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Maryland’s Stem-Cell Wars

by Ralph BraveBaltimore City Paper
September 1st, 2004

On Friday, March 5, 2004, the members of the Maryland House of Delegates' Health and Government Operations Committee gathered to hear testimony on House Bill 1021. Few committee members could have expected to hear claims that the bill proposed Nazi-like policies, or counterclaims that opposition to the legislation amounted to murderous indifference. Yet that was precisely the vitriolic debate launched that day between two of the most powerful religious lobbies in the state.

"In the early part of the 20th century, Hitler justified horrible scientific experiments on classes of human beings that he decided were not persons," Nancy E. Fortier, a Ph.D. in chemistry, told the committee in representing the Maryland Catholic Conference opposition to HB 1021. "Jewish people, homosexuals, people with disabilities, and the mentally ill were deemed nonpersons; the experiments with and killing of these human beings were explained away as morally acceptable because the information learned from the experiments would benefit mankind." HB 1021, she suggested, proposed to commit no less a crime.

The unmentioned irony of her testimony was that the lead legislative sponsor of HB 1021 is himself Jewish, and his bill had the support of the Maryland Jewish Alliance, as well as 13 of the state's leading rabbis. Within a few days, the Jewish Alliance distributed a letter to all members of the Health Committee expressing "strong objection to and grave disappointment" with the Nazi comparison drawn by Fortier. "Your analogy is alarming in its disregard for the significance of human suffering," the letter read.

But the Jewish Alliance did more than take exception to the Catholic Conference's rhetoric. The letter declared that the Jewish Alliance's support for the bill was driven by the Jewish tradition requiring the use of all available knowledge to heal the ill. The authors cited Jewish religious law that "when one who delays" in using knowledge to heal, "it is as if he has shed blood." In other words, within the Jewish tradition, opposition to HB 1021 could be equivalent to murder.

What issue could possibly have brought these two groups, which generally go out of their way in their expression of ecumenical tolerance, to hurl such heated invective at each other?

What else but embryonic stem cells-those cells that scientists themselves have described as "magical" and biology's "holy grail." Cells that, if their proponents are to be believed, hold the key to halting the tremors of Parkinson's disease, allowing victims of spinal-cord injury to stand up and walk again, and restoring the memories of Alzheimer's sufferers. Cells that require the destruction of the embyros from which they are "harvested."

Embryonic stem cells have served as a focal point of national debate ever since Aug. 9, 2001, when President George W. Bush, in his first national televised address since taking office, announced a policy of restricting federal spending on such research. The Bush policy was designed to satisfy those who wanted the research to go forward, by allowing the National Institutes of Health to fund research on embryonic stem-cell lines that had already been created. (The president's claim that under his policy more than 60 stem-cell lines were available for research was quickly discredited; at most, it appears that 21 of these are viable for research purposes.) But Bush also sought to satisfy his beliefs and his pro-life constituents by banning federal funding for any additional embryonic stem-cell lines.

At the time, some of the field's leading researchers, such as John D. Gearhart of the Johns Hopkins Medical Institutions, issued cautious statements of appreciation for the president's compromise. But those days of stem-cell détente are long gone, and most researchers are now uninhibited in expressing urgency in their desire to see the national policy changed or else Bush and his stem-cell restrictions defeated.

One important side effect of the Bush policy has been to shift some of the embryonic stem-cell debate to the state level, where embryo research policies are determined jurisdiction by jurisdiction. The result for Maryland, and other states, has been nothing less than a stem-cell war-a war first between research advocates and pro-life forces, and an emerging war between states over support for stem-cell funding.

After the March hearing on HB 1021, the bill died a quiet death, not even coming up for a Health Committee vote. In the meantime, Cardinal William H. Keeler, archbishop of Baltimore, telephoned Marc Terrill, president of the Associated Jewish Community Federation of Baltimore, to make amends for Fortier's use of the Nazi analogy. (Asked for comment, Fortier says, "I think the analogy holds true, but I will not make the analogy again because I don't intentionally offend people.")

