing assisted oocyte production (AOP) procedures. The bill limits, in accordance with the National Academy of Sciences, compensation to only allow reimbursement for direct expenses. It also provides payment for expenses associated with any necessary pre and post-procedure medical care.

"The bill will provide a streamlined set of standards for egg donations and continue state oversight that began in 2003 with SB 322 by Ortiz. Under SB 1260, an advisory committee created by SB 322 will finish making recommendations to the Department of Health Services (DHS) so that DHS may develop stem cell research guidelines for reviewing stem cell research projects."
The Health Services advisory committee has said it "is concerned with the designation of the IRBs (institutional review boards)as regulatory bodies of stem cell research, the breadth of the requirement for provision of medical care for adverse medical consequences of donating oocytes for research purposes, and the broad and ambiguous restrictions on who may be a research oocyte donor," according to the latest legislative analysis of the bill.

Tuesday, June 27, 2006

China No. 1 on ESC Spending, except for California?

Earlier this spring, some members of the California stem cell agency's task force on intellectual property wondered about the size of funding worldwide for embryonic stem cell research, excluding the United States.

The answer seems to be something in the neighborhood of $600 million annually, but that figure could well be low. The total is derived from a report on the CIRM Strategic Planning Site, which reviewed research activities in a number of countries. The report seems to confirm the conventional wisdom that CIRM, at $300 million-plus a year, would be the world's single largest source of funding for embryonic stem cell research.

The CIRM document is called "Overview on the Current State of the Development of New Human Embryonic Stem Cell Lines." The document is heavily qualified and "is not intended to be comprehensive or exhaustive." For example, some of the funding reported is current only as of 2004. And it is not entirely clear whether some of the numbers include funding for non-embryonic stem cell research.

Squishy as the numbers may be, they do provide a window on the size of programs in various countries. The CIRM staff report did not attempt to come up with a total or a ranking, a task attempted by the California Stem Cell Report. Our results are filled with caveats to numerous to mention.

China appears to have the largest annual program with a total as high as $249 million with the United Kingdom following at about $193 million, although it is not clear that all of the UK funding is available. Likewise, China's spending may be less.

Australia comes in at about $47 million, Singapore at $25 million, Korea at $18 million, Canada at $17 million, Israel at $7 million, Sweden at $2.2 million and India at $1.9 million. You may think some of these numbers seem strange. So do we, for a variety of reasons.

For example, Singapore has created a $600 million fund to invest in cutting-edge life science projects, including stem cells. But it is not clear from the document whether any of that money is included in the $25 million total for stem cell research expenditures.

Singapore is also involved with Australia in an endeavor called ES Cell International Pte Ltd. (ESI). It is not clear how the funding for that group is split between the two countries.

Other examples could be cited. But this is a rough cut. Many other interesting bits of grist can be found in the document.

Correction

In a June 20 item, we incorrectly described the Wisconsin State Journal as the Madison State Journal.

Is WARF Patenting Chickens?

Advice to Wisconsin from a Santa Monica group: Get the dollar signs out of your eyes.

John M. Simpson, stem cell project director for the Foundation for Taxpayer and Consumer Rights, wrote an op-ed piece in the Wisconsin State Journal concerning the state's stem cell patents. In it he chastizes the Wisconsin Alumni Research Association.

He wrote:
"Patenting embryonic stem cells because you have a method to isolate them is like patenting chickens because you have a new method to provide chickenfeed. Or, like patenting food because you can cook. Nonetheless, WARF claims and has, at least for now, been granted the rights to all human embryonic stem cells in the United States. The patents' dubious validity is underscored by the fact that no other country in the world recognizes these claims."

Friday, June 23, 2006

Correction on CIRM Firing Policy

David Serrano-Sewell, CIRM Oversight Committee member, corrected us on the "Two-Boss Brew" item June 20.

Here is what Serrano-Sewell said,
"The ICOC approved (13-5 vote) the 'internal goverance policy.' As you note, the amended policy granted to the Chair the authority to concur with the hiring of certain CIRM staff, Senior Officers. The proposed policy was amended to limit the Chair's concurrence authority to two Senior Officers in legal and communications. Please note, the adopted policy does not grant to the Chair the authority to fire or concur in the firing of those Senior Officers.

