My commute begins each morning when I get on the N-line MUNI, one of San Francisco's oldest remaining streetcar lines that winds its way through the city's sleepy Outer Sunset district. A blur of pastel houses, dotted with restaurants, churches and Chinese supermarkets pass by the window until a pleasant robotic voice overhead chimes "UCSF," and I exit the train.
I enter the hospital across the street, where I take an elevator up nine floors. After I walk through a series of long hallways punctuated by double doors, I arrive at what would have been a wall on the south face of the hospital fifteen years ago. Instead, I'm facing a bridge, and on the other side I see what looks like a gray slab perched on a hill. The structure is buttressed by thin beams sprouting radially from the ground, and it looks a little awkward—as if it could fall the moment the next big earthquake hits. This gray slab is the University of California, San Francisco, Dolby Regeneration Medicine Building, and it is home to some of the most exciting advances in stem cell research happening today.
Built in 2011, the Dolby building is a blip of modernity on an otherwise aging campus. Chic yet utilitarian, it is easily distinguishable from the rest of the UCSF Parnassus campus, and can be spotted from miles away directly in the shadows of Sutro Tower.
As I cross the bridge to enter the building, a sentence slowly reveals itself, etched into segmented window panes lining the path: "This building is dedicated to the pioneering spirit and vision of the voters of California. Their passage of Proposition 71 created the California Institute for Regenerative Medicine, which provided major support for this facility."
Almost 15 years have passed since Prop 71 became law, and California voters made a three-billion-dollar bet on the promise of stem cell technology. At the time of its passage, the policy proposal was as groundbreaking as it was subversive.
It is easy to interpret Prop 71 as having been a direct rebuke of the Bush administration's antagonism toward embryonic stem cell research. The measure primarily sought to wean dependence on federal dollars by establishing a source of research funding separate from the National Institutes of Health. This move signaled to physicians and academics around the country that despite the negative rhetoric emerging from the White House, their work would still be valued within California, and it bolstered the state's reputation as a leader in the fight to pioneer new stem cell–based cures.
But Prop 71 undermined the federal government in other, subtler ways as well. Addressing the three-billion-dollar question of who would be responsible for meting out the state's newfound endowment, it outlined the development of California's Institute for Regenerative Medicine, a kind of pseudo-NIH staffed by scientists and ethicists, that would adjudicate claims from vying researchers. In this way, Prop 71 went beyond providing an alternate source of funding for embryonic stem cell research, and challenged the very relevance of the federal government.
Perhaps most fundamentally, as a final provision Prop 71 also enshrined the work of embryonic stem cell research as a constitutional right. The providence of that last addition has been vindicated in light of the Department of Health and Human Service's announcement Wednesday that it would revoke federal funding for any research that relies on fetal tissue derived from elective abortion.
Although Wednesday's announcement is its latest manifestation, Republican opposition to embryonic stem cell research far predates the Trump administration. There are two major avenues through which the federal government has historically sought to impose its agenda on stem cell research: the Food and Drug Administration and the National Institutes of Health. In practice, the FDA has been relatively lax in its interpretation of its role as an arbiter of stem cell research—many would say to a fault. The method of choice has instead fallen to leveraging much-needed NIH grant money, which scientists and universities depend on to stock their labs, attract post-doctoral candidates, and, most vitally, perform their lifesaving research.
Throughout the 90s, Republicans in Congress constantly sought ways of manipulating the NIH to undermine research using embryonic stem cells, with the passage of the Dickey-Wicker Amendment as the most notable and longest-lasting result of that era. First signed into law in 1995, the Dickey-Wicker Amendment prohibits NIH funding for any research that involved the destruction of human embryos. As a result, stem cell researchers were forced to adapt and restructure their research around the 60 or so preexisting embryonic stem cell lines that were already available. Republican hostility to embryonic stem cell research continued into the Bush presidency, with the president immediately reaffirming his commitment to Dickey-Wicker via executive order within his first 150 days in office, and later vetoing two different opportunities to expand federal support of embryonic stem cell research.
When Obama assumed the presidency in 2009, stem cell scientists saw a friendlier face in the Oval Office. For his part, Obama sought to declaw Dickey-Wicker by reversing the restrictive mandates of the preceding administration. He directed the NIH to develop revised guidelines to increase funding for research utilizing embryonic stem cells, citing what he saw as a "false choice between sound science and moral values." His executive orders were nonetheless constricted by existing regulations, to the extent that federal grants could not fund the generation of embryonic stem cell lines, but it allowed researchers to work undeterred by the prospect of executive branch interference.
This week, in prohibiting NIH funding of research involving fetal tissue, and specifically targeting UCSF, Trump is harkening back to the reactionary attitudes of the 1990s. The future of embryonic stem cell research appears uncertain once again, as researchers are forced to scramble to adjust to arbitrarily changing norms uninformed by science. A longstanding Republican trend has been to exalt the use of induced pluripotent stem cells, which come from the skin and can mimic the behavior of embryonic stem cells.
It should be noted, though, that even if the reliance on embryonic stem cells for their unparalleled totipotency—the ability to differentiate into any cell in the body—has dwindled in the aftermath of the discovery of induced pluripotent stem cells, there are still subtle but important distinctions between induced pluripotent stem cells and embryonic stem cells, which preclude the former's total eclipse of the latter.
Moreover, there is an inherent dishonesty in Trump's ban of fetal tissue use in federally funded research. The rationale provided by the Department of Health and Human Services states its decision is based on, "promoting the dignity of human life," but in preventing the utilization of tissue that will be routinely generated anyway, they are actively undermining research that will improve our ability to do exactly that.
At least for the moment, abortion is legal and happening. All scientific and ethical arguments aside, fetal tissue will continue to be generated. Now, though, instead of being used for potentially life-saving research, it will simply be thrown into a biohazard waste bin where it can help no one.
Fundamental to Prop 71 was the recognition that stem cell research will likely play a disproportionate role in curing certain otherwise untreatable diseases. The measure was less a "screw you" to the Bush administration, than it was an investment in our future (though it was probably both). It has spawned countless breakthroughs in potential treatments for diabetes, heart disease, HIV, spinal cord injury and osteoarthritis.
The measure was not perfect. Robert N. Klein II, one of the largest donors in support of proposition 71, ended up as head of the governing body for seven years, and questions concerning bias in the disbursement of its ample endowment linger—curiously, more than 90 percent of awards have been granted to the alma maters of sitting board members.
However, its role as a source of hope, both symbolic and realized, for the field of stem cell research is inarguable. The federal government weakens the image of the U.S. as a hub for discovery and medical ingenuity every time it prioritizes political gain over scientific progress.
These opinions are the author’s own, and are in no way intended to represent the University of California, San Francisco.