But the Maryland stem-cell war is far from over. Heightened awareness of the issue through its emergence as a major issue in the presidential campaign guarantees an intensified public debate ahead. Meanwhile, several states have launched their own multibillion dollar stem-cell research initiatives: New Jersey has begun a stem-cell institute at Rutgers University with $6.5 million in seed funds and a promise of another $43.5 million over the next four years; California stem-cell advocates have placed a bond initiative on the November ballot to fund research over the next 10 years to the tune of $3 billion. If stem cells achieve even half their vaunted potential to revolutionize the practice of medicine, such new investments in other states could potentially challenge Maryland's status as a biotechnology leader.

But what is this stem-cell debate really all about? What are stem cells anyway? Where exactly is stem-cell science at this point? How close are stem cells to clinical application? Can or should Maryland really do anything about it?

On the seventh floor of the recently opened Broadway Research Building of the Johns Hopkins Medical Institutions, John Gearhart enjoys an unobstructed view of the Baltimore skyline. From this office, Gearhart directs his primary enterprise, the Institute for Cell Engineering. For anyone interested in stem cells, this institute and its laboratories are one of the centers of this new universe. Here Gearheart and his colleagues are working with a variety of stem-cell lines. The future of medicine and, in a way, the future of life itself is being created here.

The atmosphere in Gearhart's lab is intense but friendly, serious but upbeat, reflecting the confidence from the fundamental discoveries already made, the certainty of their significance, and Gearhart's own spirit of rigor and challenge orthodoxy-a good combination for a scientist. Gearhart initially came to Hopkins in 1979 to undertake studies in the new field of in vitro fertilization. From there, he became interested in uncovering the causes of Down syndrome and other birth defects. Those mysteries could be approached only by understanding human development at its very earliest stages.

Working with mouse embryonic stem cells in the 1980s and early '90s, Gearhart decided to see whether he could discover the same cells in humans. Since mice and humans are both mammals, sharing more than half of the same genes, it made sense that they would share similar developmental mechanisms.

In 1998, Gearhart announced that he had successfully isolated human "pluripotent stem cells" from donated fetal tissue. These cells are considered "pluripotent" because they have the ability to generate every other kind of cell needed to make up a human being, and "stem" because they are the origin of all types of cells and are able to renew themselves by dividing. No other cells can do this. At around the same time as Gearhart's announcement, James Thomson of the University of Wisconsin announced that he had isolated similar cells from a very early-stage embryo. The stem-cell revolution was launched, and Gearhart and Hopkins were among its leaders.

"The new millennium promised to usher in the era of the human genome," Gearhart and his colleague Peter Donovan boastfully but accurately wrote in an overview of the field in 2001. "So far, a different area of biology-stem cell biology-has captured both the scientific and international headlines."

This is true to such an extent that Gearhart is constantly besieged by requests from the media, professional societies, and even other nations like Abu Dhabi to explain the new world of stem cells. His achievement and mastery of the field have earned him that kind of demand.

At the conclusion of a panel discussion featuring Gearhart at Time magazine's Future of Life conference in Monterey, Calif., in 2003, panel moderator Michael Kinsley gently tapped Gearhart on the shoulder and whispered, "Less time at conferences, more time in the lab." Kinsley, the founding editor of Slate.com and now editorial page editor of the Los Angeles Times, suffers from Parkinson's disease. Gearhart also faces those kinds of demands.

As he told the President's Council on Bioethics in 2002, "The thousands of communications that we have received from patients and patient-based groups, about our work and about moving our work along-not only is it emotional, it is unbelievable. . . . When we published our paper [in 1998], within a few days we had 10,000 e-mails alone about it."

Gearhart views the entry of the issue of stem cells into partisan politics as almost tragic, as he is certain that pluripotent stem cells promise to revolutionize the treatment of human disease. "We need and should have support from all sides for this research," he says.

What makes stem cells so special is really not that hard to explain, for it touches on one of the greatest of life's mysteries, the kind that even a child thinks about. But it requires a little scientific explanation.

All of us begin life as a single cell, created at the moment when a sperm and an egg meet. This solitary cell soon starts dividing, creating more cells like itself.

If that's all it did, none of us would be here. Within a few days, this cell starts doing something else besides dividing and creating identical cells. It starts generating different kinds of cells. This capacity to create different kinds of cells-known as "differentiation"-is the essential power needed to create complex organisms, whether a mouse or a human. By the time a human being is complete, its body contains more than 220 different cell types, from lung cells to skin cells to brain cells.

