In a few weeks, Californians will be voting on Proposition 71, the California Stem Cell Research and Cures Initiative. If enacted, this measure would drain $3 billion over 10 years from the general fund to finance stem cell research and biotech companies in California. But the citizens of California should vote "no" for reasons that go beyond fiscal responsibility. I'm even talking about citizens who are pro-choice Democrats and frustrated by President Bush's restrictive stem cell research policy.
The $3 billion would be awarded and overseen by the so-called Independent Citizen's Oversight Committee (ICOC) -- a 29-member group composed of representatives of California universities, nonprofit research institutions, private life science companies and disease advocacy organizations. The ICOC would have broad new powers to define the trajectory of human cloning technology (somatic cell nuclear transfer) over the next two decades. It would also rewrite ethical guidelines for human-subjects research and for allocating patents to the private sector.
This structure of governance is a recipe for trouble. When we mix big money, big science and new biotechnologies with the state, stronger mechanisms for public accountability are required.
Contrary to what its name suggests, the ICOC is neither "independent" of interest-group politics nor does it include any "citizen" members. Hard- driving university scientists, disease group advocates and private industry executives who will make up the ICOC all have vested interests in how the money is to be used. Scientists want to cure disease, but they may be focused on building institutes and generating papers. Companies want to make money, and charge the public high prices for therapies. Advocates for research on particular diseases, although they deserve to be at the table, do not represent the collective public interest when they battle to make their diseases the highest priority for the public.
Instead, a truly independent citizen's oversight committee is needed. The public should be directly represented when the stakes are so high -- when there is so much money to allocate across public versus private research ventures; when new ethical rules for the conduct of research, such as rules for the donation of human eggs, are being written; when the goals of curing disease, protecting egg donors, and economic growth need to be balanced. Such value-based decisions should not be left to an ICOC composed of special interests. At best, important citizen groups will be left out. At worst, the goal of improving health for all may be abandoned, and the social controls over foundational new biotechnologies relinquished.
Advocates of the measure claim that annual public reports and meetings provide transparency and accountability. But Prop. 71 provides for only limited public input, and fails to meet existing standards for public participation in Big Science spending decisions. Even the National Institutes of Health, which have been roundly criticized for the institutional opacity of funding decisions, has a Council of Public Representatives and Public Liaison Offices that formalize a decision-making role for the public. The Institute of Medicine has emphasized in a recent report that such public oversight and accountability must be reinforced if the trust between biomedical sciences and society is to be preserved and nurtured.
Public accountability is especially important with regard to the research institutions proposed by Prop. 71. The initiative enshrines new stem cell institutions within the California Constitution itself, making changes extremely difficult. The proposition creates a permanence and inflexibility that can frustrate future attempts to build in more accountability. In areas of contested values like human therapeutic cloning, more, not less, public participation is needed to diffuse future controversies that may hinder research.
Instead of funding Prop. 71, we need to create socially robust institutions to guide stem cell research and ensure that it is conducted responsibly and for the public good. A useful model in this regard can be found in the United Kingdom, where a governmental agency -- the Human Fertilization and Embryology Authority -- was created in 1991 to regulate stem cell research through a permitting process. Its policy has been deliberate and transparent. As a result, the research is moving forward with public support.
Large biotechnology interests have backed television ad campaigns on behalf of the proposition, setting out the terms of debate as "Finding Cures" versus "Religious Prejudice." As many scientists have warned, these framings mislead the public about the immediacy of stem cell therapies. They also push the public conversation away from important questions of institutional governance. If California is serious about its dual goals of finding stem cell cures and generating private sector growth, it should develop better institutional structures to bring public accountability to such a complex mission.
A "no" vote on Prop. 71 is not a vote against stem cell research. Rather, it represents a thoughtful position that we, the people of California, want more discussion and more accountability. The legislative process is a better alternative for stem cell research funding.
David Winickoff is assistant professor of bioethics and society at UC Berkeley.
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