Following the Supreme Court’s June 24 ruling on Dobbs v. Jackson Women’s Health, the Cancer History Project has created a timeline of the regulatory history of women’s reproductive rights based on news stories from The Cancer Letter that track the impact of “pro-life” policies on cancer research and cancer care.
Over the past 50 years, this battle has been waged on three fronts:
- Fetal tissue and embryonic stem cell research,
- The alleged link between breast cancer and abortion, and
- State laws governing access to abortion.
A half-century ago, the debate over fetal tissue research emerged in the context of standards for human subject protection in government-funded experiments. In 1974, research using fetal tissue was mentioned alongside experimentation on prisoners and patients in mental institutions.
On several occasions, appropriations for NIH were held hostage to the issue of funding fetal tissue research. Every year since 1996, Congress amended the Labor-HHS appropriations bill to prohibit NIH funding of research “in which a human embryo [is] destroyed, discarded, or knowingly subjected to risk of injury greater than that allowed for research on fetuses in utero.”
To adjust, NIH created two types of fetal tissue research—the sort that requires destruction of fetal tissue and the sort that doesn’t.
For more than a decade, NCI-funded research had to be limited to 60 cell lines that were already in use. Mouse models were seen as a potential alternative to the “NCI 60.” The ban on federal funding for embryonic stem cell research was ultimately lifted by then-President Barack Obama in 2009.
“This research has been a political football over the course of the last 30 years, with different administrations of the federal government taking different positions on it,” I. Glenn Cohen, deputy dean and faculty director of the Petrie-Flom Center for Health Law Policy, Biotechnology & Bioethics at Harvard Law School said to The Cancer Letter.
Dobbs changes the rulebook. “Essentially, what Justice Alito’s opinion is saying, or what I understand him to say, is that if the state were to want to ban this research entirely, to say, ‘Any research involving the destruction of an embryo is banned in X state,’ there’s nothing in the Constitution that prohibits that,” Cohen said. “That’s how I read his opinion, which is to say, because it involves the destruction of potential life, and there’s no right to destroy potential life.”
The alleged link between abortion and breast cancer surfaced—and quickly became politicized—during the George W. Bush Administration. No evidence exists to demonstrate that women who had had abortions or miscarriages are at an increased risk of breast cancer, NCI said at the time.
The political atmosphere was so charged and pitfalls so deep that, in 2012, Susan G. Komen for the Cure, a fast-growing breast cancer charity, was dealt devastating blows from both sides of the abortion issue. Komen’s attempt to stop funding breast screening at clinics operated by Planned Parenthood triggered boycotts from pro-choice advocates. As the charity reversed course, anti-abortion groups attacked.
Last year, after Texas enacted a law that restricted abortion, two scientists who coordinated peer review for Cancer Prevention and Research Institute of Texas, resigned in protest. CPRIT officials thanked the departing scientists for their service, saying that the research institute is focused on cancer, describing abortion as an describing the law in question as “unrelated to CPRIT’s mission.” Subsequently, 50 physicians and scientists who conduct reviews for CPRIT signed a strongly-worded letter stating:
“The state’s overt attack on women’s reproductive rights and its misguided and harmful COVID policies demonstrate an unwillingness by Texas lawmakers to prioritize the long-term health of citizens over short-term political gain,” CPRIT’s reviewers said in the statement shared with The Cancer Letter. “We strongly believe in the CPRIT mission and are committed to supporting it, but we must speak out against policies that are anathema to its spirit. Failure to do so would implicitly signal that we accept those policies; we do not.”
Post-Dobbs, this debate has gone national.
HEW has announced proposed rules to prevent abuses in research on special categories of human subjects.
The proposed rules would augment more general regulations issued last May 30 (The Cancer Newsletter, June 7) providing procedural protection for all human subjects in HEW-supported research.
The new rules provide special protection for pregnant women, fetuses, abortuses, prisoners, and the institutionalized mentally disturbed.
DAVID OBEY, Wisconsin Democrat, arguing for his amendment to the Labor-HEW appropriations bill which would have adopted the same compromise language on abortion funding which Congress agreed to last year: “If we’re not careful . . . on abortion restrictions, we
probably will never get a Labor-HEW appropriations bill and will fund all year on a continuing resolution.” The House voted Obey down, retaining the strict requirement that Medicare-Medicaid funding for abortions would be permitted only when the life of the mother was threatened. Another drawn out fight with the Senate looms.