How can it do that, differentiate after starting out as a single cell and go on to create all the different kinds of cells that are needed? While a complete answer to this question is not yet known, thanks to Gearhart and others, a fundamental mechanism has been uncovered: the embryonic stem cell.

Stem cells have the capacity to create many different kinds of cells. For example, the blood stem cell has the ability to create all eight different types of blood cells that flow through our bodies. Other stem cells can create a variety of cell types, such as nervous-system cells.

These stem cells appear, it turns out, about six days or so after the single egg cell has been fertilized by a sperm. At that time, this early-stage embryo consists of no more than 100 to 200 cells in total, 15 to 20 of which are stem cells.

With this discovery, and with the subsequent ability to isolate these stem cells and work with them in the lab, scientists have gained the ability to observe and understand the development of a human being from its earliest beginnings, and determine how things go right-and also how things can go wrong.

Therapies and cures for those things that go wrong-for devastating diseases and injuries-represent the ultimate goal of stem-cell research. The transition to "cell-based" approaches, where diseased or damaged tissues are replaced or replenished with healthy cells that have been developed in the lab from stem cells, has given this field the name of "regenerative medicine."

Or, perhaps more accurately, regenerative medicine is a prospective field. No one has yet been cured with cells or tissues derived from embryonic stem cells. No human trials have yet been conducted. But therapeutic results have been achieved with mouse models for brain diseases, metabolic disorders, and spinal-cord injury. In 2003, Gearheart's lab published results showing the ability of "human pluripotent cells to restore function to rats with a virus-induced" motor paralysis.

Earlier this year, Geron Corp., which funded Gearhart's early work producing pluripotent stem cells, and the University of Minnesota signalled plans to approach the U.S. Food and Drug Administration in the next few years for permission to conduct the first human trials for treating spinal-cord injury with embryonic stem cells. Even if approved, this is just the initial round of testing for safety. Some years remain before genuine human clinical therapeutic trials will begin. At times, scientists refer to decades of work needed. Gearhart wrote in a Aug. 23 Washingon Post op-ed piece, co-authored with Hopkins bioethicist Ruth Faden, that "even in the most promising areas, reliable cures are . . . as much as 5 to 10 years away."

But embryonic stem cells have opened an astonishingly broad research window that has never been available before. By harvesting embryonic stem cells with genetic-based diseases, scientists will be able to observe the molecular and cellular changes that occur as the disease develops from the very first cell.

James Battey, chairman of the National Institutes of Health Stem Cell Task Force, says that this research ability will bring opportunities for therapy development other than with lab-grown replacement tissues. He foresees an enhanced ability to develop targeted drugs based on this new genetic knowledge. In an interview, Battey also proposes that "understanding the molecular switches of events will allow us to mobilize cells within the patient to become the healthy replacement cells and restore function." Gearhart foresees this approach of working with cells within the patient's own body as an ultimate goal of stem-cell research.

There remains a tremendous agenda for the most basic scientific research on stem cells that must be addressed before any cell replacement techniques can be safely applied to humans. Battey cites understanding cell cycle control, proving long-term genetic stability of the cells, and understanding cell specialization and transplantation as some of the major areas that must be conquered.

One problem often cited by stem-cell research opponents is the ability of embryonic stem cells to infinitely divide and differentiate into all cell types. This also poses a potential hazard. Only the products of embryonic stem cells that have become a particular cell type could be used in therapies. If a pure embryonic stem cell were transferred into a patient, that cell could keep dividing, generating many different kinds of cells, producing a deadly tumor.

Opponents of the research often cite such dangers or lack of certain knowledge as grounds to prohibit embryonic stem-cell research. But in most cases this opposition, like that of the Maryland Catholic Conference, is actually grounded in opposition to the destruction of embryos from which the stem cells are retrieved.

Indeed, the controversy over embryonic stem cells is based on this one fundamental reality: Currently, they can only be retrieved from early embryos, thereby destroying the embryo. While some types of stem cells have been found in umbilical cords and in adult bone marrow, Gearhart says that "only embryonic stem cells can form all the cell types present in the body and can renew themselves indefinitely. This is the only source of stem cells for which this can be said and in which it has been demonstrated."

