by Donald Ness
Throughout history, science has often been the victim of politics. New discoveries challenge society's perception of the world, and often people are resistant to accept these new paradigms. Often, political idealogies fly directly in the face of scientific evidence. These fact-contradicting idealogies are held by laymen, as well as other scientists who are clinging to their own research efforts. Examples include the Catholic Inquisition's scrutiny of Galileo's belief that the sun was the center of the solar system rather than the Earth, and more recently the discovery that embryonic stem cells may not be (and may never have been) the silver bullet for curing diabetes.
Embryonic stem cell (ESC) research has recently created a huge wave of media coverage, with parties interested in the medical value of using ESCs pressing against fundamentalists for government funding. Type 1, or juvenile-onset, diabetes was a cornerstone for the pro-ESC party in convincing politicians for government funding. The Juvenile Diabetes Research Foundation (JDRF) is the leading charitable funder and advocate of Type 1 diabetes research worldwide whose mission statement is to cure diabetes (JDRF, 1). Naturally, JDRF became a big player in getting ESC research funding. However, all the hype has polarized JDRF's research efforts towards ESC research, and they are now neglecting promising research that may be closer to curing diabetes in humans. JDRF's political affiliations with ESC have blurred it's own mission statement and hindered it's dedication to finding a cure.
Diabetes is an endocrine disorder characterized by excessive urination. In the United States, 18.2 million people—6.3 percent of the population—have diabetes. Complications of diabetes include heart disease and stroke, blindness, kidney disease, nervous system disease, amputations, ketoacidosis, and hypoglycemic coma (NIDDK, 7). The direct financial cost of all diabetes care in the United States was $92 billion in 2002 (Munro, 190). Typically, diabetes refers to diabetes mellitus which means "sweet urine". The sweetness is caused by glucose spilled over from the kidneys, stressed by high levels of glucose in the blood. There are various forms of diabetes including Type 1 diabetes (insulin-dependent diabetes), Type 2 diabetes (non-insulin-dependent diabetes), gestational diabetes, and less common types resulting from genetic conditions.
Type 1 diabetes accounts between 5 percent and 10 percent of diabetes diagnosed, and is also known as juvenile-onset diabetes because it usually affects children and young adults. It is a gene-related autoimmune disease in which the body attacks its own pancreatic beta cells, which secrete insulin in response to rising glucose levels. Insulin is a small protein that stores soluble nutrients absorbed from the intestine as insoluble, energy-rich products such as glycogen, protein, and fat. For example, insulin stimulates the muscles and liver to convert glucose into glycogen. The absence of insulin is the direct cause of high blood sugars. Scientists believe it is a combination of genetic and environmental factors that triggers diabetes, and have identified 20 genes related to Type 1 diabetes, although the function of these genes is still unknown. Also, certain viruses are believed to be environmental factors influencing the development of diabetes (Encarta, 1-2).
Presently, there is not a cure for Type 1 diabetes, but diabetics can be treated with insulin delivered to the body by syringe injections, or an insulin pump. In the past, insulin extracted from pigs and cows has been used in humans, but the immune system induces an antibody response against the foreign insulin decreasing its effectiveness. However, genetic engineering has made it possible to manufacture recombinant human insulin by inserting the human gene into E. coli (marketed as Humulin) or yeast (marketed as Novolin). In addition, slightly modified forms of insulin have been created using recombinant DNA technology to give diabetics even further control of their glucose levels (Kimball, Hormones, 3). Humalog and Novolog are fast-acting and are used as bolus insulins. Lantus is long-acting and is used as a basal insulin which lasts about 24 hours. Insulin pumps can also be used to finely control bolus and basal insulin rates. Because the pump is always attached, the amount of syringe injections is greatly reduced. Regardless of the method for insulin transport, diabetics must continuously monitor their blood sugar levels with glucose meters.
Stem cells are cells that divide to form one daughter cell that differentiates into another type of cell, and one daughter that is also a stem cell. Embryonic stem cells are pluripotent which means they can differentiate into any cell in the body. One goal of ESC research is developing specialized cells such as neurons, heart muscle cells, and insulin secreting cells. Already, ESCs have been shown to differentiate into a variety of cell types (HHS, The Embryonic Stem Cell, 7-8). However, ESCs can only be harvested from embryo or fetal tissue, which is the main reason that research using them is so controversial. Even though stem cells can be differentiated into specific cell types, allografting these cells may trigger a rejection from the hosts immune system. Scientists have developed a technique called somatic-cell nuclear transplantation, or theraputic cloning, in which a human egg's nucleus is replaced with a nucleus from a somatic cell from the host. The now-diploid egg is allowed to develop in culture until ESCs can be harvested from it. These ESCs are now genetically identical to the host. There are problems with this technique, including aneuploidy in resulting cells and amplified somatic mutations (Kimball, Stem Cells, 1-4). Embryonic stem cells are important because they offer insight into human development, and may help cure diseases.
