Registration of Stem Cell Based Clinical Trials

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WORLD STEM CELL REPORT 2009 GENETICS POLICY INSTITUTE 501c3

2010 WORLD STEM CELL SUMMIT DETROIT, MI OCTOBER 4-6, 2010 WWW.WORLDSTEMCELLSUMMIT.COM WWW.GENPOL.ORG15

STEM CELLS, REGENERATIVE MEDICINE, AND SOCIETY

ubstantial progress in stem cell research hasbeen made since the first report on thederivation of human embryonic stem (ES)

cells.1 As we celebrate the 10th anniversary of thislandmark event, we also witness new scientific2

and policy3, 4

milestones that reinvigorate hopesfor moving forward the clinical translation of stemcell-based interventions. Nevertheless, stem cell-based therapies remain largely at theexperimental stages and the road towards theclinical is still paved with major scientific5, 6 andethical7 hurdles. A positive signpost though, is therecent approval of what will be the worlds firstclinical trial of a hESC-derived product by theUnited States Food and Drug Administration

(FDA).

8

Geron Corporation has been grantedclearance for an Investigational New Drug (IND)application for the clinical trial of GRNOPC1 inpatients with acute spinal cord injury.

This article briefly addresses the rationale for establishing clinicaltrial registries (CTR) and the challenges arising from theirimplementation. A Clinical Trial Registry (CTR) is a publiclyavailable database of all human interventional clinical trials*regardless of the stage of development at inception, while inprogress or after completion and of their publication status. Theraison dtre for mandating the prospective registration of all stem-cell based clinical trials will be discussed. It is beyond the scope of this

paper to provide a comprehensive analysis of the wide range ofpossible approaches, policy responses and their implications.However, we want to provide a starting point for discussionsurrounding key questions and challenges facing clinical trialregistration, questions that go beyond a call for voluntarypublication.

SMoving Towards the Clinic: Science,Policy and Ethics

Alongside these new scientific advances, important policydevelopments have also taken place. The International Society forStem Cell Research (ISSCR) adopted the first professional guidelinessetting standards for the clinical translation of stem cells9 in three

major areas: cell processing and manufacturing, pre-clinical studiesand clinical research. The guidelines encompass recommendationsand establish principles for the scientific, clinical and ethical conductof translational stem cell researchers, clinician-scientists, andregulators in the international community.

In the context of medical research ethics in general, anothersignificant policy development took place while we celebrate a decadesince James Thomsons discovery. The World Medical Associationamended the Helsinki Declaration,10 the primary source and arbiterof research ethics worldwide.11While the Declaration is addressedprimarily to physicians, the WMA intends for the Declarations scopeto reach a full range of stakeholders.

Both the Helsinki Declaration and the ISSCR guidelines

recognize that authors, editors and publishers have ethical obligationswith regard to the full publication of research results, whethernegative, inconclusive or positive. Similarly, they recognize the rightof research participants in particular and society in general to haveaccess to this information. Moreover, the Declaration of Helsinkitook the unprecedented move to call for the registration of everyclinical trial in a publicly accessible database before the recruitment ofthe first research subject (Principle 19). In contrast, the ISSCRguidelines called only for the publication of both positive andnegative results and adverse events at professional scientificconferences or in peer-review scientific journals before reporting theirresearch to the lay media or to patient advocacy groups and

associations (Recommendation 33).The aforementioned policy recommendations are of significantimportance as they establish principles for strengthening transparencyin clinical research by calling for the prospective publication ofresearch results. By promoting transparency, they are encouragingscientific and ethical integrity in clinical trials. They are also seeking

Registration of Stem Cell-BasedClinical Trials: A Scientific and

Ethical ImperativeBy Rosario M. Isasi, J.D., M.P.H.