The House Energy & Commerce Committee last week passed a bill to reauthorize NIH that includes a provision requiring HHS to fund human fetal tissue transplantation research.
The provision overturning a Bush Administration ban on fetal tissue research threatens to throw the NIH reauthorization into a battle with the Administration, as well as the strong anti-abortion lobby, which believes fetal research would serve to encourage abortion.
NIH last week issued interim guidelines for supporting and conducting therapeutic human fetal tissue transplantation research.
The guidelines are in response to the Jan. 22 executive order from President Bill Clinton ending the moratorium in effect since 1988 banning the federal funding of research involving transplantation of fetal tissue from induced abortions.
NIH Human Embryo Panel Defines Acceptable Research
Sept. 30, 1994
The NIH Human Embryo Research Panel said this week that federal funding for research involving human embryos is “acceptable public policy” provided the research is subject to strict guidelines.
After eight months of deliberations, the panel recommended that research proposals be subject to review by an ad hoc NIH research panel in addition to existing levels of review. The panel’s report described in detail situations in which it believes that human embryo research is appropriate and when it is not. The panel was chaired by Steven Miller, president emeritus of the Johns Hopkins Univ.
Among research the panel deemed unacceptable for federal funding were: cloning of human preimplantation embryos by separating blastomeres or dividing blastocysts, followed by transfer in utero; studies designed to transplant embryonic or adult nuclei into an enucleated egg, including nuclear cloning, in order to duplicate a genome or to increase the number of embryos with the same genotype, with transfer; research beyond the onset of closure of the neural tube; research involving the fertilization of fetal oocytes with transfer; preimplantation genetic diagnosis for sex selection except for sex-linked genetic diseases; development of human-nonhuman and human-human chimeras with or without transfer.
HHS Concludes NIH May Fund Human Stem Cell Research
Jan. 22, 1999
The Department of Health and Human Services has concluded that a Congressional ban on human embryo research does not apply to research using human pluripotent stem cells, paving the way for NIH to fund research using the cells, which are capable of developing into most of the body’s cell types.
In a legal opinion announced Jan. 19, HHS said its Office of General Counsel concluded that the law prohibiting human embryo research does not apply to stem cells because “such cells are not an embryo as defined by statute,” according to an NIH statement.
Commission Calls for Funding to Derive Human Stem Cells
Sept. 17, 1999
The National Bioethics Advisory Commission earlier this week recommended that the federal government begin to fund the derivation of embryonic stem (ES) cells and embryonic germ (EG) cells used in research.
The report also calls for creating a national mechanism to review protocols for deriving human ES and EG cells and for monitoring the use [of] these cells nationwide. Though the recommendations of the commission apply to the public sector, the document asks private researchers and professional societies to follow the same set of standards.
NIH this week published draft guidelines for government funding and oversight of research involving human pluripotent stem cells.
The guidelines largely formalize and clarify existing NIH policies of funding stem cell research, but not the derivation of stem cells from human embryos. Earlier this year, the National Bioethics Advisory Committee recommended that the government begin to fund the derivation of stem cells (The Cancer Letter, Sept. 17).
This cannot be done because every year since 1996, Congress amended the Labor-HHS appropriations bill to prohibit NIH funding of research “in which a human embryo [is] destroyed, discarded, or knowingly subjected to risk of injury greater than that allowed for research on fetuses in utero.”
Anti-abortion activists are pushing legislation that would ban federal funding of stem cell research altogether.
NIH funds can be used to “support research to derive pluripotent stem cells from fetal tissue, as well as research utilizing such cells,” the guideline states. Though NIH has had the legal right to fund such work, it has not done so in the past, sources said.
The American Cancer Society will “accept and support” research grant proposals involving human pluripotent stem cells, conditional on compliance with “minimum requirements” for guidelines that it urged NIH to put in place.
