On the heels of federal debate over human embryonic stem cell research, and two years after the passage of California's stem cell research initiative, the issue returns to a state ballot. But this time, in the central state of Missouri, the policy proposal is much different.

Unfortunately, many of the worst aspects of the public discourses seen in Washington and California are being repeated in Missouri: Exaggerated promises of imminent lifesaving cures and major economic benefits by the research advocates, and a focus on the moral status of the embryo by the loudest opponents that obscures other important issues. What's different in Missouri, however, is the questionable relevance of the actual policy proposal.

Background: What Amendment 2 would (and would not) do

In November, Missourians will decide the fate of Amendment 2, which would add 2000 words to the state constitution, ensuring that any stem cell research permitted by the federal government is allowed at the state level. Furthermore, it would prohibit human reproductive cloning—certainly an admirable policy goal.
In contrast, both the federal and California policies concerned public funding. The national bill, passed by both chambers of Congress but vetoed by President Bush, would have expanded funding eligibility to stem cell lines from embryos created but not used for fertility purposes. The California voter initiative set aside $3 billion in state funds to support a wide range of stem cell research, including research cloning, and created a constitutional right to conduct stem cell research.

What's actually at stake in Missouri is the use of cloning techniques to create stem cell lines. In recent years, certain conservative state legislators have regularly introduced a bill to ban both reproductive and research cloning. None of these bills have even reached the floor of either chamber for a vote, and the current governor—as well as his likely opponent in the 2008 election—have promised to veto any ban on research cloning.

Technically, research cloning is at an early stage—no one has yet succeeded in deriving a stem cell line from a cloned embryo—and experts are split on its importance. Some say it will be essential, while others say that it is not needed, or not even possible. Other observers argue that even if cloning-based therapies are technically possible, they will be financially prohibitive. Only a handful of labs in the world are trying to produce stem cells from cloned embryos, and none of them are in Missouri.

In other words, Amendment 2 would create a constitutional protection to perform a line of research that is presently legal, currently speculative, and not even being done in the state. Thus, it would go to the greatest length possible at the state level—modifying its constitution—to enact a policy that is at least two degrees away from having an impact on stem cell research: Researchers would need to be engaged in research cloning, and a prohibition on the practice would need to have a significant chance of becoming law. Until then, in terms of policy impact, Amendment 2 is merely a ban on reproductive cloning.

On the other hand, the desire for stable policy among researchers is understandable. The Stowers Institute for Medical Research, a major new research center in Kansas City, Missouri with a $2 billion endowment from its namesake, claims it attempted to hire a scientist for human research cloning. But the leading candidate was unwilling to leave his current position if the future legality of his work was in doubt at his destination.

Unfortunately, if research cloning efforts do begin in the state, Amendment 2 would allow Missouri scientists - unlike those in California, Massachusetts, and a number of other countries—to pay women to provide eggs for their work. The text of the initiative is misleading on this point: The permissibility of paying for eggs is made clear only in the "definitions" section.

The Campaign

The public discourse over Amendment 2 has quickly polarized, with accuracy as a casualty. Initiative supporters call themselves the "Missouri Coalition for Lifesaving Cures" and ask rhetorically, "Should Missouri patients have access to medical cures that are available to other Americans?" Similarly, Claire McCaskill, the Democratic Senate candidate and a supporter of Amendment 2, used the words "lifesaving," "cure," or "save [a life]" twenty-two times among her 732 words in an interview on the topic with the Associated Press.

This rhetoric, which pervades the campaign, makes it almost impossible to realize that it's unfortunately much too soon to be promising stem cell cures, and that this is especially the case for those based on cloning techniques. In fact, if there ever are cloning-based stem cell therapies, they will be extremely expensive—possibly hundreds of thousands of dollars. Even if an anti-cloning bill were to be law, a trip to an adjacent state would add relatively little to the cost. A much more significant hurdle to health care is how the half-million uninsured Missourians can pay for the most basic medical treatments, much less those that might cost a quarter of a million dollars.

Finally, Amendment 2 advocates argue that significant economic development is at stake. It's true that the Stowers Institute threatens to build its planned expansion across the state line in Kansas if Missouri were to ban research cloning. But the campaign's website asserts that the initiative will "keep and attract millions of dollars in research investments to our state." It also touts a study of the likely economic benefits of Amendment 2 by The Analysis Group, which promises that the initiative will "reduce state health care costs by billions." Yet these conclusions are based on cures for six diseases that include those that are more common, yet less likely to be treated with stem cells, such as heart attacks, stroke, and Alzheimer's.

These exaggerations have been propagated by a campaign that has already broken the state's fundraising records. At $16 million, by June it had already shattered the state's record for fundraising for any campaign - and that total is four months before the election. This is already about three times the amount spent, on a per capita basis, by California's Proposition 71 campaign. Furthermore, $15.4 million of the campaign's war chest comes from a single source: James and Virginia Stowers, founders of the medical institute.

The rhetoric of the initiative's opponents is also troubling. Despite their name, Missourians Against Human Cloning are led and funded by opponents of all human embryonic stem cell research and abortion rights. One key player in the MAHC camp is Focus on the Family, the right-wing evangelical Christian organization. In a pamphlet opposing Amendment 2, Focus on the Family cynically used quotes from women's reproductive health advocates, including Judy Norsigian of Our Bodies Ourselves and the Center for Genetics and Society. These pro-choice individuals and organizations support embryonic stem cell research, but have raised concerns about research cloning and the collection of the women's eggs that are needed for it. In contrast, the leaders of Missourians Against Human Cloning spend their other efforts working to prohibit abortion and access to contraception.

Missourians Against Human Cloning routinely blur the distinction between reproductive cloning and research cloning. Though this conflation can be seen as a logical extension of their position that an embryo is a full-fledged human being, failing to acknowledge the difference between a cloned child and a cloned embryo certainly skews consideration of the issue.

Opponents of Amendment 2 also touted the statements of David Prentice, a consultant with the anti-abortion Family Research Council, claiming that adult stem cells are currently treating sixty-five diseases. This was quickly refuted by more reputable scientists.

Stem Cell Déjà Vu

Observing these debates from California, one can only feel a sense of déjà vu. Two years ago, proponents of California's stem cell research initiative spent millions of dollars on ads that simplified numerous complex issues into support for or opposition to embryonic stem cell research. They featured doctors in white coats, researchers in their labs, and children with diseases that may some day be treated, asking for support. As in Missouri this year, the campaign was bankrolled with millions by a single research advocate. California's campaign even used the same consultants to provide an inflated report of economic benefits. In California, however, opponents of the initiative included pro-choice groups such as the Center for Genetics and Society, the California Nurses Association, and the Pro-Choice Alliance Against Proposition 71.

Beyond the results of the Missouri initiative, what is at stake is public understanding and responsible policy on somatic cell nuclear transfer. The overheated rhetoric is part of a broader pattern in the public discourse around embryonic stem cell research across the US. The polarized debate causes critical issues beyond the moral status of the embryo to be overlooked. While embryonic stem cell research holds significant medical and scientific potential, the necessity of research cloning remains unclear, and it raises other serious concerns.

Ballot initiative campaigns are notorious for presenting the public with confusing claims about controversial and often complex proposals, and the Missouri stem cell research initiative is no exception. The result is an electorate that will be forced to make an up or down policy choice on the basis of distorted information and misleading analysis.