Adding to the controversy is cloning for stem-cell research and therapy. Stem-cell therapies will only be effective if a patient's body can accept the new cells. Through cloning-replacing the DNA of an egg cell with a patient's own DNA, and then stimulating it to start dividing-scientists have proposed the possibility of creating an embryo whose stem cells would be a perfect genetic match for the patient. The problem of the patient's immune-system rejecting the new cells would be overcome. But by this technique, embryos are created in the lab precisely so that they can be used to harvest stem cells. The embryos are destroyed in the process.

Of course, all of this reignites the passions and debates so familiar from abortion- and reproductive-rights controversies. Critics object to both the creation of embryos for "spare parts" and to the proliferation of cloning technology applied to human embryos, which they contend opens the door to reproductive cloning. For this reason, opponents of embryonic stem-cell research have refused to support legislation which would only ban reproductive cloning, and leave cloning for research and therapeutic purposes legal. Ironically, thanks to this lack of support for legislating the issue piecemeal, reproductive cloning remains legal in Maryland to this day.

Opponents of embryonic stem-cell research often claim that therapies and cures are not assured, and therefore should not be pursued. But even if embryonic stem cells were proven to cure every disease known to humankind, many of these opponents would still be opposed to their use.

Opponents of embryonic stem-cell research often expertly explain the latest findings in adult stem-cell experiments, arguing for exclusively funding that work. But virtually all stem-cell scientists believe that research should proceed on all fronts. "It probably will turn out that different sources of stem cells will prove valuable in addressing different diseases," Gearhart says. "We can't predict in advance which those will be."

Gearhart openly acknowledges the difficult moral dilemma posed by embryo research. In the Aug. 23 Washington Post piece, Gearhart lays his moral case on the line: "While we recognize and respect embryos as early forms of human life, we do not believe that embryos in a dish have the same moral status as children and adults. We believe that the obligation to relieve human suffering binds us all and justifies the instrumental use of early embryonic life."

Give Baltimore City Del. Samuel "Sandy" Rosenberg (D-41st) this much credit when it comes to state stem-cell policy: At least he keeps trying.

On Feb. 8, 2002, exactly six months after President Bush's restrictions on stem-cell research were announced, Rosenberg introduced a state bill to create a "Task Force to Study Stem Cell Research." The task force was to look into all aspects of stem-cell research, from the effects of the Bush policy on Maryland to the issue of how embryo research should be regulated by the state.

But the state Department of Business and Economic Development came out strongly in opposition to the legislation, writing in a letter of testimony about concerns that the bill created "the specter of a significantly increased regulatory environment," which would "have an anticompetitive effect" on Maryland's biotechnology sector. For similar reasons, the Technology Council of Maryland also declared its opposition.

The Maryland Catholic Conference also opposed the bill, since it included no designated seats for members of the religious community or pro-life advocates. Even the American Academy of Pediatrics opposed the bill, as it was not an "expert panel," but instead had a majority of politicians and political appointees.

In the midst of such conflicting forces, Rosenberg's 2002 stem-cell bill died without a Health and Government Operations Committee vote. Instead, the committee chair, Montgomery County Del. John Hurson (D-18th) and Rosenberg directed the state Department of Legislative Services to conduct a study on the subject.

A four-page Legislative Services summary of existing state and federal law, issued in December 2002, concluded that "the current federal administration appears largely content to allow states to establish parameters for stem cell research as well as legislate on human cloning.

"Currently," the summary concluded, "there is no law in Maryland specifically authorizing, banning, or otherwise regulating human cloning or embryonic and fetal research." But, the survey warned, any state law or regulation ran the risk of being outdated by scientific advances, "an important consideration for policymakers as they consider options to encourage, oversee, or limit human embryonic stem cell research."

These opinions and perspectives on the 2002 bill reflect an ongoing tension within the biotechnology community: Some want to keep the state code clear of any regulation, while others believe that some legal safeguards would provide the public with assurance that the research is proceeding ethically.