*The World Health Organization defines, for the purposes of registration, a clinical trial as any research study that prospectively assigns human participants or groups of humansto one or more health-related interventions to evaluate the effects on health outcomes. Clinical trials may also be referred to as interventional trials. Interventions include but are

not restricted to drugs, cells and other biological products, surgical procedures, radiologic procedures, devices, behavioural treatments, process-of-care changes, preventive care, etc.

This definition includes Phase I to Phase IV trials. http://www.who.int/ictrp/en/
http://www.worldstemcellsummit.com/http://www.genpol.org/http://www.genpol.org/http://www.genpol.org/http://www.worldstemcellsummit.com/


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trial results.23 It sought transparency and accountability in scientificresearch with human participants.

When proposing human clinical trials, ethics demandsevidence.24 Clinical trial registration aims to meet this ethical duty byfacilitating access to the details of both clinical trials protocol and itsinitiation (e.g. objectives, main design features, sample size, and

tested treatments) and to results of key trial endpoints,25

in acomprehensive and objective manner. As stated in the introduction,a Clinical Trial Registry (CTR) is a publicly available database of allhuman interventional clinical trials regardless of the stage ofdevelopment and of their publication status.

In order to be effective, clinical trial registries must be globalcomprehensive, accurate, and publicly accessible. In addition, accessto a registry should be simple, inexpensive and appropriate to theintended user population to allow for the unrestricted disseminationof research results. All these should be coupled with an independentverification of postings and compliance mechanisms in order toensure that ethical standards in clinical practice are respected.

The raison dtre for the establishment of a CTR is to serve as a

vehicle for knowledge transfer by providing an unbiased public recordon safety and effectiveness, which in turn is translated in thefoundation of evidence-based medicine. Moreover, by requiring theprospective registration of clinical trials at their inception, theproblem of bias in the body of evidence could be largely eliminated,as registration in a CTR would occur independently of the ultimatefindings or publication status of a trial. (Table 1)

to maintain public trust, essential for the feasibility of any scientificendeavor but even more so in an area that has elucidated so muchpolitical, social and ethical controversy, that of stem cell research.

Over the past decades, clinical trials of stem cell-basedinterventions (e.g. transplantation) have been carried out usingumbilical cord blood stem cells and autologous adult stem cells (e.g.

hematopoietic stem cells or blood stem cells) to treat diseases such asleukemia, lymphoma and several inherited blood disorders. Thesafety and efficacy of these interventions has been well established.Conversely, interventions using human embryonic stem cells andfetal tissue are still in early experimental stages. Controversial clinicaltrials using these same sources of stem cell lines are reportedly beingconducted in several countries,12 some with little scientific or otheroversight and no evaluation of clinical outcomes and safety.

Indeed, unproven stem cell interventions outside a clearlyregulated clinical trial are proliferating around the world, facilitatedby loopholes in several national regulatory systems or evenencouraged by government support.13 Confusion between theseunproven interventions and scientifically sound and rigorously

designed clinical trials puts at risk not only the safety of researchparticipants, but also damages the integrity of the field as it erodespublic trust.14 Similar negative effects arise from the lack oftransparency in disclosing the protocol design and its outcomes in anumber of legitimate stem cell-based clinical trials and interventions.

In the field of stem cell research, the prospect of clinical trialregistration has seldom been explored. This is inspite of a globalconsensus15 that recognizes the need for prospective registration of allinterventional trials as a scientific, ethical and professional imperative(if not a legal obligation) for scientists, governments and fundingorganizations.16 This duty is grounded in the fundamental need todisseminate knowledge and protect and respect research participantsand patients.17 Notwithstanding this consensual duty, a gap between

the number of trials conducted and the number for which results arepublicly available persists and has been well-documented.18 To addressthis problem, a wide variety of stakeholders have adopted a broadrange of approaches.19, 20 They range from policies mandating clinicaltrial registration as a pre-condition of publication,21 to the creation ofnational registries* and an International Clinical Trial RegistryPlatform by the World Health Organization (WHO).**