The statement, approved by the National Board of Directors last month, said ACS “concludes that human pluripotent stem cells research holds significant promise to eradicate or ameliorate many diseases, including cancer. The Society believes that such research may be conducted in a moral and ethical manner using stem cells derived from human embryos that were not being used and would otherwise be discarded, as well as stem cells derived from fetal germ cells obtained from elective or spontaneous abortions.”
NIH Guidelines Define Eligible Research Using Stem Cells
Sept. 8, 2000
NIH last month released the final guidelines on research involving human pluripotent stem cells.
The guidelines define the areas of research involving human pluripotent stem cells that are eligible for funding, state the standards for informed consent and establish a “review group” to review documentation of compliance. […]
The guidelines are based on the NIH interpretation of the long-standing restrictions on the use of federal funds for human embryo research, NIH officials said. According to that interpretation, HHS cannot pay for derivation of stem cells from human embryos, but can pay for research utilizing human pluripotent stem cells once they are derived.
AMERICAN ASSOCIATION for the Advancement of Science sent a letter to President George W. Bush expressing its strong support for federal funding of research using human stem cells from embryonic, fetal and adult sources.
“It would be tragic to squander this opportunity to pursue work that can potentially help millions of Americans in need,” the letter says.
According to the letter, the discovery of stem cells, capable of giving rise to virtually any tissue type, could be the most significant scientific and medical breakthrough in the past decade. The result of such research could lead to treatments or cures for Alzheimer’s disease, diabetes, spinal cord injury, and heart disease.
The letter was signed by Mary Good, chairman of the AAAS Board, Peter Raven, president of AAAS, and Floyd Bloom, president-elect of AAAS.
In addition to the letter, the AAAS November 1999 report on stem-cell research was sent to President Bush, recommending that “federal funding for stem cell research is necessary in order to promote investment in this promising line of research, to encourage sound public policy, and to foster public confidence in the conduct of such research.”
The report concludes that it is possible to conduct embryonic stem-cell research in a fully ethical manner. According to the report, the case for public funding is made even stronger by the amount of stem-cell research taking place in the private sector without public oversight. Public funding, the reports states, would help to ensure that the research is closely monitored and meets ethical standards.
Frist Backs Federal Funding For Stem Cell Research
July 20, 2001
Sen. Bill Frist (R-Tenn.) said this week he will back the use of federal funds for research using human embryo cells.
Frist, a physician, joins a list of conservatives who have recently spoken out in favor of funding the research, including Sen. Orrin Hatch (R-Utah).
“After grappling with the issue scientifically, ethically and morally, I conclude that both embryonic and adult stem cell research should be federally funded within a carefully regulated, fully transparent framework,” Frist said July 18 to a Senate subcommittee.
Responding to Congressional pressure, NCI has removed from its Web site a “fact sheet” discussing the risk of breast cancer in women who have had abortions.
Late last month, NCI officials pulled Fact Sheet 3.53, titled “Abortion and Breast Cancer,” from the Cancer Information Service site that provides information to the public.
The document, which said recent studies have found that women who have had abortions “have the same risk as other women for developing breast cancer,” was removed as a result of a June 7 letter to HHS Secretary Tommy Thompson signed by Rep. Chris Smith (R-NJ) and 27 other members of Congress known to oppose abortion.
Smith’s letter criticized changes made to the fact sheet last March, and asked for the page to be removed from the Web site for review. An NCI spokesman said the fact sheet was under review. “After several members of Congress voiced concern about the accuracy of the fact sheet and requested a review of its contents, NCI removed the sheet and is in the process of reviewing it,” said Peggy Vaughn, a spokesman for the Institute. “After that review process, it will be returned, but there is no set timetable for that.”
Under pressure from abortion opponents, NCI has weakened its assessment of published research examining whether having an abortion changes a woman’s risk of developing breast cancer.
A statement posted on the NCI Web site Nov. 25 draws no conclusion about breast cancer risk in women who have had abortions, and characterizes the available data as “inconsistent.”
More than 30 published studies since 1957 have examined the “possible relationship between abortion and breast cancer,” the statement said. “Some studies have reported statistically significant evidence of an increased risk of breast cancer in women who have had abortions, while others have merely suggested an increased risk. Other studies have found no increase in risk among women who had an interrupted pregnancy.”