The following year, Rosenberg took a step beyond urging study of the issue. On Feb. 5, 2003, he introduced House Bill 482. Citing the degenerative conditions of "[a]n estimated 128 million Americans," the new bill was a declaration of state policy that all stem-cell research, including embryonic stem-cell research and the cloning of embryos for research, "shall be allowed." The bill also included a requirement for institutional review boards for such research and the prohibition of the sale or purchase of embryos and aborted fetuses.

With this bill, serious fighting broke out. The Maryland Catholic Conference weighed in with its opposition. For the first time, the conference's Fortier made the comparison of embryonic stem-cell research to Nazi experimentation, though at this time no one took exception. National forces were also drawn to the battle: Five pro-life members of the President's Council of Bioethics sent a letter of opposition to the Health and Government Operations Committee, as did the National Catholic Bioethics Center.

Johns Hopkins stem-cell researchers John Gearhart and Curt Civin appeared before the committee in support for the bill. In his testimony, Gearhart specifically urged committee members to consider not only the "incalculable" medical benefits, but also that "the intellectual property and technology developed through these [stem cell] studies will contribute substantially to the biomedical research and biotechnology base of the State."

Where Rosenberg's previous study bill received opposition from Democratic Gov. Parris Glendening's Department of Business and Economic Development, this time Republican Gov. Robert Ehrlich's secretary of Health and Mental Hygiene, Nelson Sabatini, came out strongly in favor of the bill. "Maryland has historically encouraged open scientific research and technological innovation, thereby generating favorable economic development as evidenced by the proliferation of biotechnology companies in the state," Sabatini's letter, dated March 12, 2003, stated. "The Department believes the authority to perform stem cell research is important and necessary to improving the future health and welfare of Maryland's citizens."

Did that mean that Gov. Ehrlich supported embryonic stem-cell research and research cloning? Apparently not. At first, upon questioning by City Paper, the governor's press secretary Henry Fawell asserted that "Secretary Sabatini would certainly not take a position in direct conflict with the governor. He testified with the consent of the governor and his office." But several days later Fawell produced a copy of a letter to committee Chairman Hurson, dated six days after the endorsement letter, in which the secretary recants departmental support, claims that it was mistakenly submitted by staff, and that the state Health Department and administration had had no position on the bill.

Indeed, as a congressman in 2001, Ehrlich supported the Bush restrictions on stem-cell funding and voted in favor of a ban on all cloning, including for research. Fawell says that while the governor "believes that there are tremendous benefits that can be achieved from limited and reasonable stem-cell research," he wants to avoid abuse and misuse of the science." The governor, Fawell says, is neither pro-choice nor pro-life in regards to the stem-cell issue, but makes his decisions on such issues based on each procedure. As regards research cloning, "he has concerns about creating life for the purposes of destroying it." As governor, Ehrlich has shown no movement from the stances he took as a congressman.

On March 18, 2003, the House Health and Government Operations Committee voted unanimously against the bill.

In 2004, Rosenberg returned with HB 1021. Titled the "Human Cloning Ban and Stem Cell Research Protection Act," the bill offered this compromise: an absolute ban on human reproductive cloning, with any such efforts made a criminal act, in exchange for protection of cloning for stem-cell research. The bill would have also barred a cloned embryo from being on the premises of any in vitro fertilization clinic.

The business community now returned with reservations about any new regulations. With these concerns and the Nazi analogy controversy, the bill was never brought to a vote.

Explaining his reasons for holding back stem-cell legislation in committee during the past two years, House Health Committee Chairman Del. Hurson says, "We realized that it was going to take a lot more work to get a successful vote in both the Senate and the House and on the floor. Also, one of the implications of putting a bill like this on the floor of the House is that you could suddenly have a full-fledged debate on abortion on your hands, since an amendment about abortion could be considered germane. Just from a practical level for the legislature, we try to avoid putting those kinds of bills on the floor unless there's an agreement among all parties not to have that kind of debate. We didn't have that agreement."

Doubtless Maryland's stem-cell wars will continue into 2005 and beyond. Del. Rosenberg says he plans to reintroduce legislation next session, though the specifics remain unclear. "Bioscience is an important part of our economic and academic growth," he says. "We risk falling behind our competitors if we don't support it. We will reintroduce legislation next year. Whether it goes beyond the bills of previous years and also tries to do something in terms of money, we don't know yet." The details of the bill, he says, depend in part on the outcome of the November presidential election.