"Arguably, the policy is confusing. The President could hire a Senior Officer with the Chair's concurrence and then fire that same Senior Officer without the (Chair's) concurrence."
We thank Serrano-Sewell for the heads up. We appreciate all such messages and try to correct mistakes promptly.

"Good" Audit, Poor Cooperation at CIRM

Should an auditor hired by a state agency refuse to provide copies of information about that agency to the one of the key fiscal watchdogs for the state of California?

One would think not. After all, aren't all state agencies supposed to be working together?

That situation involved the California stem cell agency and the auditing firm, Gilbert Associates, that it hired to conduct an audit as required by law. The state Controller's office is the agency that attempted to secure copies of the information. But Gilbert refused to provide the copies, arguing that the information was proprietary. Based on statements from CIRM and the controller's office, the situation has been cleared up.

But it does not augur well for CIRM's responsiveness to continuing concerns about its openness and transparency.

John M. Simpson, stem cell project director for the Foundation for Taxpayer and Consumers Rights of Santa Monica, Ca., said,
"CIRM would have us believe that the audit demonstrates the institute operates within the common practices of state agencies. Other state agencies don't hire auditors who stiff the controller's office when it's operating on behalf of the people of California."

"The bottom line is simple. CIRM is a state agency; they must act like one. I guess CIRM management needs to engrave that motto on their foreheads."
We should not have to remind readers that audits vary widely. And some auditors feel unwilling to bring bad news to the enterprises that hire them. The headlines were full of news a few years ago about collapsing companies with beautiful audit findings.

Here is a link to the San Francisco Chronicle story by Carl Hall on the audit findings. Here is the CIRM press release, the controller's report and the audit itself, which covers only the 2004-2005 fiscal year.

Black Leaves Oversight Committee

Gov. Schwarzenegger has the opportunity to make another appointment to the Oversight Committee of the California stem cell agency with the departure of Keith Black, director of neurosurgery at the Cedars-Sinai Medical Center in Los Angeles.

Black resigned quietly earlier this year. No announcement was made of his departure.

A spokeswoman for the agency said Black resigned because of "time constraints."

Looking Inside CIRM's Planning

Embedded in the California stem cell agency site are significant documents that provide insight and information dealing with how the agency will give away $3 billion.

For example, one summary from a May 25 meeting discusses funding mechanisms involving business and nonprofits as well as whether new embryonic stem cell lines should be the focus of early funding.

The document is intended to be comprehensive concerning discussion at the meeting but does not imply any commitment by CIRM. However, if you are interested in where the $3 billion will go or want some of it, you should watch the strategic planning process carefully. And make your voice heard as well. The agency is moving rapidly.

Here is a sample of interesting themes emerging from the May planning conference on funding structures:

Partnering with other agencies, much as does the Juvenile Diabetes Research Foundation, to extend the reach and impact of funding.

Emphasizing early phase discovery research with a strong focus on "world-class science."

Shaping the nature of grant applications prior to receiving them as do other funding organizations.

And there was this interesting caveat:
"CIRM must be aware that it will be difficult to put out large numbers of grants without potentially exhausting their review committee. For example, JDRF funds about $120M in research per year to about 500 investigators, has about 15 different types of grants, and used 150 scientific reviewers last year. That is far more reviewers than CIRM has."
At another point, the question of renewed federal support for ESC emerged, although questions were raised about the impact.
"Given the flat state of NIH funding, funding will still be tight even if the bill passes. It is not necessarily innovative to derive new ESC lines so funding may be difficult to come by," the document said.
The item below outlines several other documents as well. In the coming months, we will continue to alert you to planning documents as they are posted on the CIRM Web site.

CIRM's Strategic Plan: A Guide (v1.0) to Planning Documents

Here are links to interesting and fresh documents related to strategic planning by the California stem cell agency. During the months ahead, we will continue this regular alert to significant planning documents as they are posted on the Web.

Cord blood -- "Overview of Current Umbilical Cord Blood Banking, Clinical, and Research Activities" – Document reports a suggestion that a "donor-sibling cord blood banking service" be created for California families and that NIH cord blood funding has declined from $21 million in 2002 to $18.6 million in 2006.