Data from large epidemiologic studies demonstrate that abortions and miscarriages don’t increase women’s risk of developing breast cancer, an NCI-sponsored workshop concluded.
Last week, the Institute brought together about 100 experts to consider published studies as well as new, unpublished results probing the potential impact of pregnancy and its termination on breast cancer risk.
The absence of a link between abortion and breast cancer was so apparent that no debate about the issue was heard at the three-day conference. Instead, participants of the workshop Feb. 24-26 focused on studies of hormones present during pregnancy in humans and rodents. The conference concluded that women who have their first child while still in their teens or early 20s have a lower lifetime risk of breast cancer, but for some years after pregnancy at any age, women are at a higher risk of the disease, said Leslie Bernstein, professor and senior associate dean at the University of Southern California Keck School of Medicine.
Bush Stem Cell Policy Harms NIH Science, Directors Say
April 8, 2005
Several NIH institute directors say the Bush Administration restriction on funding for research on human embryonic stem cells harms the ability of federally-funded scientists to conduct important work in this field.
The comments, solicited by Sen. Arlen Specter (R-Penn.), chairman of the Senate Appropriations Subcommittee on Labor, Health and Human Services and Education, were made public at the subcommittee’s April 6 hearing on NIH appropriations.
The institute directors wrote in letters to Specter that NIH and U.S. scientists who rely on federal funding could fall behind those in countries that don’t restrict the number of human embryonic stem cell (hESC) lines available for research.
“It is clear that the state of the science is evolving very rapidly, and limitations of the President’s policy become more apparent,” wrote James Battey, director of the National Institute on Deafness and Other Communication Disorders. Battey recently stepped down after serving three years as chairman of the NIH Task Force on Stem Cell Research.
Cancer Researchers Support Human Stem Cell Research
July 22, 2005
Three professional societies representing cancer researchers and clinicians support further “responsible” exploration in stem cell research to accelerate therapeutic developments for patients.
As debate over stem cell research continues in Congress and several state legislatures, the American Association for Cancer Research, the American Society of Clinical Oncology, and the American Society of Hematology have drafted position statements addressing the issue.
NIH Director Elias Zerhouni said federal restrictions on use of government funds to conduct research on embryonic stem cells should be lifted so that U.S. scientists can remain competitive.
“It is clear today that American science will be better served, and the nation will be better served, if we let our scientists have access to more cell lines,” Zerhouni said at a March 19 hearing of the Senate Labor, HHS, Education Appropriations Subcommittee, in response to questioning by Sen. Tom Harkin (D-IA), the subcommittee chairman.
Federal funds can be used to study only certain cell lines that were available in 2001, but they are of poor quality and it’s unlikely that any of them would be used for human interventions, Harkin said.
National Academies Updates Stem Cell Research Guidelines
Sept. 19, 2008
The National Academies released amended guidelines for research involving human embryonic stem cells, revising those that were issued in 2005 and updated in 2007.
One reason for the 2008 modifications is to provide guidance on the derivation and use of new human stem cells that were first developed last year. These “induced pluripotent cells” are made by reprogramming nonembryonic adult cells into a stem-cell-like state, in which they can be manipulated to form a wide array of specialized body cells.
March 13, 2009
President Obama March 9 signed an executive order lifting a ban on federal funding for embryonic stem cell research and issued a memorandum calling for guidelines for protecting government scientists from political pressure.
Obama’s action revokes George Bush’s 2001 executive order that prohibited the use of federal funds for stem cell research. The use of stem cells is not limited to surplus embryos generated by fertility clinics.
President Barack Obama said July 8 that he intends to nominate geneticist Francis Collins as NIH director.
Collins, 59, served as director of the National Human Genome Research Institute at NIH for 15 years, stepping down last year to pursue other projects, including working with the Obama campaign.
Collins’ nomination for NIH director had been rumored for months, and came two days after the administration released final regulations governing stem cell research, allowing many older stem cell lines to be eligible for federally financed research.
Justice Department Appeals Judge’s Stem Cell Injunction
Sept. 3, 2010
The Justice Department earlier this week challenged a court ruling handed down last week by U.S. District Judge Royce Lamberth that froze federal funding for embryonic stem cell research.
