Scientists using "gene therapy" have for the first time created significantly smarter mice, demonstrating that a seemingly minor genetic alteration can improve performance on a wide range of learning and memory tasks.
Gene therapy, the insertion of normal or modified genes into an animal or human, is often undertaken to correct genetic or acquired disorders. Thousands of patients in almost three dozen countries are currently undergoing gene therapy for diseases ranging from cystic fibrosis to cancer and AIDS.
No one seriously objects to these clinical trials. But gene therapy can also be used for nontherapeutic purposes, even including attempts at genetic "enhancement" to increase human physical or mental capacities above those currently deemed normal.
For this reason, the mice experiments bring to the fore a long-simmering debate about the ethics of making "designer humans." "We're in an era when breakthroughs in biology and intelligence are outpacing the culture's capacity to deal with the ethics," says Joe Tsien, the Princeton University molecular biologist who led the mouse-improvement research. "There will be issues of access and who can afford it. Whether the social wealthy class will have the intellectual advantage over poor people, these are real questions coming down the road."
Others have gone further. Physician and gene therapist W. French Anderson of the University of Southern California has written that "until we have acquired considerable experience with regard to the safety of [gene therapy] for severe disease, and society has resolved at least some of the ethical dilemmas that this procedure would produce, non-therapeutic use of genetic engineering should not occur." He has denounced enhancement gene therapy as "medically hazardous, morally precarious, and philosophically debatable."
Yet in other contexts society has already come to terms with these issues, if not completely resolved them. People frequently enhance their appearance or health through the use of other medical technology. Drugs are frequently employed to treat such relatively trivial conditions as modest obesity, stuffy noses, age spots and baldness. There have been numerous clinical trials of appetite suppressants, memory- and performance-enhancing drugs, and human growth hormone for short children.
Gene therapy is simply part of a continuum of therapies that introduce or modify DNA or modulate genes' activity. Among the therapies on the continuum:
- Organ transplantation. Transplanted organs are a source of normal genes, which in turn synthesize functional levels of an enzyme or other substance that is deficient because of genetic disease. Common practice includes lung transplantation for cystic fibrosis and bone-marrow transplantation for severe immune deficiencies.
- Vaccination. Being inoculated results in irreversible changes in blood cells' DNA, initiating the synthesis of mediating antibodies.
- The administration of drugs to activate dormant genes. For example, a chemical called 5-azacytidine has been used in sickle-cell anemia (a hereditary abnormality in the oxygen-carrying molecule, hemoglobin) to activate hemoglobin genes that normally would be inactive after birth.
Over many decades, these therapies have raised all manner of medical and ethical issues similar to those of gene therapy. There is no obvious basis for subjecting gene therapy to regulation or moral scrutiny more restrictive than for other therapies. Arguments against testing gene therapy for enhancement should be weighed against society's permissiveness toward experimental medical and surgical interventions in general, and those intended for nontherapeutic purposes in particular.
A vast array of entities, at many levels of government, regulate gene therapy. These include hospital-based Institutional Review Boards, company- or university-based bio-safety committees, the National Institutes of Health's Recombinant DNA Advisory Committee (on which I served in 1980-93), the NIH director and the Food and Drug Administration. This intensive and duplicative regulation offers a sharp contrast to the degree of oversight of a new surgical procedure, for example, which might be completely unregulated or subject only to approval of a hospital-based committee.
Patients' psychological well-being and freedom to choose are also important considerations. "Mere" enhancement is not trivial to the adolescent boy who is six inches shorter than anyone else in his class, or to many people of either sex who suffer hair loss. The huge societal demand for cosmetics, cosmetic surgery and health clubs proves how important people consider it to look and feel good.
The issues surrounding when treatment is warranted, what risks are worth taking, and whether people have equal access to therapy are no different for gene therapy than for other interventions. Therefore gene therapy, even when used for enhancement, shouldn't be treated differently from any other medical intervention. It certainly shouldn't be rejected out of hand, particularly when existing oversight mechanisms subject it to an extraordinary level of scrutiny.
Many people seem to feel that tinkering with genes is somehow different. New technology, especially unfamiliar technology that seems to disturb the natural order of things, tends to elicit what George Orwell called "vague fears and horrible imaginings." Such apprehensions have a long history. Techno-skeptics predicted electrocution from the first telephones, believed Edward Jenner's early attempts at smallpox vaccination would create monsters growing from the site of injection, and doubted the possibility of matching blood for transfusions.
Conversely, has anyone raised the specter of poisoning or cancer from silicon chips, to which nearly all of us are exposed daily? Of course not. Today's electronic devices seem to us an extension of their mechanical predecessors; everyone understands them. Gene therapy, by contrast, is less familiar--but it's nothing to fear.
Henry I. Miller is a senior research fellow at Stanford University's Hoover Institution. From 1979 to 1993 he was responsible for biotechnology policy at the Food and Drug Administration.
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