If Democrat John Kerry is elected, there will be a dramatic shift in policy at National Institutes of Health, and significant federal research dollars will become available for a much broader range of stem-cell investigations. State policy will have less weight. If President Bush is re-elected, a continuation of the current restrictions is likely.

And if the president is re-elected and California passes its $3 billion stem-cell research initiative, that could put additional pressure on Maryland. With restricted federal funds and other states investing large amounts in the field, the state's competitive position as a biotechnology leader could be in jeopardy in the stem-cell field.

The December 2002 report on stem-cell research by the Department of Legislative Services showed that Maryland currently has the basis for a thriving stem-cell research and development enterprise. The study identified up to 10 of the state's 300 biotechnology companies as involved in stem-cell research. That same year, the University of Maryland, Baltimore had seven stem-cell research projects, while Johns Hopkins Medical had 50 researchers involved in stem-cell projects. Both UMB and Hopkins have federally funded and non-federally funded projects; in fiscal year 2002 these were worth $5.5 million.

One of the concerns raised by other states aggressively funding this research area would be their ability to recruit the most promising young scientists and biotech companies who want to pursue stem-cell researches. Gearhart sees some cause for concern: "If California voters support this bond issue, the California schools will be in a terrific position to attract investigators or new faculty, support research efforts, and thus be at an advantage in using state funds to leverage private money and federal support when it becomes more readily available. It is clear federal support will become more readily available-the question is when." He adds, "As an investigator, I would look very longingly on such state support."

But Chris Foster, deputy secretary of the state Department of Business and Economic Development, expresses nonchalance in the face of challenges from other states. "I'm not really concerned about us not throwing hundreds of millions or billions of dollars into stem-cell research," Foster says. "The way I look at it is that the life-sciences space is a very big area. Maryland does $9 billion a year every year in [research and development] for the federal government. While California's $3 billion may sound like a lot, that would mean they also just took on $3 billion in debt."

Foster also sees Maryland having advantages in other areas, such as being "the key player in things that effect bioterrorism-anthrax vaccines and things like that, those are huge markets."

Maryland, in any case, is supporting some stem-cell research through state investments by the Maryland Venture Capital Fund, a state economic development program aimed at helping young companies with startup capital. Fifty-five percent to 60 percent of these funds have typically gone into the biotech sector. At least two companies in which the Venture Fund has a stake are involved in stem-cell research, including NeuralStem Biopharmaceuticals Ltd. of Gaithersburg and Baltimore's Theradigm Inc.

Asked whether the state would benefit from taking advantage of the presence of top stem-cell researchers like Gearhart, Foster agrees. "I think you'll see us do that this coming year," he says, referring to the imminent announcement by the governor of a scientific advisory board. The board, whose charge will include advising the governor on life-science matters, will have a three-member executive team, two of whom, Foster says, are being drawn from the biotechnology industry. Foster declined to name those individuals in advance of the governor's announcement.

Even with Foster's enthusiastic perspective, it is difficult to see much state-stimulated advance in embryonic stem-cell research as long as Ehrlich maintains his loyalty to the Bush restrictions and his opposition to cloning technology being used in research. "There is no plan for a major initiative on stem cells here for a number of reasons, including the fiscal outlook," Ehrlich spokesman Henry Fawell says.

To whatever extent the state legislature can alter the dialogue and the political dynamics, Rosenberg says, "I am hopeful that a critical mass of support is building around this issue." One sign of that is his partnering with Baltimore County Sen. Paula Hollinger (D-11th) to introduce matching bills in both legislative houses next year. Hollinger, who is a nurse by profession, has already requested legislative services for a bill to be titled, "The Ronald Reagan Stem Cell Research Act." "At this point, my aim is to place state policy firmly behind stem-cell research," she says.

As chairwoman of the Senate Education, Health, and Environmental Affairs Committee, Hollinger may have more success than Rosenberg has had so far in getting a stem-cell bill onto the floor. But she acknowledges that she has two pro-life Democrats on the committee, and so will probably need a Republican vote. Asked whether she's found such a Republican vote in the past, she responds, "Occasionally."