Clinical Trial Registration and ItsRaison dtre

The movement towards establishing clinical trials registrationemerged as a reaction to scandals surrounding structural flaws in the

clinical trials enterprise22

that ranged from publication bias,regulatory lapses, to secrecy and intentional misrepresentations of


*See for example the following national clinical trial registries: USA Clinical Trials.gov, Australian New Zealand Clinical Trials Registry (ANZCTR), Chinese Clinical Trial Register(ChiCTR), Clinical Trials Registry India (CTRI), German Clinical Trials Register (DRKS), Iranian Registry of Clinical Trials (IRCT), Japan Primary Registries Network, The

Netherlands National, Trial Register (NTR), Sri Lanka Clinical Trials Registry (SLCTR)

**The WHO International Clinical Trials Registry Platform (ICTRP) overall objective is to ensure that a complete view of research is accessible to all those involved in health caredecision making. This will improve research transparency and will ultimately strengthen the validity and value of the scientific evidence base. The ICTRP was developed in

collaboration with the International Standard Randomised Controlled Trial Number (ISRCTN) register, based in the UK, and the ClinicalTrials.gov registry, based in the US, theICTRP with the aim to promote consensus regarding international norms and standards in clinical trial registration. The ICTRP requires that clinical trials are registered at inception

and proposes that a unique Universal Trial Reference Number be given to each trial to prevent duplication. The ICTRP is not a registry itself but a comprehensive search portal for

registries that exist worldwide. http://www.who.int/ictrp/en/

Table 1: Clinical Trial Registry: Objectives

1. Respect the investigator-participant covenantto contribute to biomedical knowledge by

making trial methods and findings public.2. Strengthen protection and respect for research

participants

3. Foster accountability and transparency withregard to global standards for ethical research.

4. Provide a foundation for evidence-basedmedicine

5. Serve as a vehicle for knowledge transfer byproviding an unbiased public record on safetyand effectiveness

6. Advance innovation and acceleration of

research practice in clinical therapies


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Transplantation of cells derived from pluripotent stem cells isstill a highly innovative practice and consequently, a great degree ofuncertainty exists with respect of weighing the benefit/risk ratio forsuch interventions. The advantages that pluripotent stem cells possessin terms of their capacity for self-renewal and differentiation; arepaired with the immense challenge of establishing mechanisms toadequately control them in order to prevent negative effects such as

Furthermore, it is the goal of a CTR to enable to carry out meta-analyses. Meta-analyses or quantitative overviews are the primarymeans by which the safety and efficacy of new drugs and otherinterventions are assessed. Often individual clinical trials lackadequate statistical power to reliably adjudicate between alternativetreatments strategies. It is therefore necessary in many instances to

conduct meta-analyses or quantitative overviews of all relevant trialsin order to draw conclusions about the efficacy of a particulartreatment or procedure.26 To this date, the results of meta-analysisstudies have improved clinical practice in many areas of medicine.27

Stem cell research plays a key role in the increasingly promisingarea of regenerative medicine, showing potential to improve ourability to treat, prevent and cure disease by providing a potentialunlimited source of cells for organ transplantation and therapies.Stem cell research could also provide a successful model system fordrug discovery, including the development of new testing methodsfor efficacy, toxicity and safety. It will improve our understanding ofthe processes of human cell differentiation and development, withpossible positive consequences for the treatment of diseases such as

cancer. Finally, research using induced pluripotent cell (IPs cells) andsomatic cell nuclear transfer (SCNT) will create patient-and-diseasespecific stem cell lines for research purposes and eventually, for safeand effective therapies.28


Table 2

The registration of all interventional trials is ascientific, ethical and moral responsibility. WHOInternational Clinical Trials Registry Platform (ICTRP)

