If the 20th century was the century of physics, the 21st century will be the century of biology. While combustion, electricity and nuclear power defined scientific advances in the 20th century, the new biology of genome research, which has provided the complete genetic blueprint of a species, including the human species, will define our century.
For the first time, we will have a complete description of life at the most fundamental level of the genetic code. This map will describe for us the exact content and structure not only of every gene associated with a species, but also the pre-coded information, or “chemical spelling,” that controls when a particular gene is turned “on” or “off,” leading to a biological effect.
In humans, for example, this means we will know exactly what genetic predisposition makes a person susceptible, say, to prostate cancer or Alzheimer’s disease. We also will know how to manipulate a gene to produce blue eyes or dark skin. The human genome is 1.5 meters long and has 3 billion letters, all of which are likely to be decoded, along with the genomes of hundreds of other species, by the year 2005.
In a very real sense, then, man will reach the final frontier of his own fate when, in the Age of the Genome, he possesses the blueprint to redesign his own species. What is specific to humanity? When science intervenes to alter a genome that took millenniums to develop, where is the boundary between culture and nature? What genetic intervention, if any, is off limits? These are the great ethical questions that the new biology presents to us.
History has shown that knowledge provides the power for positive change as well as for new levels of abuse. And abuse of the knowledge of the human genome is something that cannot be taken lightly in this era of revived nationalism and ethnic cleansing from the Balkans to Rwanda.
* The Benefits: The use of genomic information over the next 10 to 100 years will utterly transform medicine and the medical industry. As elucidation of the human genetic code progresses, we will begin to find associations between minor differences in the spelling of some genes that will determine the susceptibility to disease. Once we know the exact “misspelling” that causes the susceptibility to disease, we can target that gene with a drug or virus designed for that purpose, or even “graft” a correct spelling onto the targeted gene to cure the disease. At the least, we can determine who is “at risk” for Alzheimer’s or Huntington’s or a certain cancer and monitor the person.
For example, a person who is at high risk of getting prostate cancer after age 40 can have checkups every six months. If cancer is caught in the early stages, it is curable. Prediction and prevention of disease will thus be the earliest consequences of genome research in medicine.
With this knowledge, future drug prescriptions will be given based on genetic testing and phenotypes. Genetic knowledge will also enable humanity to confront an even larger problem just over the horizon. The overuse of antibiotics during the 20th century produced strains of micro-organisms that are resistant to its cures. As a result, the world could well revert to the pre-antibiotic era when millions could die from infections. Genomics is already having an impact here. The first organism to have its genetic code completely decoded was a human pathogen. We expect to decipher the genomes of many micro-organisms, including the biggest killers, such as tuberculosis, cholera and malaria, which together are responsible for 20 million deaths each year. Each deciphered genome provides potential targets for biotech and pharmaceutical companies to develop new antibiotics.
The impact of this knowledge on the health industry can’t be underestimated. Just 50 diseases are responsible for 90% of human illness and death. If these diseases can be predicted and prevented, or treated by newly designed antibiotics, the high cost of hospital care, the most rapidly rising costs in modern economies, will plummet dramatically. Conversely, the pharmaceutical companies that develop drugs that can target genes identified with disease will come to dominate the health industry worldwide.
* Too Many Healthy: As always in science, positive advances can have negative consequences elsewhere. The world now has 6 billion people. If we save millions more and their children through genomics, how will the planet cope? In principle, responsible scientific advances that prolong life must go forward only in tandem with efforts to ensure the biosphere’s compatibility with more population. Already, population growth is outpacing food production, and the oceans are being rapidly depleted.
One answer of genomics is plant engineering, or transgenics, that can increase crop yields. The map of the genetic code of a plant will be completed by early in the 21st century. Already, genes that confer resistance to certain insects have been inserted in the corn genome, resulting in crops with over 20% increased yields. This kind of development is critical for a country like China, where there is a burgeoning population but every square inch of arable land is already under cultivation. The positive impact of agricultural transgenics for everyone becomes clear when we realize that, if food production stopped today, there would be only six weeks of food reserves left to feed the entire planet.
* Potential Abuse: The history of eugenics from early in the 20th century to the Nazis and the more recent rage of “ethnic cleansing” are certainly a warning that humanity may not be ready for the genetic knowledge we are coming to possess. Master-race efforts at “genetic cleansing” may well be imaginable in the distant future and cannot be excluded. The immediate threat, however, is genetic discrimination. While we are just now beginning to identify the spelling errors in the genetic code associated with colon or breast cancer or Alzheimer’s or Huntington’s, there will be a gap of years, if not decades, between this discovery and a cure based on the targeted gene. In the meantime, individuals so diagnosed might well be discriminated against by insurance companies that will refuse to take them on or employers who will refuse to hire them. Clearly, human rights and civil rights law will have to be updated to include this new class of diagnosed person. At this stage, one can only imagine the future potential of abuse.
Is it possible to have a new human being? Once we know the full lay of the genome map, we can, theoretically, design such a new human being. If enough money and research are put into human and bird genome research, we could no doubt put a bird’s wings on a man.These are not trivial issues. In a hundred years, all this will be possible. We have to admit that it could happen. Historical experience has shown time and again that when something becomes possible sooner or later someone does it. That is the risk.
There is no universal system of ethical criteria that says, “This is good. This is possible, but it is bad, so don’t do it.” Now that we are at the threshold of the most fundamental knowledge man can attain of his own being, such a universal system is imperative. What we propose is the establishment of a kind of worldwide “upper chamber of parliament” for this purpose. We mean a parliament in the sense of a deliberative body of experienced scientists and philosophers, let us say of 60 or so members, rotating in two-year terms to advise decision-makers in business and politics with the weight of their collective authority. This body, perhaps under United Nations auspices, would inform the public of what is at stake in a given scientific advance and propose solutions.
Everything depends on the prudent application of the accumulated wisdom of human experience to the stunning new scientific discoveries of our age. Cognizant of both the great possibilities and the risks that knowledge of the human genetic code brings, our hope is that future generations will never have to ask, with T.S. Eliot, “Where is the wisdom we have lost in knowledge?”