On the evening of November 3, 2020, like most Americans, I was waiting with excitement and a certain amount of trepidation for election results. While most of the country was focused on Biden versus Trump, my attention was drawn repeatedly to the emerging results for California Ballot Proposition 14. Proposition 14, The California Stem Cell Research, Treatments, and Cures Initiative of 2020, is a continuation of Proposition 71, which was passed in 2004 by a strong majority, almost 60%, of California voters including numerous Republicans as well as Democrats. Like Proposition 71, Proposition 14 will fund the California Institute for Regenerative Medicine (CIRM) for another 10 years by authorizing $5.5 billion in bonds. Poll numbers had been good, as they were for Proposition 71, but we were worried about the effects of the SARS-CoV-2 pandemic on public attitudes. Ultimately, Proposition 14 passed, although it took 9 more days to get there. From election night until November 12 we were all waiting hopefully while dropping from 52% Yes to 51% Yes with 49% No, which was the ultimate tally of the votes. Once again, Bob Klein, a Palo Alto housing developer, lawyer, and patient advocate, served as lead author and chair of the campaign for Proposition 14. Bob organized and led a team of committed patient advocates and recruited expert political advice from the political consulting firm Winner and Mandabach, with communications handled primarily by Fiona Hutton and Associates. As with Proposition 71, I served as co-chair of the scientific advisory board (SAB) for the Proposition 14 campaign along with Irv Weissman from Stanford, and Mitra Hooshmand, who had done her Ph.D. work with Aileen Anderson, served as liaison between the SAB and the campaign committee. The scientific advisory board consisted of academic and clinical stem cell and regenerative medicine experts from across California universities, research institutes, and academic health centers. From my vantage point, the SAB worked together effectively and efficiently with the campaign team to get Proposition 14 written, qualified for the ballot, and ultimately passed. During this effort, I learned a great deal about the importance of patient advocates in a political campaign and the interplay of scientific evidence with the needs and behavior of print and broadcast media and the political system. A note about Bob Klein: I have developed enormous respect for Bob’s energy, intelligence, and commitment. Although not a scientist, Bob is a devoted patient advocate committed to medical science in the hope of bettering human health. Bob has worked for more than 20 years to leverage stem cell research in the hopes of finding better therapies to reduce human suffering. Bob’s personal focus is on type 1 diabetes, which afflicted his late son Jordan. I’ve never met anyone quite like Bob—although not a scientist, he listens carefully to scientific arguments, and he has an appreciation for scientific data and principles. But, Bob made his own decisions integrating campaign needs and political reality with accurate scientific advice. Bob’s decisions in this arena have been very good over the years I’ve known him. Based on my experience, science and scientists should provide good, sound, objective expert scientific advice about data, interpretation, design, and outlook, including managing expectations. But, scientists shouldn’t necessarily decide what political directions to go in.A key point about the scientific advisory board to the campaign: it was designed to give advice, not to make decisions. This fits with my own thinking about the role of science in the political process. Based on my experience, science and scientists should provide good, sound, objective expert scientific advice about data, interpretation, design, and outlook, including managing expectations. But, scientists shouldn’t necessarily decide what political directions to go in. That is up to the expert political leadership and communications teams, who must balance scientific input with real world political reality, fundraising, and ultimately messaging. This balancing act can sometimes lead to tension as messages get hammered out that are scientifically accurate but still compelling and understandable to the public at large. We have recently seen the importance of this principal in the sadly erratic handling of the COVID-19 pandemic. An example of this tension is in the messaging around patient responses in early clinical trials. There were numerous cases in CIRM-supported clinical trials of patients who appeared to clearly improve, including children whose genetically damaged immune systems were apparently restored by transplant of genetically engineered hematopoietic stem cells. More than 50 of these children responded dramatically in clinical trials. These results seemed to be very clear given historical data that these children rarely if ever recovered their immune systems on their own. Although most of these children have been healthy for years, as a scientist I knew that the trials didn’t reveal how long restoration would last, nor were there actual placebo controls as ordinarily wanted in gold-standard double-blind clinical trials. Nonetheless, my and others’ judgment was that given the obviously strong responses, messaging could legitimately talk about these children as having their immune systems restored. Similarly, many cancer trials produced dramatic effects with two FDA-approved cancer therapies being developed with important CIRM contributions. In addition, companies developing these and other cancer therapies such as antibodies directed against the CD47 “Don’t Eat Me” signal or ROR1 were purchased for substantial sums based on promising early clinical trial data. What was tricky was finding ways to state these findings without understating