A Snap-shot of Stem Cell-based Clinical Trialavailable through WHOs ICTRP*

Key Word Number of Trials

Stem Cells 1837Hematopoietic Stem Cells 470Autologous Stem Cells 19Cord Blood Stem Cells 03Embryonic Stem Cells 03Adult Stem Cells 18Fetal Stem Cells 0IPs 03*The search was conducted on June 15th 2009.

http://www.who.int/ictrp/en/

tumor formation, excess proliferation, inappropriate differentiation,improper localization, among other serious adverse events. Thepotential for significant risks arising from these interventions aredistinct from all other therapies. Accordingly, they warrant particularscrutiny with regards to their protocol design, conduct and analysis(e.g. type of cell, disease or condition concerned, control cases,

participant enrollment, ethics approval, outcomes, follow-up, etc.); tosay nothing about evidence of safety and efficacy.29 On this latterpoint, the recommendations issued in ISSCR`s Clinical Translationguidelines are illustrative. The guidelines call on researchers topublish positive results, negative results, and adverse events and thuspromote transparency, to prevent others from being subjected tounnecessary risk in future clinical research and to ensure thedevelopment of clinically effective and competitive stem-cell basedtherapies.30

The impact of trial registration of cell-based clinicalinterventions should not be taken lightly. The continuous andcomprehensive registration of these interventions could significantlyimpact the foundation of evidence-based medicine, and even shape

clinical practice by supporting the translation of research from thebench to the bedside through the development of best practiceguidelines. To draft best practice guidelines such as those adoptedby ISSCR -, professional organizations rely on the body of scientificevidence; which in turn outlines the current standard of careSimilarly, policy-makers often rely on such evidence when draftinglaws and regulations dealing with scientific and medical practice. Asa result, clinical trial registration could have a great impact in shapingnot only public policy, but also medical or product liability. The latteris of particular importance given the already mentioned proliferationof scientifically unproven and ethically problematic cell-basedinterventions.

The principle of benefit sharing provides an additional

justification for advocating for the prospective registration of clinicaltrials. Clinical trials contribute to building societys collectiveknowledge. The financial investments committed by sponsors ofclinical research especially when obtained by public funders demand for the resulting knowledge to be shared.31 by informingpriority setting and the planning of future studies, identifying trendsand gaps and avoiding unnecessary duplication (which must bedistinguished from appropriate replication) of research.

Of equal importance are the objectives of respecting theinvestigator-participant covenant to contribute to biomedicalknowledge by making trial methods and outcomes public. Mostoften, the participation of healthy volunteers in a clinical trial takesplace because such individuals believe they are contributing to thegeneration of medical knowledge. However, when the knowledgegained is never transferred, the trust between investigators, researchparticipants and the public at large is breached.

Fostering accountability and transparency with regard to globalstandards for ethical research is also a goal of clinical trial registration

A fundamental tenet of research ethics is respect for autonomy. Forresearch participants to be respected as autonomous agents, they mustprovide free, voluntary and informed consent. The latter can only beachieved by publicly disclosing the body of evidence as pertains totrial findings (inconclusive, negative or positive), thus making explicit


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the current standard of care .This public record empowers researchparticipants, enabling them to make informed decisions, especially

with respect to the balancing of the benefits and risks of participation.It further mitigates the chances of therapeutic misconception.Strengthening protections for research participants in early stem cell-based clinical trials is necessary given the highly innovative nature of

these interventions, and the likelihood that recruitment of researchparticipants would be done from the most vulnerable populations(e.g. the severely ill).32

Clinical Trial Registration: Challenges

At the present time, registration of clinical trials is generallyvoluntary, making compliance mechanisms difficult to enforce.However, some national jurisdictions and international institutionspolicies have adopted policies making registration a compulsoryrequirement (e.g. USA, India, Australia, Argentina, EuropeanCommission, etc.). Unlike the World Health Organizations ClinicalTrial Platform, which is based on voluntary registration, theInternational Committee of Medical Journal Editors (ICMJE)33

mandates that any manuscript detailing clinical trial findings must berecorded in a publicly accessed registry before it can be published.The ICMJE, an organization which represents eleven renownedmedical journals, has thus taken the initiative to prevent publicationbias while giving researchers an incentive to register their trials.

