It has been six years since California voters, awed by Proposition 71's list of potential cures for cancer, diabetes, heart disease, Alzheimer's and more than 70 other conditions, approved $3 billion in funding for stem cell research in the state. It has been nearly as long since Geron Corp. proclaimed that the first-ever human test of embryonic stem cells was nigh.
Since then, the California Institute for Regenerative Medicine, created by that 2004 ballot initiative, has handed out more than $1 billion in research funding. But there have been no "miracles" — no paralyzed people abandoning their wheelchairs or diabetics throwing away their needles. There hasn't even been a human trial of embryonic stem cells, those amazing shape-shifters that can grow into any cell in the body. In 2009, Geron almost made it into the clinic. But then mice it had treated for spinal cord injury developed worrisome cysts, and federal regulators called a halt to the pending human study.
So were Californians duped?
Some would say yes. "There have been no cures, no therapies and little progress," Investors Business Daily complained in an editorial earlier this year. Rush Limbaugh went further, declaring embryonic stem cell research "fraudulent, fake."
But the truth is that science is a long and arduous process, and "breakthroughs" rest on a foundation of basic science. Most of the money spent so far has gone into new labs, training, tools and technologies and basic research, building blocks that are necessary precursors to discovery.
One day, treatments based on embryonic stem cells may be able to correct any number of life-threatening and disabling conditions. But this prospect is not a tidy matter of changing a few switches in cells and then popping them back into a malfunctioning part.
"It's very important to understand that these things won't happen quickly, nor should they," says Elaine Fuchs, who studies skin stem cells at New York's Rockefeller University. But the fundamental revelations emerging from labs here thanks to stem cell initiative funds are "incredible, exciting and inspired," she says.
Fuchs, incoming president of the International Society for Stem Cell Research, says money from the California initiative helped scientists learn how to generate pluripotent cells with much the same properties as embryonic stem cells, produce and grow both types of cells more efficiently, and understand the microenvironment of signals and internal changes that shape a cell's activity. "Really, the entire field of biology benefits," she says.
It's no surprise that the initiative's proponents made big promises: They had something to sell. But instant miracles are uncommon in science, and journalists should do a better job making that clear. We need to highlight the uncertainties in science and, in medical quests such as stem cell therapies, emphasize the baby steps involved that in fact are big leaps: reproducing and growing these flexible cells, understanding how they work, using them to learn about disease, designing treatments and then testing the safety of any resulting therapy.
In the aftermath of the stem cell initiative, William H. Fisher, chief executive of the Alzheimer's Assn. of Northern California and Northern Nevada, found himself repeatedly having to explain such matters to hopeful families. "I don't blame the Prop. 71 people, I blame the media," he says. Alzheimer's regularly led the list of potential stem cell cures in news reports, he says, but there's no reason right now to believe that embryonic stem cells will solve the disease.
Storytellers at heart and fans of the dramatic, journalists gravitate toward the remarkable possibilities of medicine and the tragic plight of patients in need. We traffic in the language of life-saving miracles and then, for balance, throw in a dash of skepticism from a critic concerned about the sanctity of life or the exploitation of egg donors.
But science isn't a pro/con equation. When we pit enthusiastic researchers against those who cite moral objections or technical difficulties, we obscure the uncertainty that scientists themselves acknowledge. In such a context, "the belief that a cure is 'just around the corner' is able to develop and circulate," wrote sociologist Robert Evans and colleagues last year in a study of stem cell rhetoric.
By falling prey to researchers' natural enthusiasm and fixating on near-magical potential breakthroughs, journalists set us up for disappointment. In one hospital, for example, a wife insisted that her dying husband be kept on a ventilator because she was certain that stem cells could save him if he would just hang on.