ESC Databanks -- "Overview of Current ESC Databanks" – Covers many efforts worldwide. Topics for CIRM include whether there is "a need for CIRM to provide an information resource on human embryonic stem cell lines" and whether CIRM should "create its own ESC characterization database using a best practices approach."

CIRM mission statement proposals – This 18-page document includes proposals presented to the Oversight Committee as well as ones suggested by committee members. Sample from one committee member: "Set the highest standards for scientific integrity, openness, collaboration and technology transfer."

Previous postings on the California Stem Cell Report related to CIRM planning include: questions being asked, Interviewees and their answers, Hall's discussion questions, planning Web page , report from last fall's scientific conference, formal kickoff/overview , clashing interests.

CIRM Strategic Planning: The Questions Being Asked

Here are the questions that are being asked by CIRM as it interviews scores of persons around the country during its planning process. We are posting it verbatim because it does not seem to be available on the CIRM Web site.

The text follows:


Thank you again for your willingness to participate in our interview process for the CIRM scientific strategic planning initiative. We are asking all interviewees to answer questions 1 through 3, as well as 13, but would greatly appreciate your input on the remaining questions on which you would like to comment.

This template is intended for your use only; there is no need to return it to us.

1.In ten years, what will success for the Institute look like?

2.What specific objectives should the Institute pursue in order to realize that vision of success? What are concrete measures of progress along the way to those objectives?

3.What are the most pressing needs that the Institute must address immediately to achieve its goals?

4.Is there "low hanging fruit", that is, opportunities for quick, visible, low-risk successes?

5.What is the best way to foster stem cell research that achieves treatments and diagnostics? Should we target specific diseases for funding or sponsor more broadly based initiatives within which a variety of diseases can be accommodated? If we decide to fund specific diseases, how do we decide how and when to fund to fund that research?

6.Are there specific funding structures (particularly novel ones) that will best help us achieve our objectives?

7.How do we balance funding for targeted research versus funding for discovery?

8.How far along the basic / translational / clinical research continuum should the CIRM aspire to move?

9.When and how should we involve the private sector?

10.How will we know when and how to advance findings into the clinic?

11.How can we encourage collaboration particularly between basic and clinical scientists to advance the science into the clinic?

12.CIRM is allowed to spend up to 10% of its allocated funding for facilities. How important do you consider this as a focus for spending? How can this money best be used?

13.Is there anything else you would like to add or any questions you would like us to address going forward?

Tuesday, June 20, 2006

Still Simmering: The Two-Boss Brew at CIRM

(This correction was posted 6/23/06:David Serrano-Sewell, CIRM Oversight Committee member, corrected us on the "Two-Boss Brew" item June 20.

(Here is what Serrano-Sewell said,

"The ICOC approved (13-5 vote) the 'internal goverance policy.' As you note, the amended policy granted to the Chair the authority to concur with the hiring of certain CIRM staff, Senior Officers. The proposed policy was amended to limit the Chair's concurrence authority to two Senior Officers in legal and communications. Please note, the adopted policy does not grant to the Chair the authority to fire or concur in the firing of those Senior Officers.


("Arguably, the policy is confusing. The President could hire a Senior Officer with the Chair's concurrence and then fire that same Senior Officer without the (Chair's) concurrence."
We thank Serrano-Sewell for heads up. We appreciate all such messages and try to correct mistakes promptly.)

For Robert Klein, chair of the California stem cell agency, it was a "watershed issue." For Zach Hall, president of the agency, it was a matter of no comment.

The issue was the "two boss" conundrum at CIRM. One member of the Oversight Committee, Jeff Sheehy, said, "This is the sloppiest thing I ever heard of."

The issue surfaced earlier this year over seeming picayune matters (see "dualing execs"). But it has resurfaced again and does not seem likely to go away.

The latest forum was this month's meeting of the Oversight Committee, which oversees CIRM, hires the president and elects the chair. Both have major overlapping responsibilities by law but the conflict has boiled down nominally to to such things as travel, office assignments and concurrence on hiring senior staff.

