From The New England Journal of Medicine
Let's dispense with the suspense. This is a short, readable, thought-provoking book that discusses in nontechnical terms the future of humankind in the age of genetic engineering and should be read by anyone who wishes to participate in a public discourse that will shape the future. The central topic is the technology of genetically altering germ-line cells. Altering germ-line cells, which produce ova and spermatozoa, is considerably different from altering somatic cells. Germ-line changes will affect every cell in the body and will be passed on to future generations, whereas somatic-cell changes affect only specific cells within a given organ system and are not passed on.
It is interesting to see the shift in opinion within the scientific community, which previously discounted germ-line therapy, eugenics, and cloning as unachievable and morally suspect. With familiarity, increased understanding, and discussion, many now see these forms of technology as inevitable, and most of the contributors to this book are willing to consider them and some even to defend them.
Germ-line engineering, by providing a means for humans to control and direct the evolution of their species, is another blow to the fading credibility of supernatural explanations of human nature and purpose. Having established humans as inconsequential animals destined to exist only a brief time on a speck of a planet in a huge cosmos, science has left us with the ultimate truism that for humankind, man is the measure of all things.
The book is based on a 1998 symposium and is supplemented with short essays by 17 authors who represent a broad spectrum of expertise and opinion. The organization allows the reader to reach a relatively painless understanding of the technical and societal issues involved. The short-essay format does not allow detailed analysis of the issues or defense of the opinions expressed and may leave the reader wanting more.
The book is divided into three parts. Part 1 consists of reviews of the current state of germ-line engineering. The attempt is to be realistic and practical. Topics covered in this section include the introduction of genes into an existing chromosome and the introduction of an artificial extra chromosome into the gamete. The discussion covers numerous issues, including the need to understand gene regulation and interaction, reversibility, and prevention of generational transmission. The need to increase the interaction between genetics and information technology is emphasized. The consensus is that the technical issues can ultimately be resolved and that the only question is how long that process will take. Whereas Campbell and Stock predict applications in the next two decades, Anderson is more cautious and prefers to envision the development of somatic-gene therapy before a venture into the germ line. The problems with somatic-gene therapy include methods for introducing a fully functional gene into a cell that needs it and for keeping it functional over time. Capecchi suggests that germ-line therapy might be easier to bring to practical application since it avoids these problems. If past experience is any guide, its development may take longer than estimated. We have known the genetic sequence of the sickle cell gene for 20 years and the sequence of the cystic fibrosis gene for more than 10, yet there are no somatic-gene therapies available. These forms of technology, however, will be real and practical within the lifetimes of our children or grandchildren.
In the discussions of this technology, therefore, it is assumed that the procedure is "no more risky in humans than natural conception," and the discussants proceed to analyze what kinds of limits should be imposed on its use. However, it is clear that a few discussants are concerned not with physical risks, but with risks to society and its moral structure. They raise the usual objections to hubris and "playing God" and raise antireductionist objections as well. Most of the participants, however, set aside these objections and are concerned with the question of use.
The initial discussions are in terms of therapeutic or health-related applications, such as ways to introduce resistance to human immunodeficiency virus infection or prevent cancer. Capecchi uses the example of eliminating Huntington's disease. However, the issue of enhancement (i.e., the use of germ-line alteration to enhance desirable natural characteristics) is soon raised. This will be a clear demand as the technology is developed.
Each essayist is asked whether he or she would use an artificial chromosome to extend the life of his or her child. This is an unfortunate choice of question, since it involves the confounding "quality of life" issue. A better choice would have been a question about an intelligence-enhancing gene, which focuses on the use of this technology.
McGee argues that given safety, human germ-line modification is no different from many other efforts of parents to modify their offspring. The issues of increasing the existing inequities in society, the moral status of contingent persons and embryos, and unreasonable expectations of parents are discussed in this context. McGee finds nothing wrong, in principle, with enhancements. As with technology in general, scientific ignorance within society is the greatest threat to the intelligent and ethical application of germ-line modification. Until this problem is rectified, it will be necessary to regulate and control this new and powerful technology. The possibility of international and national regulations is addressed in the last two essays. Humans will develop this technology using their own intelligence; that same intelligence is the only means available to direct and control its use rationally for the development of a new, healthier, happier, and kinder humankind. The species that invented gods is the only one that can emulate them.
George Cunningham, M.D., M.P.H.
