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Paulos Mar Gregorios
Contents
Introduction: Two Preliminary Observations
-
The Origin and Development of Genetics
-
A Brief History of some Recent Developments
-
What is Gene Therapy?
-
The Nature of Ethical Reflection
-
The Ethics of Human Genetic Therapy
Conclusion
Notes
Introduction: Two Preliminary
Observations
As one looks at the ethical issues raised by
new possibilities in Human Gene Therapy, two fundamental observations
emerge.
First, Gene Therapy on human beings is still
in its incipient stage. Apart from a few bone marrow transplants and some
first steps in transfusion of blood from the umbilical cord of a newborn
sibling (with germ cells in it), very little has been clinically established
as of now, as far as I know. The laboratory or experimental work, which
should precede clinical trials has barely begun, and still faces ethically
controversial, technically difficult and bureaucratically complicated
decisions.
Second, distinctions should be made, not only between Somatic
Cell Correction in the patient and Germ Line Correction (ovum, sperm and
embryo), but also among (a) technical problems to be solved, (b) ethical
issues to be settled, and (c) bureaucratic hassles to be tided over. A brief
history of recent developments will make abundantly clear the significance
of the latter distinction.
I. The Origin and Development of Genetics
The Science of genetics is so new. But its
rudiments had already been grasped in the last century. And the
possibilities implied in that limited knowledge already created an ethical
discussion on eugenics, or selective breeding of humans (not genetic
engineering as such, because it was not then a real possibility).
It started off with great furor, as early as
1865, When Francis Galton, a younger cousin of Charles Darwin, When he
wondered in writing, apropos of the then new discussion of possibilities of
selective breeding of plants and animals for the benefit of farmers:
“Could not the race of men be similarly
improved? Could not the undesirables be got rid of and the desirables
multiplied?” [15]
The word “eugenics” was created by Francis
Galton in 1883, to denote an almost religious doctrine, that the human stock
could be improved by giving “the more suitable races or strains of blood a
better chance of prevailing speedily over the less suitable”. Daniel J.
Kevles, in his “Genetic Progress and Religious Authority: Historical
Reflections” [16], tells
us that Galton actually proposed Eugenics as a substitute for orthodox
Christian doctrine. Of course clerical writers opposed Galton vehemently,
but at the turn of the century when the work of Gregor Mendel was discovered
and publicly acknowledged, the religion of Eugenics received a new boost.
In the period from 1900 to 1930 the religion
of Eugenics spread widely in England and in the U S A, among liberals who
were dissatisfied with traditional Christianity and charmed by the dramatic
achievements of modern science. Eugenics itself became a sort of organised
religion, and many organisations were formed for promoting Eugenics, and a
great deal of material was published on the subject. The American Eugenics
Society was formed only in 1923, but already before that “Fitter Families
Contests” started at the Kansas Free Fair in 1920 had begun to be repeated
in seven or more States in America. In 1923 the quasi - religion of Eugenics
also published its Ten Commandments, The New Decalogue of Science written by
the most ardent evangelist of Eugenics, Albert E. Wiggam, a journalist and
popular lecturer. The book soon became a bestlseller. Three years later, the
American Eugenics Society published its official Catechism with the title:
“A Eugenics Catechism” [17];
it taught that Eugenics could improve the human race and increase the number
of geniuses by “selective love-making”.
The Gospel of Eugenics received support from
what were coming to be called “modernist” clergy, including Dean Inge of St.
Paul’s Cathedral in London. Liberal Jewish Rabbis and Methodist Pastors
began using their pulpits to propagate the Gospel of Eugenics, in America
and Britain. In 1929, the Kansas Free Fair had a placard with asked the
question in bold lettering: “How long are we Americans to be so careful for
the pedigree of our pigs and chickens and cattle, and then leave the
ancestry of our children to chance, or to ‘blind’ sentiment?” Our famous
I.Q. tests were first created by a devotee of this religion. Henry H.
Goddard, a Psychologist who intended to use I.Q tests as a means to
detecting the “feeble - minded” and eliminating them in order to improve the
human stock.
