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Bush's no-win choice

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Why the president's stem-cell decision could define his term

For the longest time, we have been told that George W. Bush is a different kind of leader. He runs the White House like a sleek business. The nerdy all-night debates in the Clinton West Wing Dormitory have ended. The adults are in charge now, we are told, and they are guided by simple, moderate principles that blend compassion with conservatism.

Last week Revenge of the Nerds arrived by way of tiny bundles of cells that could usher in a new era of medicine. Stem cells derived from human embryos could lead to cures for some of humanity's most devastating illnesses--but to get to the little knots of magic tissue, we have to destroy the embryos, which might otherwise one day become babies. Bush must decide whether the government will fund research on embryonic cells. It is a messy, Solomonic, profoundly unbusinesslike choice before him, one that requires Bush to decide whether compassion for sick people trumps his conservative convictions about protecting the unborn. It's a decision that requires the skills not of a CEO--a man who likes to delegate the small stuff and set the larger tone--but, yes, of a politician.

And that may help explain why Bush has been looking a lot more like his very political predecessor, turning White House meetings into philosophy seminars. Last Wednesday, while conferring with doctors on the patients' bill of rights, Bush shifted to stem cells. That morning he had been disturbed to read that a Virginia research institute was mixing sperm and egg donations to create embryos solely for the purpose of research, opening a new door to yet another roomful of questions about the limits of science. Until last week, most people in Washington thought embryonic stem-cell research was confined to embryos left over from couples seeking in-vitro fertilization. At least ivf embryos were created as an end in themselves; now scientists were concocting embryos to serve as little more than lab equipment. "Where will it end?" was the question Bush seemed to be turning over in his head. "He seems to be going over it again and again," says someone in the administration who has discussed the issue with him.

Perhaps no decision in his career has been so difficult for Bush--possibly because it has the potential to reveal what kind of President he really is. A President who keeps his promises, come what may? During the campaign, Bush took the position that the government should not fund research that involves the destruction of human embryos. It was a hard line, especially in view of his more flexible stance on abortion--he favors allowing victims of rape and incest to have the procedure. His campaign promise on stem cells was a huge relief to hard-liners who accept no compromise on the notion that life begins at conception. For them, destroying an embryo--even to get stem cells that could potentially save lives--is murder. But the moral firmness of his campaign line makes wiggling now politically unseemly. It's particularly hard for him to consider changing his mind when, in his first week in office, he ended federal funding for overseas clinics that perform or promote abortions. Even though the money didn't directly pay for abortions, Bush argued that withholding the funds would promote a "culture of life." Would he turn his back on that culture now?

For the past couple of weeks, three of Bush's top men--chief of staff Andrew Card, Secretary of Health and Human Services Tommy Thompson and political adviser Karl Rove--have been working to find a compromise that would suit both the pro-research community (represented by Card and Thompson) and the evangelical interests (which Rove is worried about upsetting). The three weren't having much luck to begin with, but last week the opposing sides dug in. The announcement that the Virginia institute had created embryos just to get their stem cells--and news the very next day that a Massachusetts company was trying to clone embryos for the same reason--got everyone's blood up. "The blast faxes have been going all morning," said a pro-lifer who was lobbying the White House. There were many fevered comparisons to W.'s one-term dad. Conservatives hold it to be gospel truth that the old man ruined himself by breaking a campaign promise. Would this be W.'s version of "no new taxes"?

But those who favor research also latched onto the Virginia and Massachusetts news to push their position. If the pro-lifers were saying "See, we told you the stem-cell scientists were cloning monsters," the pro-research folks seemed to be answering that government regulation is the only way to keep the monsters from taking over the research. "The nation's best scientists work on [federal] funding," says Douglas Melton, chair of molecular and cellular biology at Harvard. "The work will be driven behind closed doors, completely unregulated. And because these are [private] companies, they have to consider the market value rather than the therapeutic promise."