In the stem cell research context, as previously stated, the ISSCRstopped short of calling for mandatory clinical trial registration of allstem cell-based clinical trials. It opted instead for calling for thepublication of research findings via scientific conferences and peer-reviewed journals, thus confining to a certain extent* thedissemination of knowledge to professional circles. The timelypublication of research findings is particularly important in a rapidlyevolving field that has elicited so much hope, hype and polarizedpolitical, social and ethical debates. Dissemination of researchfindings in scientific circles (e.g. conference, journals) and trialregistration should not be interpreted as excluding requirements butrather as having a complementary role. A clinical trial registry ifadequately designed targets not only the scientific audience but alsoto the lay public, thus making information available to a wideraudience.

The success of a clinical trial registry relies on its ability to meetthe needs of the primary intended users, patients and other membersof the public. But ultimately it depends on a willingness to contributeto a joint enterprise for the common good.34 In order to ensurecompliance, institutional review boards should require clinical trial

registration as a condition of approval35

and so institutionalresponsibility would be established.Aside from implementing compliance mechanisms, the

auditing, monitoring and oversight of existing registries are additionaldifficulties that must be overcome in order for clinical trialregistration to be effective. Similarly, to maintain trust, safeguards toprotect privacy and confidentiality of research participants andproprietary information should be established. A registry includes

extensive data coming from multiple sources; it requires frequentupdating to remain thorough and correct. Therefore, verificationprocedures must be enforced to ensure accuracy and qualityassurance.

It is argued that clinical trials should be registered at all phases,even at inception, in order to ensure full disclosure. Without the

registration of clinical trials at all phases, it would be impossible eitherto know adverse reactions or to assess safety and efficacy. Theregistration of early-phase clinical trials would ensure then that therisks related to new interventions or treatments are publicly known,36

thus preventing ineffective or harmful interventions from continuingIf clinical trials are registered only after they have been completed andfound to be favourable, or published, publication bias will result.Furthermore, requiring that clinical trials be registered at inception

would prevent the loss of potentially valuable scientific informationdue to early trials that are often terminated for economic reasons. 37

Particular challenges relate to the design and scope of a clinicaltrial registry for stem cell lines, especially concerning theestablishment of a minimum data set as it would require agreement

on standard data elements. A mandatory, minimum data set fosterstransparency and accountability by providing a comprehensive andtransparent (non-promotional) posting of methodology and resultsThe currency and accuracy of the information in a prospectiveregistry is of paramount importance. In the case of stem cell clinicaltrials, data must include information regarding the origin of thehuman stem cell lines, their derivation and culture methods andconditions, traceability requirements as well as their bankingprocedures.

Clinical trial registration still faces unyielding resistance from thepharmaceutical and biomedical industries. As these industriesaccount for the majority of clinical trials sponsors, it is essential thatthese industries participate and comply with registration and

publication standards. Their reluctance steams on the alleged adverseeffects of trial registration on their intellectual property rightscommercial or academic competitive advantage; as well as on thedangers of international piracy and/or the disclosure of trade secrets.3

All of these factors could negatively target their therapeuticdevelopment and regulatory strategies, potentially damaging investorinterests and stock value.39

The pharmaceutical and biotechnological industries concedethat the dissemination of knowledge and the protection of the rightsand the safety of patients (and research participants) should triumphover concerns for the confidentiality of proprietary interests, theprotection of academic freedom and the exclusivity of research ideas.40

However, they argue that clinical trial registration would not have theeffect of increasing safety or protections for researchparticipants/patients nor of diminishing publication bias. It remainsto be seen if a balance between those conflicting interests could beachieved in order to serve the public interest. As pointed out byRennie, the financial cost of an effective, independent andtransparent clinical trial register would amount to a tiny fraction ofthe costs of the trials themselves, or the costs of not knowing their

*ISSCR published along to the Guidelines for the Clinical Translation of Stem Cell, a Patient Handbook on Stem Cell Therapies (December 2008), providing valuable scientificinformation for patients and their doctors evaluating a stem cell therapy.


