Many of the public figures working to shape America’s science policy are troubled by recent advances in biotechnology. They are not alone; their angst is shared even by some of the scientists who are at the vanguard of this research. As we push further into uncharted territory by deciphering and laying bare the workings of life, it’s worth asking just what is it that so worries us.
Four years ago, the announcement of the rough sequence of the human genome provoked widespread commentary about finding the “Holy Grail of Biology,” reading the “Book of Life,” and breaking the “Code of Codes.” This unalloyed enthusiasm, coupled with projections of rapid progress in biomedicine, created soaring biotech valuations until investors realized how long and arduous the path might be from identifying gene targets to identifying therapeutics and moving them into the clinic.
Today, two unprecedented revolutions are under way. The first is the silicon revolution: telecommunications, computers, artificial intelligence and the related technology that is ever more shaping our lives. The second revolution, a child of the first, is the one in molecular biology. Science has slammed evolution into “fast forward,” and no one can say where the process will ultimately carry us.
Look at the Human Genome Project. We now have a list of our genes; we have libraries of their common variants; we have micro-array technology to screen for these variants at ever lower prices. And we are developing the bioinformatics capabilities to make sense of the tsunami of information that is about to sweep over us.
The greatest immediate consequences of genomics, then, will flow from widespread and inexpensive personal genetic testing that will arrive over the next five to 15 years. One near-term result of such testing will be a dramatic shift toward preventive medicine. This will not only mean nutritional and lifestyle interventions, which are notoriously hard to adhere to, but long-term pharmaceutical interventions. This shift will be a huge scientific, clinical and political challenge. Who will pay for such measures? How will people make informed decisions about what to do?
Pharmacogenetics, the tailoring of drugs to our individual genetic constitutions and biochemistries, is another likely development. It will no doubt bring more and better drugs, but they won’t be cheaper, and it is not clear how we will test them. The current regulatory environment simply is not equipped to test personalized preventive interventions. One thing we can count on, though, is that in the decades ahead we will spend more of our Gross Domestic Product on health care and more of our health-care dollars on drugs.
Our ideas of political correctness also will be challenged. As we uncover the constellations of genes that help to shape us, we will find many differences among individuals and among populations. We’ll have to come to grips with the fact that these differences often have biological underpinnings. Some worry that we are not up to this task and fear that the coming storm of knowledge will tear apart the human family. But why should it? Many societies already deal with such differences quite well within the egalitarian framework we so value.
Such immediate challenges, however, are not the source of our deep angst about biotechnology. Our real fears come from more distant possibilities that could be far more difficult and divisive. Three basic realms are apparent. The first is the reshaping of our biology. What if we could unravel the processes of aging and learn to retard, or even reverse, critical aspects of it? This is a key focus of regenerative medicine, and its success would affect virtually every aspect of human society. People often tell me they don’t think it’s a good idea to extend the human life span. Then they sometimes whisper, “but put me on the list.”
A second thorny area is our mounting reliance on pharmacology not just to heal ourselves but to manage our emotional states. Such “cosmetic psychopharmacology” will be increasingly challenging in coming decades. Ritalin, Viagra, Prozac and other such drugs are only clumsy baby steps. The potential is now emerging to short-circuit the emotional programs that have arisen in our evolutionary history to direct our behavior so as to further survival and reproduction. The depth of the challenge is illustrated by the rising problem of obesity. Humans were simply not made to live in a pastry shop. If someday we can take a pharmaceutical cocktail to make us feel happy and fulfilled, will we say no? Should we?
Another area where biotechnology challenges us is reproduction. Setting aside the familiar low-tech methods of mate selection, we can anticipate the arrival of three high-tech procedures to let us consciously choose our children’s genes. The first is reproductive cloning. Media obsession with this is due more to the symbolism of such an alteration of human reproduction than to any plausible consequences of the occurrence. After all, here is a technology that does not yet exist for humans, and yet enormous global attention has greeted the flimsiest of claims about the procedure. Even more importantly, fear that someone, somewhere, might clone a child has generated serious attempts to criminalize basic biomedical research in regenerative medicine, endangering the hopes of real people with real diseases and real suffering.
A second means of selecting our kids’ genetic constitutions is embryo screening, or preimplantation genetic diagnosis (PGD). In this already common procedure, a single cell is removed from a six- or eight-cell embryo in vitro and a genetic test performed on it. The results then are used to decide whether to implant that embryo or discard it in favor of another.
The ultimate means of changing human reproduction, however, is through direct germline intervention — direct alteration of the genetics of the first cell of the human embryo. This would be the beginning of conscious human design. Technologies like human artificial chromosomes, which would be required for this, are under development and already have been used in tissue culture.
If we could stop biotechnology dead in its tracks, other technologies would still reshape our society. When we contemplate the future, we should remember that our great grandparents would not be comfortable in the world of today, yet few of us would really want to live in their world. So it could be with our future, too. We might not find it appealing, but our descendants will, and they will likely look back at the present era as primitive and uninviting.
