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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.
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Most Helpful Customer Reviews
22 of 23 people found the following review helpful:
5.0 out of 5 stars
Putting groundbreaking human genetics in perspective,
By J. L. Umphres (Los Angeles, California) - See all my reviews
This review is from: Engineering the Human Germline: An Exploration of the Science and Ethics of Altering the Genes We Pass to Our Children (Hardcover)
Important developments in the rapidly-changing field of human genetics are in the newspaper virtually every day, but the underlying ethical and moral issues seem to remain constant from year to year. This book does a very fine job of exploring those concerns and examining the larger implications of human "germline" engineering. Although it also contains additional related essays, "Engineering the Human Germline" basically seems to be an edited transcript of a thought-provoking symposium (of the same name) which a thousand or so others and I attended at UCLA in March 1998. During that public event, an impressive panel of experts delivered intelligent, understandable lectures, then debated the great promises and dangers which might result from altering the genes which get passed to our children, grandchildren, etc. (such theoretical alteration of genes, in a nutshell, is what "germline" genetic engineering is). "Engineering the Human Germline" proves to be a worthy record of that symposium. Some say the human gene pool is a sacred thing and that we should never "play God." Clearly, if you monkey around with the genetic code of an early-state embryo, you might wind up with a monstrosity on your hands. But what if (at some point in the future) you knew exactly what you were doing when you corrected (or requested the correction of) a pre-embryo's faulty genetic code? What if, as a result of your intervention, the resulting human being neither developed a deadly or life-shattering genetic disease (that it would have inherited, otherwise), nor passed the faulty gene(s) on to the next generation? The value of this promise seems to be at the core of what's explored by the numerous contributors of "Engineering the Human Germline." At one point in this book we have a very outspoken James Watson (the 1962 Nobel-winning co-discoverer of DNA structure who also helped establish the Human Genome Project) saying, "It's common sense to try to develop it <germline engineering>... If we could make better human beings by knowing how to add genes, why shouldn't we do it? What's wrong with it? Who is telling us not to do it?... We should be honest and say that we shouldn't just accept things that are incurable. I just think, 'What would make someone else's life better?'" All in all, "Engineering the Human Germline" is a balanced, intelligent, readable resource for professionals, students or the average citizen who wants to know more about the groundbreaking developments in human genetics and the surrounding issues which will affect us all.
2 of 2 people found the following review helpful:
5.0 out of 5 stars
Complete and Non-technical,
By
This review is from: Engineering the Human Germline: An Exploration of the Science and Ethics of Altering the Genes We Pass to Our Children (Hardcover)
This is an excellent review of the issues raised with manipulation of human stem cells. It covers all kinds of scenarios and sees them through various perspectives. The book is enriched by essays from distinguish authorities in complementary areas. Everyone gives their opinion and explains their point of view in a non-techincal language. Besides it includes a very interesting interview with a panel of personalities such as James Watson. I do not like long reviews, so this would be short too, just to finish a last warning, this is not the latest publication on the subject and since its publication tons of related work has been done. This is important so if you want to be updated you will certainly need recent information, nevertheless this covers all in an excellet manner, I highly recommend it.
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