Why then did the movement suddenly die out
in the 1930s? For two reasons: First, people began to see how the movement
was becoming more popular among the WASPs (White Anglo-Saxon Protestants) of
America who wanted to keep non-WASPs out of power, and who feared that too
many of these new immigrants were coming from ‘inferior’ races and
blood-stocks, especially Jews and Catholics at that! As people began to see
hidden racist motivation behind the gospel of Eugenics, it lost its
popularity. The second reason for the failure of the gospel of Eugenics was
the use Hitler began making of it in his doctrine and practice of National
Socialism. We should be grateful to Racism and Fascism for making the gospel
of Eugenics unpopular! Otherwise some of the less endowed among us in terms
of I.Q, the more “feebleminded” among us would have lost out the chance of
having progeny; if Eugenics had become universal, that could have happened
to my parents, and I may not have existed! But Eugenics is not the theme of
this conference, and it does not even need the new genetic technology. I am
sure. However, that Eugenicists can find many uses for genetic engineering.
Closer to our own time and theme, in June
1983, a group of fifty nine prominent clerical leaders in America, published
and released to the press a “resolution” urging that “efforts to engineer
specific genetic traits into the germ line of the human species should not
be attempted”. The signatories were all noted religious leaders, Roman
Catholic, Main Line Protestant, Sectarian Protestant, Jewish and all,
including Professor J. Robert Nelson, then of Boston University, Methodist
Bishop James Armstrong, President of the National Council of Churches of
Christ in the USA, Bishop Crutchfield. President of the Council of Bishops
of the united Methoodist Church, Dr. Avery Post, President of the United
Church of Christ, and Jerry Falwell of the Moral Majority.
This clerical outburst had been prepared for
by similar explosions in the scientific community itself. In 1973 the
International Congress of Genetics had raised quite a furor about the
dangers inherent in the new technology of genetic engineering. The
scientists were at that time prone to overestimate the possibilities for
altering human personal characteristics and traits through genetic
technology, both at somatic and germ-line levels. In 1974 a group of eleven
of the world’s leading geneticists called for a moratorium on recombinant
DNA techniques to create new bacterial strains. Were they justified in
raising all that hullabaloo at that time? Well, who knows whether our common
enemy, the AIDS virus came into being as a result of some of these research
projects to create a new virus to be used in War, against which the human
organism would have no immunity?
In 1975, 140 gene scientists assembled at
the Asilomar State Park in California and issued guidelines for controlling
or regulating research in recombinant DNA technology. In that same year a
Harvard biologist had claimed to have synthesized a rabbit gene. In 1976,
Har Gobind Khorana, a scientist of Indian origin, claimed to have made a
gene entirely out of shelf chemicals, which would work when implanted in a
bacterial cell.
Some genetic scientists were already talking
about using gene technology at the germ – line level, not only to improve
the human stock, but also to create new types of inferior human beings,
organic robots who will do our dirty work for us, drones who would neither
protest nor strike. workers who would not even ask for higher wages. Why
not, if humanity is to take charge of its own destiny and reconstruct its
own organic endowment, to suit its tastes and to meet felt needs? That is
the question that scares, and probably made the eminent clergymen a bit
squeamish about genetic alteration of the human germ-line.
II. A Brief History of some Recent
Developments
In October 1984, Dr. W. French Anderson,
Chief of the Laboratory of Molecular Haematology at the US National
Institutes of Health, a pioneer in this field as well as a prime actor in
the dispute that ensued, reported in Science that Gene Therapy experiments
had been successfully completed in fruit flies (drosophila melanogaster) and
in mice. [1]
This was probably in response to a report in
The New Scientist of September 27, 1984 that Human Gene Therapy was, as of
then, still a “distant prospect”. [2]
Following Anderson’s announcement, Stephen Budiansky suggested on November
29, 1984 that clinical trials of Human Gene Therapy was just about to begin
in the USA. [3] He did not
know at that time that it would in fact take more than four years after
that.
The US Congessional initiative in the matter
was taken by Representative (later Senator) Al Gore (Democrat, Tennessee),
through a bill asking the Congressional Office of Technology Assessment
(OTA) to conduct an analysis of the ethical and scientific issues involved
in Human Gene Therapy. The OTA report came out in December 1984; it made
clear the distinction between somatic body cell correction in the individual
patient and Germ Line Therapy (ovum, sperm, embryo) which affects the
progeny as well. Gore, who had become Senator by then, saw no unique ethical
obstacles to the former, provided of course that safety, efficiency and all
the rest were taken care of as in any other therapy. The OTA report was
hesitant however, about the ethics of germ line genetic therapy: about the
“need, technical feasibility or ethical acceptability of gene therapy that
leads to inherited changes”. [4]
The American Congress has its own
Bio-medical Ethics Board; but that board has enough hot potatoes on its
plate, like fetal abortion, in vitro fertilisation and fetal research. It
was able to meet only in December 1988 for the first time, and it had not
taken on Gene Therapy on its agenda.