or inflating the significance of the early results.Results from trials of cell transplants to treat spinal cord injury, blindness, and other conditions were less dramatic but compared to clinical experience strongly suggested that the cell therapies were having important, positive effects. What was tricky was finding ways to state these findings without understating or inflating the significance of the early results. Again, the role of scientific advice is to help ensure that the campaign messaging is as accurate as possible. We generally managed to develop statements that were scientifically accurate while reflecting uncertainty as straightforwardly as possible. What was often difficult were situations where long and involved statements, caveats, and detailed descriptions couldn’t be used or wouldn’t be accepted because of typical time limits required in sound bites or quotes for radio, TV, or print media. In those situations, my judgement was that the observation needed to be accurately stated and the need noted for additional work as an important reason to pass Proposition 14 so that there would be funds to continue the trials to learn rigorously what was going on in the early-stage therapy trials. TV, radio, and newspapers always carried the hazard, which we often experienced in both the Proposition 71 and Proposition 14 campaigns, that the media outlet we were dealing with would cherry-pick the statements that they wanted to use in their coverage. They would not necessarily include the caveats and in many cases they exaggerated the promise and speed with which effective treatments could be developed. These types of situations were obviously less than ideal, but that is a persistent and long-term hazard of science reporting that I and other scientists have often experienced. These problems are not good reasons to avoid working with the press. Science reporting, even in a political context, is crucial to the long-term health of science and should be fostered and improved since we must find ways to keep the public who pays for our work informed about what we are doing with their funds. I worked closely with Bob and the communications team to try and get communication as accurate as possible while reflecting uncertainty where warranted. Similar to what happens in the writing of scientific papers with collaborators, the discussions often came down to discussions and debates about a single word! One huge problem that we encountered was the pandemic itself. After working for several years to do the background work needed to write the ballot proposition and to begin the public education process, we were irreversibly committed to the 2020 ballot. The pandemic hit while we were about 85% of the way to securing enough signatures for the initiative to qualify for the ballot in November 2020. There was a great deal of scrambling as the campaign worked to mobilize volunteers throughout the state. This effort focused on patient advocacy organizations, patient advocates and their families, and many of the people more formally involved in the campaign itself. We managed, but it was nerve-wracking and a close call. We encountered two additional and formidable problems. First was the problem of how to hold the various meetings needed to garner editorial board support and endorsements from chambers of commerce, political figures, and prominent scientists. Thus, the Proposition 14 campaign was completely different from the Proposition 71 campaign where we had traveled around the state giving interviews, appearing at TV stations for discussions and debates, and meeting with dispersed newspaper editorial boards in the very large state of California. As part of the adjustments needed, I effectively converted my dining room into a makeshift studio for TV and other interviews. The second problem we encountered was that the COVID-19 pandemic created significant political and social questions that had to be answered. California was clearly experiencing new fiscal problems and stresses owing to the pandemic so that we had to make the case more clearly that Proposition 71 and CIRM had made enough progress on treating diseases successfully to warrant the new fiscal commitment required. We were helped in making this case by arguing that Proposition 14 was structured such that financial benefits and stimulation of job creation in this area of biomedicine would accrue early by stimulating the expansion of California’s already substantial biotech and pharma industries. In fact, the argument that California’s innovative science and technology communities were uniquely poised to build on this type of public funding of stem cell research and medicine was well received. Thus, since bond payments wouldn’t start for 5–6 years after initiation of the new effort, the state would accrue financial benefits before payments needed to be made and after the economic problems wrought by the pandemic diminished. Finally, we continued to make the argument that the cost of the proposed research would be an average of $5 per year per California citizen. This amount is a tiny investment compared to the substantial annual financial burden (estimated to be >$300 billion/year) of chronic disease that we thought could be significantly reduced over time by research. An odd feature of this year’s campaign was that most newspaper editorial boards declined to endorse Proposition 14 for reasons that we thought were inadequate or incorrect. We nonetheless secured most other important endorsements including almost all of the important chambers of commerce, which in turn allowed us to make the case that tax and business issues had been appropriately evaluated by groups most engaged with California’s economic health. We also obtained endorsements from the University of California Regents, Governor Newsom, and many other