Stem cells also exist in adults. Adult stem cells (ASCs) are multipotent which means they can differentiate into a limited number of cells in the body (Kimball, Stem Cells, 2). Many animal and human tissues contain ASCs. For example, the bone marrow contains ASCs which produce blood cell types. However, ASCs are rare, and dispersed in tissues where their behavior can depend on their local environment. Their primary functions are to maintain the steady state functioning of a cell, and to replace cells that die from injury or disease (HHS, The Adult Stem Cell, 1-3). According to the Chairman of the Science, Technology and Space Subcommittee of the Senate Commerce, Science, and Transportation Committee, at least 45 diseases and medical conditions have been treated using adult stem cells. Examples include a 70% healing in a damaged spinal cord, and a treatment of Parkinsons resulting in an 83% improvement on the Unified Parkinson's Disease Rating Scale (ADRF, 3).
Dr. Denise Faustman, an associate professor at Harvard Medical School and the director of the immunobiology lab at Massachusetts General Hospital, has cured Type 1 diabetes in mice and is in the process of fundraising for clinical trials on humans. Dr. Faustman's lab identified two cell protein pathways that are defective in diabetic mice: the major histocompatability complex (MHC) class I and self peptide pathway, and the tumor necrosis factor (TNF) alpha pathway. Reselection of autoimmune naive T cells is possible by the introduction of matched MHC class I and self peptide complexes, whereas self-directed autoimmune memory T cells can be reselected by the induction of the endogenous TNF alpha with Freund's complete adjuvant (CFA) (Faustman, 1223). An adjuvant is a substance which is sometimes included in a vaccine formula to enhance or modify the immune-stimulating properties of a vaccine. In her treatment, Dr. Faustman also injected nonobese diabetic (NOD) mice with splenocytes from live donors. She discovered these cells rapidly differentiated into islet and ductal epithelial cells within the pancreas. Surprisingly, her treatment worked even without the introduction of donor spleen cells, which suggests that new islet cells do not need to be implanted as long as autoimmunity is treated. Her results have been published in prestigious journals such as Science and have been independently confirmed by a JDRF funded researcher (ADRF, 5). She did not use any ESCs in her treatment, but perhaps most surprising is the fact that JDRF has denied her requests for funding three times.
Launched in 1970 by only a few parents, JDRF now boasts thousands of volunteers worldwide who raise nearly $150 million per year in charitable donations. Many of the JDRF volunteers are wealthy, educated parents of children afflicted with the disease and know how to attract media, raise funds, and influence politicians. "Children's Congress" and "Promise to Remember Me" are two campaigns held by JDRF, in which kids visit lawmakers in Washington. Their personal stories put a face on diabetes, and as a legislator it is difficult to not support their hopes for a cure. JDRF employs three lobbyists in Washington who recently helped persuade Congress to give scientists $750 million over five years for investigating Type 1 diabetes (Munro, 190). They also contributed $1 million to pass a ballot to invest $3 billion of California taxpayers' money in stem cell research.
The majority of JDRF's research funds are directed towards embryonic stem cell research. In 2004, Dr. Robert Goldstein, JDRF Chief Scientific Officer stated at a Senate hearing: "adult stem cells have not shown to hold as much promise for juvenile diabetes as embryonic stem cell research." Yet, JDRF has not provided scientific support for this claim. An article published by JDRF in 2005 titled Limitations of Adult Stem Cells contains more propaganda than scientific fact. Nearly all of the limitations of ASCs listed are shared with ESCs, something the article fails to mention. One ambiguous excerpt claims "Adult stem cells cannot be induced to develop into any cell type." In 2002, Helen Blau, a distinguished scientist at Stanford University, has shown that adult bone-marrow cells are plastic enough to convert into muscle and other cells (ADRF, 3). It has been 20 years since the first successful isolation of a mouse embryo-derived stem cell line, yet the JDRF is still giving millions of dollars to ESC researchers such as Dr. Doug Melton (ADRF, 4-5). Despite Dr. Melton's difficulties in his research, he publicly dismisses scientists—such as Dr. Faustman—who argue that diabetes can be treated with ASCs (Munro, 190). These misleading and innacurrate public statements coupled with ESC researchers' ambitions, media hype, undeliverable promises, and billions of taxpayer money clearly shows JDRF's political intentions.
Knowing JDRF's political agenda, it is not difficult to see why they rejected Dr. Faustman's research. The ESC researchers in the medical science review committee at JDRF are in direct competition with Faustman's research, and it is not in their best interest to fund her work. Rival researchers may lose their research funding. If Faustman's research does cure diabetes, it will most likely cut revenue for other therapies such as the Edmonton Protocol, a procedure developed in Canada involving the transplantation of islet cells, and pharmaceutical companies, who make about $1.3 billion a year selling insulin-related products. However, Faustman's therapy could create opportunities for research in other autoimmune diseases besides diabetes, such as multiple sclerosis, lupus, and muscular dystrophy (Munro, 190).
Scientific data should not be politicized in order to control research funds. In order to politicize scientific evidence one must make misleading or inaccurate statements against it, which is unethical. The JDRF should stop misrepresenting facts as a means to funnel charity money into ESC research under the guise of Type 1 diabetes research. ESC research is important for understanding human development, but it will not be the cure for diabetes. The JDRF should adhere to its mission for a cure, and distribute research funds in a non-political manner—a manner that only takes into account scientific data, not hype.