Hollinger says her motivation comes in part from her past nursing practice in neurology, where she served patients with Parkinson's and others who might benefit from this research. "Also, I had a mother who died two years ago who suffered from Alzheimer's or some form of dementia," she says. "So I've worked both personally and professionally with patients who might benefit from this research."

Indeed, the disease-specific advocacy groups becoming more active and vocal could significantly alter the context of the debate over stem cells. In California, for example, the Juvenile Diabetes Research Foundation has put $500,000 into a stem-cell campaign, while on Capitol Hill disease advocacy groups have played a key role in turning even Republican congresspeople against the Bush policy. But these groups have been almost entirely silent on the issue in Annapolis.

"Even though it's there in the abstract, I think we need to do a better job of generating public support," Rosenberg says. "I think a majority of Marylanders would support appropriate therapeutic stem-cell research. But when you've got another side which is so vociferous, so zealous, and distorting what the bill does, that makes it difficult without more active public support."

The pro-life groups will certainly remain active. Given the legislative leadership's hesitance to move any bill to the floor that remains controversial, Rosenberg worries that continued conflict gives opponents of stem-cell research the "equivalent of what in First Amendment law is considered a 'heckler's veto.' By speaking about this legislation in a distorted way, the threat of controversy in effect vetoes the bill coming to the House floor."

However, House Health Committee Chairman Del. Hurson, who supports embryonic stem-cell research but remains uncertain about cloning, says he believes the recent national focus on this issue and other states' stem-cell initiatives have changed how the issue will be viewed in Annapolis.

"I think Maryland does need to respond," he says. "You're running out of stem-cell lines [available for federal funding]. That has put a real crimp in the research ability of the United States. Heavy-duty biotech states like Maryland have to step forward and start to really try to move this thing because the federal government is stuck. We've now had four years of education on this, thanks to Delegate Rosenberg, and I think we're probably ripe to pass something. The question is how and what it's going to look like."

Hurson suggests that aiding the private sector may be the best approach to the issue.

Whatever developments occur in Maryland's stem-cell wars, or even at the federal level, embryonic stem-cell research will advance in laboratories around the nation and the world, including at Gearhart's lab at Johns Hopkins.

In fact, one of the focal points of research in his lab could ultimately transform the entire debate: discovering "the stemness" of stem cells. In other words, what exactly makes a stem cell a stem cell?

All cells of the human body, except for sperm and egg cells, are essentially alike. They tend to differ as regards to what's going on in their centers-the nucleus, where the DNA that makes up our genes is stored. It is generally believed that one cell is different from another based on which genes are active and which genes are inactive.

But when scientists recently tried to discover the genetic basis of stem cells, Gearhart explains, "one lab reported this set of genes, another lab reported a different set, and when you put them all together, you find that there's very little if anything in common among those studies as far as genetic expression is concerned."

If these studies are correct, then the key to stem cells, he asserts, must lie in the cells' chromatin, the biochemical proteins that surround the DNA and help structure it.

The goal of unraveling the nature of stemness, of discovering what is chemically or structurally unique about stem cells, is to be able to turn an adult cell into a stem cell. With this knowledge, researchers could take a bone-marrow cell and turn it into a stem cell. Not only would this mean that embryos would no longer be needed to harvest stem cells, but cloning would no longer be required to create a stem cell with the perfect genetic match for each patient.

"There would no longer be a debate whether this is ethically right," Gearhart contends. "And I think that's where we're eventually going. We're going to be learning about these properties of stemness. The more we learn about the properties of stemness, the more we can incorporate them into some kind of scientific paradigm where we can convert any cell back into a stem cell, and then to drive it into the direction we want.

"Clearly," he says, "this is the holy grail."

This research goal casts a certain ironic light on the opponents of embryonic stem-cell research: By slowing down the pace of the research, they may be prolonging the period when research embryos are needed.

On an August afternoon, as Gearhart accompanies a visitor out, he stops and draws attention to three young women in a lab area who are intensely reviewing some papers containing data or procedures. One of them is Gearhart's 16-year-old daughter Sarah, working in the lab for the summer.

He beams, unabashed, watching part of the future he helped create as a father, learning to advance the future he helped create as a scientist. Whatever anyone's position in the stem-cell wars, this is a future we all now share.

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