Political debates about policymaking become a lot less dry when the people directly affected testify in public hearings. No one knows that better than state Rep. Peter Koutoujian, D-Waltham, co-chairman of the Joint Health Care Committee for the State of Massachusetts.

He vividly remembers a hearing in which a woman with a spinal cord injury who uses a wheelchair called for support for stem cell research. She described a vision in which such research would lead to new treatments for spinal cord injuries so that no one in the future would need to deliver testimony like hers. Her words moved Koutoujian, but, as is often the case, policymaking amounts to more than empathy. Legislators must consider: What are the pros and cons? Whom will this legislation benefit? Whom will it harm? Who stands to make or lose money?

Koutoujian spoke about "The Role of Public Health in Politics and Policy Making" at a lecture on September 23 in Snyder Auditorium sponsored by the Division of Public Health Practice as part of its Public Health Practice Speakers Series. Howard Koh, former Massachusetts Public Health Commissioner and new head of the Division of Public Health Practice, introduced Koutoujian. During his tenure as commissioner, Koh worked under four governors in six years, navigating a complicated labyrinth of politics and public health. As a result, said Koh, he recognizes Koutoujian's exceptional work as a public servant.

The Health Care Committee's mission is to "promote wellness in our state," Koutoujian said. He estimated that 8,000 health care bills pass through his hands every year. His job is to keep those bills moving forward.

"There is not much division among professionals over what needs to be done (to promote health)," he said. "The trouble is how we get it to be law and how we develop and change policy."

A former prosecutor who climbed the ladder of committee leadership during three terms in the State House, Koutoujian discussed the fine line a legislator walks between initiating bills based on information from experts in the field and those framed in response to the will of the people.

"There's a dynamic tension between the two," he said. "The conflict is inherent all the time. For one thing, many experts in state agencies are political appointees. Everything they do has to be approved by the governor."

He said that he discovered the debate over legislation related to stem cell research, for example, boiled down to a framework of religion versus science-how each sector views the beginning of life. Does life begin at the moment of conception? If so, explained Koutoujian, the Roman Catholic Church could argue that stem cell research cannot be permitted because it would be tantamount to murder. If life begins at a later point in human development, stem cell research advocates see no ethical problem in using embryonic tissue for therapeutic purposes. The debate has taken on significant dimensions that go well beyond science and that need to be considered in policymaking decisions.

Further illustrating that point is yet another angle in the stem cell research debate that emerges in many policymaking decisions-economics. Koutoujian noted that there is a lot of money to be gained from stem cell research. If Massachusetts won't allow such studies to be conducted in the state, the industry will go elsewhere. California, for example, is already courting Massachusetts firms willing to relocate to the West Coast. The California state legislature passed a law last year that supports stem cell research and allows the destruction and donation of embryos within the context of research efforts.

However, he explained further, there are times when the goal of policymaking is to stimulate awareness and lively debate, as well as making a law. Koutoujian has sponsored a bill that would limit the junk food available on school property during the school day. Yet he openly questioned whether it is a good idea for the government to regulate what some could argue is the purview of the schools themselves. Instead, the intended purpose of the bill is to get people talking about the issue and perhaps, through the debate, prompt action by the schools and food purveyors themselves. For example, a soda company can conceivably replace the colas offered in its vending machines with healthier water and fruit juice product lines that it also owns with little expected impact on profits or marketability.

"My job is to reframe the question, to educate," he said.

For more information about the Public Health Practice Speakers Series, contact Betty Johnson at bljohnso@hsph.harvard.edu.