That argument was one of many paralleling the abortion debate; without government regulation, pro-choice advocates say, women will be butchered in back alleys. But Bush's decision is complicated by the many well-credentialed foes of abortion who have come out in favor of embryonic stem-cell research. Last week the Wall Street Journal reported that Nancy Reagan, wife of the conservative movement's central icon, has sent word to the White House that she backs the research. According to those familiar with the meetings, former Reagan aides Kenneth Duberstein and Michael Deaver delivered this message to House Speaker Denny Hastert and Senate Republican leader Trent Lott: "This would mean an awful lot to Nancy, especially for a cure for Alzheimer's, even if it's not for the President, but for future generations." Lott said he was moved by the appeal, though he has taken no clear position yet. Neither has Hastert.

The pro-research side already had strong emotional appeals from former Republican Senator Connie Mack, a cancer survivor, as well as G.O.P. Senators Gordon Smith and Strom Thurmond, who have relatives with diseases they believe might be cured if stem-cell research goes forward. Raising the emotional stakes, Smith went on CNN last week and challenged opponents of stem-cell research. "I ask them to go with me to the hospital and visit some of my relatives who are dying of Parkinson's and withhold that care and hope." All three men have long records opposing abortion. These are the kinds of advocates that Lawrence Soler, chairman of the Coalition for the Advancement of Medical Research, calls "the best ambassadors" because no one can accuse them of being out for political gain.

Soler is a little-known lobbyist who has put together a brilliant coalition in Congress in favor of the research. Working with Daniel Perry, executive director of the Alliance for Aging Research, Soler organized 38 national patient groups into his coalition. Soler and Perry routinely corner politicians with polls showing that majorities of Catholics and other churchgoers favor embryonic stem-cell research. They have mobilized patients and their families to press their members of Congress, and some believe that they have enough votes to override a veto on a potential research bill.

But the polls don't tell politicians who will show up to defend them on Election Day--and that issue is at the core of the White House's political calculation on stem cells. The White House looks at the poll numbers and is concerned about a possible backlash from fundamentalist Catholics and Evangelicals, the shock troops who vote, especially in midterm elections. Bush's G.O.P. can't have them sitting at home in protest if it is to hold the House and win back the Senate in 2002.

The politics of the other side is just as troublesome. Swing-vote suburban women heavily support stem-cell research. The public faces of the diseases that may benefit from the research are a p.r. dream. To name just three: Michael J. Fox, Mary Tyler Moore and Christopher Reeve.

Between these two emotionally charged armies, Bush was scrambling to find the makings of a truce. Could he maybe keep the ban but allow research to continue on the cell lines that scientists have already developed? No way, say the pro-lifers. A priest writing in last Wednesday's Wall Street Journal called that "material cooperation with evil." The research forces, for their part, argue that there aren't enough cell lines yet to do any meaningful research.

Then perhaps the President could keep his promise to conservatives by coming out in favor of a big increase in funding for research on adult stem cells--research that is uncontroversial--but ban the work that requires destroying embryos? If he couched his position as being in favor of research but opposed to destroying potential babies, he could perhaps finesse the issue. The U.S. Conference of Catholic Bishops has said that would be an acceptable compromise. But scientists and their backers in the world of patients would hate that solution, since research on adult stem cells, while promising, has three big drawbacks: adult stem cells are difficult to find in the body; they are difficult to grow; and it's unclear how versatile they will be. Embryonic stem cells are far from a proven technology--developing them into real therapies will require armies of scientists and perhaps many years of work--but they don't have those basic drawbacks.

Perhaps the worst part of this quandary for Bush is that even after he makes his tough decision, the issue won't go away. Congress will take a crack at it, and court challenges are under way. Private researchers like those in Virginia and Massachusetts will continue to study stem cells regardless of what Bush does, since they don't receive government funding. (Congress could decide to regulate all stem-cell research, public and private, which would face Bush with another hard choice.)

All of which suggests that there's no reason for Bush to move quickly on the issue. This week chief of staff Card is to meet with moderate Republicans to continue looking for middle ground. Even if they make progress, Bush will face a tougher audience next week. On July 23, he is scheduled to visit with the Pope, who has made it clear that he considers embryonic stem-cell research immoral (and who suffers from Parkinson's disease). Bush may need more than the Pope's counsel as he decides not only what to do about stem cells but also what kind of President he will be.



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Cover Date: July 23, 2001

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