The temporary injunction has put many experiments on hold and has been criticized by scientists and research advocacy organizations. Lamberth’s ruling was based on a 1996 amendment that prohibits federal funds from being used for research that destroys human embryos. It would suspend $54 million in funding for more than 20 research projects.
The U.S. Court of Appeals for the D.C. Circuit Sept. 9 agreed to lift an injunction on federal funding of human embryonic stem cell research.
Washington, D.C. federal judge Royce Lamberth issued an injunction last month against funding stem cell research on the grounds that it violates a 1996 law prohibiting federal funding of research in which an embryo is destroyed.
NIH suspended funding for research following Lamberth’s ruling. Earlier this week, Lamberth rejected the Justice Department’s request to lift his injunction pending an appeal.
The Susan G. Komen for the Cure Foundation set off a nationwide wave of outrage by telling its affiliates that they would be precluded from funding breast screening at clinics operated by Planned Parenthood.
This change in grant-making guidelines triggered protests from Komen donors and the defiance of some of the local affiliates of the Dallas-based foundation, which stages races to raise money for mammography and breast cancer research.
Within four days of this policy becoming public, the foundation said it would change its grant-making guidelines once again, making it possible for Planned Parenthood to receive funds.
The Susan G. Komen for the Cure Foundation and Planned Parenthood may have had their differences over reproductive politics, but they march in
lockstep when they overstate the promise of breast cancer screening to young women, a group of experts said to The Cancer Letter.
Much of the controversy over screening mammography is focused on women between the ages of 40 and 49. No responsible health authorities
suggest starting to screen earlier, before the age of 40.
Yet, nearly all the women Planned Parenthood serves are in their twenties and thirties—and the health claims these women see on the organization’s website go far beyond the evidence-based recommendations of the U.S. Preventive Services Task Force.
Karen Handel has resigned from her position as senior vice president for public policy at the Susan G. Komen for the Cure Foundation.
In her letter of resignation, Handel, who once ran for governor of Georgia, said she was not responsible for Komen’s decision to make Planned Parenthood ineligible to receive funding from the Dallas-based charity (The Cancer Letter, Feb. 3).
The letter, addressed to Komen founder and CEO Nancy Brinker and dated Feb. 7, states that the decision was approved by the charity’s board at its meeting in November 2011. This revelation strengthens the argument that the problems at Komen stem from its governance structure.
Participation at D.C.’s annual Susan G. Komen Global Race for the Cure was down 30 percent this year, mirroring diminished nationwide turnouts that took a toll on the breast cancer charity’s fundraising efforts.
Only 27,000 runners attended last Saturday’s race on the National Mall, a dramatic drop from the usual 40,000 that the Komen mega-fundraiser has enjoyed over the past five years.
Charity Faces Money Woes, Attacks from Right
Oct. 26, 2012
This year’s National Breast Cancer Awareness Month didn’t improve business at Susan G. Komen for the Cure, as donors continue to appear less than enthusiastic and affiliates are reporting significant dollar dips nationwide.
The world’s leading breast cancer advocacy group’s recent 3-Day Walk saw diminished turnouts and a 46 percent donation plunge in the nation’s capital this past weekend. The event is Komen’s second largest fundraiser, trailing the Global Race for the Cure in Washington, D.C.
Altogether, 1,600 walked in D.C. compared to 2,500 last year. Event donations did not fare any better, falling from $7 million in 2011 to $3.8 million this year, Komen officials said.
NCI Developing Mouse Models To Succeed NCI-60 Cell Lines
March 4, 2016
The NCI-60, a panel of 60 cancer cell lines that have become the Rosetta Stone for the development of anticancer drugs, may be entering its twilight years as NCI develops new, and more expansive, patient-derived xenografts, or PDX models.
For over 25 years, the NCI-60, a set of about a dozen tissue types—leukemia, non-small cell lung, small cell lung, colon, CNS, melanoma, ovarian, renal, and breast—have been used to perform initial screens on over 100,000 compounds.
In the 1980s, the panel became the first tool to provide the answers to a fundamental problem in oncology: since growing implanted tumors in mice was too slow a process, how can experimental drugs be tested without subjecting patients to toxicity and risk?