It was the latter that raised fresh questions about the future dynamics of CIRM. While the agency will administer $3 billion in funding, it is a small organization, now only about 20 employes. By law, it is limited to 50, which means that two strong executives can rub against each other with great regularity. Hall and Klein are two such men.

During the debate over CIRM's internal governance policy, terms like "crazy" and "Rube Goldberg" policy were bandied about, according to the transcript.

Sheehy was perhaps the most vociferous in confronting the situation. At one point, he said,
"We basically set up the situation where someone is going to have two bosses with equal authority....I work for people, so I kind of have a sense of what this means. and this is insane. I couldn't work in that environment. and I don't know why we would want to set up that structure" which he called "completely, totally untenable."
Sheehy was among those concerned about the implications for CIRM when it comes time to find replacements for Hall or Klein or, for that matter, finding top executives who are comfortable serving two masters – not to mention the 29-members of the Oversight Committee.

Sheehy said,
"The more we muddy these (management) lines, the more dangerous it is. We're making compromises. Even having to have these things negotiated out must make the job of the president extremely difficult. And I, frankly, think we should have taken care of this a long time ago. But if you guys (oversight committee members) want to go point by point over the next God knows how many years with how many presidents and fight over office space, travel allowances, hiring of staff at this level, I think we're not going to be able to do the business that we were put here to do."
Ed Penhoet, vice chair of the Oversight Committee, and others stood behind the bifurcated management. Penhoet said Klein was really an "executive chair." (Penhoet did not mention court testimony last winter by Klein, who operates his own financial firm, that he does not consider himself a state employee because he does not accept a salary.)

Others noted that the language of Prop. 71 compels a certain duality. And still others pointed to organizations, such as academic health institutions, that have executives with overlapping responsibilities.

David Baltimore, an Oversight Committee member and president of CalTech, said,
"You can't analyze this situation as you would any other organization because no one would ever set up an organization that has split authority like this except Bob, I'm afraid, because that's not an efficient or effective way to run an organization, to have two heads of two different elements that have to interact. The notion of having a CEO is that the CEO has complete control of the organization. We're not going to get there because we're not going to amend Prop. 71."
Hall's only comment during the discussion was "I have no comment."

Klein said concurrence on hiring senior staff was "critical" to his position. He later agreed to limit concurrence on the hiring of the top executives for communications and legal matters. He resisted suggestions that concurrence be changed to consultation.
"Otherwise I'm not going to feel like I can perform for this board, whether it's a legal function, the financial function, communications areas. I think it's a watershed issue."
Ultimately the Oversight Committee voted 13-5 to give Klein concurrence on the hiring of the two top legal and communications executives. That also gives him concurrence rights on firing them. The committee also, on a voice vote with Sheehy the only audible no, approved giving Hall office assignment responsibilities. On travel, by the same vote, Klein will only need approval of travel from Hall when it exceeds the budget approved by the Oversight Committee for Klein's office.

Early in 2005, the stem cell agency hired Hall, then 67 and a well-respected scientist and skilled administrator, as its interim president for one year. Ultimately he was hired as permanent president following an international search that cost $205,289. We have long suspected that the search ran into difficulties because the top candidates detected the underlying problems with CIRM's two-boss structure. Hall meanwhile was getting a close look at CIRM and Klein and probably thought the issues could be overcome. And CIRM was engaged in a truly remarkable, once-in-a-lifetime endeavor that was hard for Hall to pass up as he neared retirement. Of course, that scenario may be totally wrong but it seems to be reasonable speculation.

Discussions of the top management issues at CIRM preceded the disclosure this month that Klein was not wearing just one executive hat. He is also head of an advocacy group called Americans for Stem Cell Therapies and Cures. As its head, he sent out national emails excoriating a top California legislator as an "ongoing threat" to CIRM for carrying legislation to tighten oversight of the agency. The language in the letter went beyond the Oversight Committee's official position. CIRM said it had no comment on the Klein letter, saying he did it on his own time.

John M. Simpson, stem cell project director for the Foundation for Taxpayer and Consumers Rights of Santa Monica, Ca., told the California Stem Cell Report,
"Klein needs to decide whether he wants to be ICOC chairman or chairman of his advocacy group. I don't see how he can do justice to both effectively."

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