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results, while the personal costs of allowing the present chaotic systemto continue are incalculable.41

Conclusion

History has taught us many cautionary lessons of significantharms arising from moving forward with a scientific field of inquiry

without transparency and accountability. These harms go beyondphysical harms to research participants, but they extend to ethical andmoral ones that reach society and science itself, eroding public trust.Scientific research holds out much promise for potential socialbenefits for funders, research participants and society in general.However, this promise cannot be realized if research findings areconcealed, selectively reported or misrepresented. The globalconsensus declaring the prospective registration of clinical trials ascientific, ethical and professional obligation is a major milestone.

Yet, this recognition is insufficient in the absence of compliance. To

date, voluntary schemes calling for publication and registration havemet with limited success.

Prospective disclosure of research findings and clinical trialresults fosters innovation and scientific rigor. As stem cell researchrapidly evolves, bringing us one step closer to the clinic, the time isripe to remind us all of the ethical duties we owe to society, to science

and to ourselves. Hence, this renewed call for making clinical trialregistration a mandatory requirement.

Acknowledgements

The author thanks the Canadian Stem Cell Network and theInternational Stem Cell Forum for their funding support. The author isespecially grateful to Maya Shukairy for providing expert researchassistance and valuable comments. The opinions are those of the authoralone.

Rosario Isasi is currently a Researcher theCentre of Genomics and Policy, Faculty ofMedicine, Department of HumanGenetics, Mc Gill University.

Her research interests intersect publichealth, ethics, law and science. She hasparticular expertise in the area of

comparative law and international governance issues surroundingregenerative medicine and stem cell research. She has published inScience, Human Reproduction, Cell Stem Cell, Stem Cell Research,

AJLM, JLME among other journals.

Closely related to her academic work is her role as a policy adviser togovernment, professional and international bodies, such as theUnited Nations, where she played an active role in the adoption of

the UN Declaration on Human Cloning. Most recently, she hascontributed to the Bioethics Education Project of the Royal Collegeof Physicians and Surgeons of Canada.

Rosario Isasi is the Academic Secretary of the International StemCell Forum Ethics Working Party and a member of the HinxtonGroup, an international Consortium on Stem Cells, Ethics andLaw. She is also a member of the Legal and Human Rights AdvisoryBoard of the Genetics Policy Institute; and member of the advisoryboard of Global Lawyers and Physicians, a transnationalprofessional association of lawyers and physicians working together

to promote human rights and health.

She holds her J.D. from the Pontifical Catholic University of Peru,where she practiced corporate and health law. She received herMasters of Public Health from Boston University, USA.

Rosario M. Isasi, J.D., M.P.H.

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Transplantation: Guidelines for Scientific and Ethical Review. ClinicaTrials, 5, 517-522.

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11. Goodyear, M.D., Lemmens, T., Sprumont, D., et.al. (2009). The FDAand the Declaration of Helsinki. BMJ, 338(7704), 1157-58.

12. Kiatpongsan, S., & Sipp, D. (2009). Monitoring and RegulatingOffshore Stem Cell Clinics. Science, 323, 1564-65.

13. MacReady, N. (April 2009). Special Report: The Murky Ethics ofStem-Cell Tourism. The Lancet,10, 317-18.

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n March 9, 2009 President Barack Obamasigned an Executive Order expandingfederal funding for research using

embryonic stem cells in a White House signingceremony packed with legislators, scientists, andpeople who have suffered from a range ofdiseases and medical conditions that couldbenefit from the research. The Presidents

executive order was a major milestone in the 10-year effort by those patients, scientists,academics, and others who have argued insupport of a broader federal stem cell policy.1

In some ways, the most telling aspect of the ceremony was thatwhen President Obama signed the Executive Order, numerousmembers of Congress were in attendance. Their presence signaled asignificant shift in public opinion regarding the use of federal fundingfor embryonic stem cell research; further, it demonstrated theattitudinal changes regarding stem cell science that have taken placesince 1998, when embryonic stem cells were first derived.