When the NCI-60 was established, it became the standard procedure for researchers who wanted to test anticancer agents in highly controlled laboratory experiments. The panel removed patient-to-patient variability, and it was comprehensive: researchers could blast it with an array of drugs and identify which cell lines were responding.
Two weeks ago, a group of 41 House members urged Trump to replace Collins with someone more “pro-life.”
The Obama administration urged NIH to make use of embryonic cells produced in private labs.
“Our underlying concern remains that Dr. Francis Collins will continue to pursue unethical human embryonic research priorities left over from the previous administration,” the legislators wrote.
“While we deeply respect Dr. Collins’s Christian faith and commitment to public service, the stances that Dr. Collins has taken in the past regarding embryonic stem cell research and human cloning are not life-affirming and directly conflict with the pro-life direction of your new presidency.”
Two members of the highest-level review board of the Cancer Prevention and Research Institute of Texas have submitted their resignations from the board of the state-funded institute.
“Inaction would be a tacit endorsement of this unfair law,” committee members Tom Curran and Myles A. Brown wrote in a letter to CPRIT Chief Scientific Officer James K. V. Willson.
“We feel we have no choice, given the highly discriminatory and unconstitutional law (S.B. 8) severely restricting the reproductive rights of women passed by the Texas State legislature and signed into law by the governor,” Curran and Brown said in their letter of resignation from CPRIT.
“It is hard to comprehend the enormous suffering and long-term damage to the health of the women of Texas, particularly in underserved communities, that this law will engender.”
Curran and Brown said they are resigning despite their deep and long-standing admiration for CPRIT.
Fifty physicians and scientists who review grant proposals at the Cancer Prevention and Research Institute of Texas have signed a strongly-worded statement in protest of recent Texas policies and laws that “severely undermine” public health.
The individuals who signed the letter are experts—appointed by CPRIT’s leadership to the institute’s scientific panels—who are responsible for reviewing award applications at the second largest publicly-funded granting organization for cancer after NIH.
“The state’s overt attack on women’s reproductive rights and its misguided and harmful COVID policies demonstrate an unwillingness by Texas lawmakers to prioritize the long-term health of citizens over short-term political gain,” CPRIT’s reviewers said in the statement shared with The Cancer Letter.
“We strongly believe in the CPRIT mission and are committed to supporting it, but we must speak out against policies that are anathema to its spirit. Failure to do so would implicitly signal that we accept those policies; we do not.”
The statement comes five months after two members—Tom Curran and Myles Brown—of the highest-level review board at CPRIT resigned in September 2021 in response to SB 8, a Texas law that bans all abortions after six weeks of pregnancy (The Cancer Letter, Sept. 3, 2021).
When Jill Hawkins realized that she was six weeks pregnant this March, her oncologist gave her two options.
One was to continue with the pregnancy and switch to interferon, a treatment that would be safer for the fetus, but more toxic to her. Alternatively, she could get an abortion.
Hawkins was diagnosed with chronic myeloid leukemia in August 2021 and was taking the drug Bosulif (bosutinib), a tyrosine kinase inhibitor not recommended for use during any part of pregnancy.
“At the end of the day, for me, I can handle the risk to me, or the birth defect. I don’t think I can handle both. I don’t think I can handle the uncertainty and the fear around all of it. I need to feel good about one thing. In this situation, I didn’t feel good about any of it,” Hawkins, a clinical social worker and therapist based in New York City, said to The Cancer Letter. “It’s not a good idea for my health. Do I want to let go of this pregnancy and be sad and grieve, or do I want to keep it and feel anxious and fearful of losing my life?”
Other stories in the July 1, 2022 issue:
- Harvard Law’s I. Glenn Cohen: To provide good care, doctors will run afoul of criminal law in some states as Roe v. Wade ends
- Cancer patients and their families will feel the impact of SCOTUS abortion ruling, by Karen Knudsen, CEO, American Cancer Society
- Cancer care must remain in the hands of doctors and their patients, by July Gralow, CMO, American Society of Clinical Oncology
- Virginia gynecologic oncologists: “Pro-life” is not pro-life at all
- Oncology and healthcare groups respond to the end of Roe v. Wade