I enjoyed reading Dan Callahan's interesting discussion of the liberal fetish for embryonic stem cells. Dan finds literacy programs a more worthy social priority than merely "promising" but hugely expensive research into the medical applications of stem cells. I think Dan misses something else that can be said on behalf of this research. While those who emphasize the possible medical applications of embryonic stem cell research think of it as applied science, it can also be viewed as basic science. Every part of a human body is assembled from parts that were once stem cells. Determining the conditions required to turn stem cells into specific tissue types will tell us a lot about how humans are made - it may even tell us something about what it means to be human. We can compare the large sums of money spent on stem cell research with the huge sums consumed by space exploration, another necessarily expensive basic research program. It's certainly up for debate in a liberal society how much money gets spent on basic science - a society that sends space rockets to Saturn's moons when so many people can't even read may seem obscene. But speaking as someone employed as an academic philosopher (and financially independent of pharmaceutical or biotechnology companies), I rather like the idea of the pursuit of knowledge as one of society's priorities. Those who defend NASA's billions sometimes point to the practical second-hand benefits of space exploration - even going so far as to fraudulently claim Velcro and Tang for NASA. They should instead insist that space research is really about answering fundamental questions about the makeup of the Universe and our place in it. Perhaps we should say that embryonic stem cell research is really about finding out how human beings are made. It might just possibly lead to cures for terrible diseases too.

- Nicholas Agar

I'll start off by saying that I deeply respect Daniel Callahan's body of work, and that What Price Better Health should be mandatory reading for anyone concerned with contemporary problems in medicine. That being said, I think he paints with too broad a brush in his recent post "Liberals and their Ill-Liberal Policies," and thus misses some important social structural dynamics around Proposition 71, and human stem cell research in the United States generally. More importantly, Professor Callahan trades on a political distinction that is less than helpful for understanding the benefits and dangers of our current situation. Lets take a closer look at some of his hypotheses.

We'll call the first hypothesis the "Blue State Hypothesis;" namely, Prop 71 passed because Californians wanted to give the bird to the Bush Administration. This seems plausible at first blush, but historically Californian voters' record is much more uneven. For example in 1994, voters approved both Proposition 184 (three strikes initiative) and 187 (denial of basic social services to undocumented workers). In 1998, voters passed both Prop 227 (eliminated bi-lingual instruction in public schools), and Prop 4 (which banned steel-jaw leg hold traps used by fur trappers). In 2004, the same year Prop 71 passed, citizens voted down Prop 72, which would have expanded basic health care insurance coverage. Overall, this presents a confusing, if not schizophrenic, picture for a blue state. Clearly, voting outcomes do not map cleanly onto other variables, such as party affiliation or ideology, and certainly it is difficult from these outcomes to determine if the state has a single voting profile. The bottom line is that initiative voting patterns represent a complicated mix of factors that do not reduce to single issues, such as opposition to federal policies or people.

The second hypothesis ("The Liberal Bio-elite") is that liberals now unquestioningly support biomedical research. During the Proposition 71 campaign, however, the leading public critics of the initiative were not the Catholic Church or pro-life organizations. They were left-leaning public interest organizations, such as the Center for Genetics and Society (CGS) and the Feminist Pro-choice Alliance. CGS in particular were instrumental in raising a variety of issues, from open meetings to financial disclosures, both during the campaign and the early stage of implementation of the California Institute for Regenerative Medicine (CIRM). The Christian Right has been completely absent from any of the public meetings of the CIRM, and has placed all their bets on stopping the Institute through the court system, which appears to have been an unsuccessful gambit.

The final hypothesis ("Follow the Money") is somewhat muddled. Prop 71 was well on the way before Bob Klein (the "super-rich real estate tycoon" that Professor Callahan describes) was brought on board. The California legislature had already passed several stem cell-friendly pieces of legislation, led by Sen. Deborah Ortiz (D-Sacramento). In fact, Sen. Ortiz should be given the credit for coming up with the idea of using the initiative process to fund stem cell research on a state level. He also asserts that the initiative received "lots of money from the biotechnology industry." This claim is difficult to evaluate, since Professor Callahan does not specify how much money constitutes "lots." Biotech's response to Prop 71 was mixed. While the southern California biotech trade organization (Biocom) quickly endorsed Prop 71, the northern California trade org (BayBio) was somewhat ambivalent, and held off endorsement until the end stages of the campaign. The largest donors to the Yes on 71 war chest, including Klein himself, were wealthy individuals that did not have direct ties to biotech. Certainly these individuals possess mutual funds or hold stock in biotech companies that could potentially benefit from Prop 71's largesse. However, the potential payoffs from a stem cell therapeutic breakthrough are so distant and uncertain that belief in a short-term financial windfall from this sector is ludicrous. Indeed during the campaign and after, venture capital firms had mixed opinions about Prop 71 and stem cell research more generally. The history of biotech in California is a mixture of a few spectacular successes, and exponentially more dismal failures.

I will finish by saying that I am deeply sympathetic to Professor Callahan's concerns about the use of public revenues for biomedical science at the expense of other priorities. However, to frame this situation in terms of a liberal/conservative distinction misses some of the most interesting and vexing issues that human stem cell research, and biotechnology in general, are provoking. Human stem cell research in particular has fractured older political constellations, and has helped to forge novel alliances. One does not have to look far; in California, progressive pro-choice feminists are in dialogue with conservative pro-life activists over such issues as the dilemmas and inequities of egg donation for nuclear transfer experiments, experiments that will be a priority of CIRM funding. Thus, it is critical that we expand our political imaginations beyond binary categories to help us think about the complexities and dangers that suffuse through our biotechnological present.

- Chris Ganchoff
University of California, San Francisco