Copyright © 2000 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
"It is unique among books published on recent genetic advancements and their impact on society. First, it is one of only a few on this controversial topic; and second, it contains opinions not only for prominent researchers, but also for ethicists and policy makers."--Annals, March 2001
"A short, readable, thought-provoking book that discusses in nontechnical terms the future of humankind in an age of genetic engineering and should be read by anyone who wishes to participate in a public discourse that will shape the future....Essays by 17 authors [capture] a broad spectrum of expertise and opinion."--The New England Journal of Medicine
"Three approaches to looking at the possibilities and dangers of manipulating genes in reproductive cells to alter both immediate patients and their offspring. First, seven scientists explain to general readers the state of the science and technology, distinguishing what is possible from what is unlikely or impossible. Then they are joined by an ethicist, a public policy specialist, and Nobel-laureate James Watson for a lively panel discussion. Finally a collection of short essays by scientists, ethicists, lawyers, theologians, and public-policy makers offer a wide range of views."--SciTech Book News
"This is a short, readable, thought-provoking book that discusses in non-technical terms the future of humankind in the age of genetic engineering and should be read by anyone who wishes to participate in a public discourse that will shape the future. It is interesting to see the shift in opinion within the scientific community, which previously discounted germ-line therapy, eugenics, and cloning as unachievable and morally suspect. With familiarity, increased understanding, and discussion, many now see these forms of technology as inevitable, and most of the contributors to this book are willing to reconsider them and some even to defend them. The book is based on a 1998 symposium and is supplemented with short essays by 17 authors who represent a broad spectrum of expertise and opinion. The organization allows the reader to reach a relatively painless understanding of the technical and societal issues involved." - George Cunningham, MD, The New England Journal of Medicine, Vol 343, No. 19
"Paints a futuristic picture of the 'practical aspects' of genome manipulation."--Nature
"The relegation of sex from being procreational to purely recreational may be premature, but Gregory Stock, one of the editors of this volume, believes that the production of designer babies will eventually take over from normal reproduction. Altering the human genome in a permanently heritable manner ... is highly controversial, and in many countries it is prohibited. As with most controversial subjects, though, much can be gained from a thorough discussion of the possible applications, both now and, more speculatively, in the future. This volume is the record of a symposium held at the University of California at Los Angeles in March 1998. It was hosted by Stock ... Technology and Society, and his fellow editor John Campbell ... The participants, mostly drawn from US academic institutions, fall into three categories, eminent practising scientists; panelists, including James Watson, the co-discoverer of the structure of DNA; and commentators--scientists, ethicists and theologians."--Nature
"Attempts to correct human diseases by inserting engineered genes into somatic, or body, cells began nearly a decade ago. In contrast, the idea of introducing manipulated genes into germline, or sex, cells has generally been taboo, since this would alter the genetic makeup of future generations. Unfortunately, somatic cell gene therapy has so far proved frustrating, and therefore in 1998 the editors convened the first major public forum to discuss the prospects of human germline gene therapy--a seemingly more straightforward approach to curing genetic disease. ... These papers balance the generally favorable statements for human germline engineering presented in the first two sections and are especially useful in appreciating the complexity and broad implications of this potential technology. General readers; lower-division undergraduates."--Choice
"This is an interesting, informative and often unsettling look at current and future genetic manipulation. Could the same techniques used for gene therapy be used to enhance traits? This text takes us further. Although the participants are predominantly American, an international perspective is attempted. The reader is left pondering the question presented to the participants: If you could do so safely, would you use an artificial chromosome to extend the lifespan of your child?" -- Laura T. Arbour, MD, Clin Invest Med, Vol 23, No 6, Dec 2000
"This lively and frank analysis of germline genetic manipulations of reproductive cells fascinates by virtue of the fact that it constitues one of the first in-depth analyses of the realistic possibilities and problems of this technology... replete with academicians...who lay the ground work for a better understanding of "genetic engineering." No uniformity of approach or ideas emerges, a true reflection of the controversial nature but also of the scientific uncertainty still surrounding this technology. The second part of the book is livelier, its debate format slipping out of the arena of typical "pros and cons" arguments to reveal the personal insights and values of the aforementioned. Discussion throughout is frank and open. The ethical evaluation of the purposes and implications of germline engineering lies in the careful, cautious, and courageous discernment of its purposes and implications as found in this book." -- Bartha Maria Knoppers, Nature Biotechnology, Vol 18, Oct 2000
"Over the past years new reproductive and molecular technologies, concurrent with progress in the human genome project, have provided a scientific foundation for speculation about manipulation of the human genome. . .In an apparent attempt to address our mixed feelings about human genetic manipulation, the present book is published. This three part volume tries to address our state of scientific progress in germ-line genetic modification."--Heredity Journal