state officials. These latter endorsements may have balanced out the unfavorable reception we received at many editorial boards. In my personal role, I elected to make contributions beyond what I had done in 2004 when we passed Proposition 71. To ensure that I complied with California state law regarding prohibition of the use of state resources for political activity, I went effectively half-time by going on 50% vacation, buying a personal laptop, and having my cell phone billed to me. Because of COVID-19 restrictions I was unable to use my office and so I was working at home owing to UC San Diego policies on work during the pandemic. As part of my personal time use, I signed one of the ballot argument rebuttals and spent a Sunday making a TV commercial that was widely aired. I also gave numerous TV, radio, and newspaper interviews countering what I thought were the sometimes completely false statements from the few and disorganized opponents. I believe that my experience again establishes that scientists can provide input to, and participate in, political debates without losing their integrity, and that their input is in fact essential. My work built upon years of advocacy and education work regarding biomedical science and its value to our citizens and our country. While challenging to balance my public service work with my time running an active lab, I consciously made the decision years ago to make my commitment to education of political figures and the public about science my primary community service work. In turn, I diminished the amount of time I spent reviewing grants and papers, or Study Section and editorial board service. Thus, my participation in the Proposition 14 campaign was a continuation of my committing part of my time to informing the public and the political system of the value of biomedical research in general and stem cell research in particular. I was prepared for the Proposition 14 campaign by a number of experiences. For example, I testified in 1998 about the value of human embryonic stem cells during hearings of the U.S. Senate’s appropriations subcommittee that handled the NIH. This subcommittee was chaired by Senator Arlen Spector whose commitment to biomedical research funding was well known. Since 1998 I testified in numerous other hearings in the Senate, the House, and the California legislature. I participated in numerous briefings of National and California legislators and staff about stem cells, cloning, and biomedical research funding in general. Finally, I participated in the passage of HR 810 in 2005/2006, which sought to broaden the range of human embryonic stem cell lines available to be used with federal funding and that was regrettably vetoed by President Bush. I have always hoped that my commitment to these issues would encourage other scientists to engage with their legislators, though perhaps not at my level of involvement. I have also learned a great deal about interactions with the media over the years. Perhaps most important is the need to properly educate a reporter about the scientific evidence and background so that they would choose appropriately representative examples and quotes.I can however say that informing public entities and the government about the value of scientific research and the importance of funding that is calibrated relative to need is essential to the health of our community and people. Would I recommend that other scientists become as involved in a political campaign as I did? Not necessarily. Everyone in our community will need to find personal solutions to deciding what fraction of their time to devote to service work and whether that work will be directed to political figures, legislators, or other community service work. I can however say that informing public entities and the government about the value of scientific research and the importance of funding that is calibrated relative to need is essential to the health of our community and people. I have found that legislators and their staff, and members of the public I’ve encountered in my neighborhood, at Rotary clubs, churches, and other civic organizations, welcome my participation. They were generally open-minded about the various issues I’ve engaged with over the years such as human embryonic stem cell research and fetal tissue research. It’s certainly been personally rewarding. Most important is that unless scientists engage with the political process and the public, then those with no knowledge of science will make decisions and policies that we will have trouble living with, and that will damage science and scientific research. The increasingly important need to include scientific principles and information in public decision-making is a long-term fight that we must collectively continue. L.S.B.G. is a Distinguished Professor in the Department of Cellular and Molecular Medicine and Department of Neurosciences at UCSD and serves as the Scientific Director at the Sanford Consortium for Regenerative Medicine. He serves as Co-chair of the Scientific Advisory Board to the following: Yes on Proposition 14 Campaign, Californians for Stem Cell; Research, Treatments, and Cures; and Americans for Cures. He also serves as a Public Policy Committee member of the ISSCR and is an Editorial Board member of Stem Cell Reports. He has an FDA consultant appointment in process and has received a nomination to CIRM ICOC as a delegate. L.S.B.G. receives funding from NIH, CIRM, and DOD. L.S.B.G. is a Cytokinetics Inc. co-founder, stockholder, and SAB member, and he owns a pending patent on formulations of a drug to treat tauopathy (U.S. Application No. 62/928,590 / UCSD Ref. No.: SD-2020-102-1, Provisional / Eversheds Sutherland Ref. No.: 24978-0522).
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Jun 19, 2023
James F. Childress 
Open Access