WASHINGTON - A week before the 2000 presidential election, former NIH Director Harold Varmus publicly endorsed Al Gore, warning that if elected, George W. Bush would shut down federal funding for embryonic stem cell research, a step that he said could delay or prevent a medical revolution that would develop cures for numerous debilitating diseases.

As president, Bush's first high profile acts included making pro-life cabinet appointments and cutting U.S. support for international family planning projects that advocate abortion, lending credence to Varmus's prediction. And as Bush's first month in office was closing, the president declared to reporters that he is against federal funding of research on fetal tissue or stem cells derived from induced abortions.

But Bush also added: "I believe there's some wonderful opportunities for adult stem cell research. I believe we can find stem cells from fetuses that died a natural death" (see BioCentury Extra, Friday, Jan. 26).

The comments suggested that Bush is looking for a way to defuse the conflict between the morals of abortion and the urgency of creating cures for the sick and disabled. As framed by his comments, the debate may come down to an argument over what constitutes an adequate supply of research material, and how such policy decisions will affect the speed of research.

In any case, on a political timeline, the stem cell issue is down to a short fuse, as the NIH is set to begin implementing the Clinton-era plans for funding embryonic stem cell research next month.

The political setup

A move by Bush to block federal funding of the research would terminate an initiative that was one of Varmus' top priorities for the last year of his tenure at NIH. Shortly after John Gearhart of Johns Hopkins University and James Thomson of the University of Wisconsin announced in 1998 that they had discovered how to coax stem cells from human embryos and culture them, Varmus began working on an equally daunting public policy challenge: eluding congressional prohibitions on federal funding of embryo research so NIH-supported researchers could have access to the protean cells.

Varmus and senior NIH scientists quickly convinced President Bill Clinton, Gore and influential members of Congress from both parties that stem cell research could revolutionize medicine, that aborted fetuses and spare embryos created at fertility clinics are the only practical source of the cells, and that the tremendous benefits of the research outweighed any moral or ethical concerns about these sources.

Varmus told a Senate committee that the "development of cell lines that may produce almost every tissue of the human body is an unprecedented scientific breakthrough. It is not too unrealistic to say that this research has the potential to revolutionize the practice of medicine and improve the quality and length of life."

Last September, Gerald Fischbach, who at the time directed NIH's National Institute for Neurological Diseases and Stroke (NINDS), told senators that "virtually every realm of medicine and human health might benefit" from stem cell research, and predicted that the new discoveries could lead to a cure for Parkinsons disease within five years.

Indeed, under President Clinton, federal science policy makers' enthusiasm for embryonic stem cell research was second only to their excitement over genomics, and the White House embraced a legal interpretation that allowed NIH to get into the field without explicit congressional approval.

Like other Clinton administration exploits, the strategy hinged on the careful definition of words and fine legal distinctions. Administration lawyers argued that stem cells are pluripotent (meaning they can become many kinds of cells), but they aren't totipotent, or capable of growing into whole organisms, and therefore they aren't embryos.

And even if the NIH were prohibited from funding the derivation of embryonic stem cells, the administration's lawyers said that once the cell lines were created, the government could support research using them.

As a result, NIH concluded that the law allows it to fund embryonic stem cell research "only if the cells were derived from frozen embryos that were created for the purposes of fertility treatment, were in excess of clinical need, and were obtained after the consent of the donating couple."