Today, for many Americans, stem cell science is viewed aspotentially beneficial not just for people suffering from disease

but in maintaining the countrys prominence and preeminence inscientific leadership. In a remarkably short timeframe, stem cellscience has made the unusual transformation from a non-issue to apolitical hot button and to an issue that transcends politics.

Background

Embryonic stem cells were first discovered in 1998 by Dr. JamieThomson of the University of Wisconsin and Dr. John Gearhart ofthe Johns Hopkins University.2, 3 While widely applauded for itspotential in the scientific community, their discoveries very quicklyset off a firestorm affecting researchers, ethicists, politicians and, mostimportantly, patients in the United States (US) and around the

world. In fact, the first series of congressional hearings on the sciencefollowed quickly, beginning in January 1999, when the SenateCommittee on Health, Education, Labor, and Pensions convenedsessions involving a series of top researchers and ethicists. 4

What became clear at the outset was that most US policymakersdid not have an understanding of stem cell research and therefore

were uncomfortable with the concept. Almost immediately, thesource of embryonic stem cells became a key issue in the discussionand debate and initially there were broad misunderstandings aboutthe origin of stem cells with many assuming the issue to be

Oassociated with abortion.

At the time, relatively few legislators had a clear understandingof the reality; the stem cells at the center of the issue were cells derivedfrom embryos created for in vitro fertilization (IVF) procedures. Infact, the cells in question were not going to be used and were slatedto be discarded.

More often than not, the creation of embryonic stem cells waserroneously linked to abortion, and the corresponding political,moral, and religious issues that it entailed. To compound theproblem, there were a handful of legislators and others that might

have understood that abortion was not tied to stem cells, but did nothave a detailed understanding of or were uncomfortable with the IVFprocess itself. As a result, the immediate political reaction to the 1998Thomson/Gearhart discoveries leaned toward a ban on the research.

The Role of Patient Advocacy

In response to initial fears and negative reactions (often based onmisunderstanding), an organized effort was launched on the part ofpatient advocacy groups to delay any potential federal ban onembryonic stem cell research. The aim was to provide education onthe role of stem cells, the science, and their potential for therapies andcures for leading conditions. In addition, time was needed to enablediscussion and debate related to surrounding ethical and religiousimplications. This effort started with Patients Cure, originally formedby Dan Perry, who was the Executive Director of the Alliance for

Aging Research. Patients Cures major focus was to slow themomentum of any amendments that might surface in Congressrestricting federal funding and support for stem cell research.

Patient advocacy in the area of stem cell research emerged amongthe campaign promises made by then Presidential candidate George

W. Bush, who pledged to impose a ban on federal funding forembryonic stem cell research. Once elected, it was clear that a largerscale and more comprehensive effort would be required to preservefederal funding for the research if not the ability to conduct stemcell research itself.

Formation of the Coalition for theAdvancement of Medical Research (CAMR)

The result was the creation of the Coalition for theAdvancement of Medical Research (CAMR). Today, CAMRcomprises more than 100 nationally recognized patient organizations,universities, scientific societies, and foundations, and conductsadvocacy and education outreach focused on developing bettertreatments and cures for people with life-threatening illnesses anddisorders.

Federal Funding of Stem CellResearch: Past, Present and FutureBy Lawrence A. Soler, J.D.

Documents

Registration of Stem Cell Based Clinical Trials