The Congress has also a Recombinant-DNA
Advisory Committee (RAC), with 17 scientists and 8 members from the general
public. Dr. Anderson and Other gene therapy researchers serve on this board.
The RAC has a special sub-committee on Human Gene Therapy. Prof. Leroy
Walters, Director of the Center for Bioethics at Kennedy Institute of
Ethics, Georgetown University, chairs this sub committee which has 3
laboratory scientists, 3 clinical practitioners. 3 lawyers, 2 public policy
specialists and one lay person on its membership. This subcommittee has
first to clear permissions for Gene Therapy experiments or clinical tests.
On August 15, 1985 Tim Beardsley reported in
Nature that disputes between the NIH and the US Food and Drugs
Administration were likely to delay research in Gene Therapy.
[5] Even in May 86, neither the
technical nor the ethical problems had been solved. Jean Marx reported in
the Research Column of Science about the delay under the title: Gene
Therapy--So Near and Yet So Far Away and the subtitle: Genes
transferred into cultural cells often work very well, but getting good
expression of foreign genes is another matter. Her bottom line was: “We
are basically making the observation that we have a long way to go”.
[6]
It was only on 19th January 1989 that the
first federal approval for gene transfer was given. And it was not a genuine
gene therapy case; the transplanted gene in itself gives no therapeutic
benefit; It serves as a marker to track the progress of a promising but
experimental cancer treatment. The experiment was to insert marker genes
into Tumor Infiltrating Lymphocytes or TIL cells, using a retrovirus
incapable of replicating itself. [7]
As the news came out knowledgeable people
thought that the last hurdle to somatic cell gene therapy in humans had been
overcome. Leslie Roberts reported in Science on 3rd March 1989: “On January
19, the United States crossed the threshold into the much debated but still
uncharted world of human gene therapy”. [8]
Though this was 17 years after the first gene had been spliced, Roberts had
spoken too soon. On 30th January 89. Jeremy Rifkin, President of the
Foundation on Economic Trends (Washington, DC) accused the RAC of ignoring
the social and ethical ramifications of gene therapy. He called for a
moratorium on the cancer experiment and on all human gene therapy research
until the NTH set up a special committee to evaluate the ethical and social
implications of this work. This lawyer filed a suit in court to stop the
experiment.
Meanwhile a new corporation had been set up
to clinically exploit the new technology that was emerging, called “Genetic
Therapy, Inc”. Two of the NIH research scientists had concluded a co -
operative Research and Development Agreement (CRADA) with this corporation:
Drs. French Anderson and Michael Blaese. The scientists had agreed to keep
the research data confidential and the company had agreed to make royalty
payments to them if they kept their side of the agreement. Clearly there was
more than one vested interest in the project.
The Federal Court eventually refused Jeremy
Rifkin’s suit. The way was now cleared for the cancer experiment, and it was
carried out on 22nd May 1989, but not by the two who had signed the CRADA
agreement with Genetic Therapy, Inc. Their collaborator, Steve Rosenberg,
who had refused to sign the CRADA agreement with the new company. finally
carried out the implantation of the marker gene to trace the progress of the
TIL cells introduced into the cancers of six terminally ill patients.
Scientific journals heralded this milestone in medical history with catchy
but cautious captions like:
“TREATMENT WITH GENES CREATES MEDICAL
HISTORY’’
Christopher Joyce in New Scientist, May
27, 89.
[9]
GENE THERAPY PRELUDE UNDER WAY’’
Charles Marwick in JI
of Am. Med Assocn. July 7, 1989 [10]
“PROGRESS TOWARD HUMAN GENE THERAPY’’
Theodore Friedmann in
Science, June 16, 1989 [11]
As far as the results of the experiment,
they were regarded as moderately successful. Barbara Culliton’s report in
Science (Septr 22, 1989) was captioned: “Gene Transfer Test: So Far, So
Good”. [12] Genetic
Therapy research has now received a new push in the west as a whole. Several
new clinical trials can now be expected in the fields of gene therapy for
various immune deficiency syndromes, chronic Hepatitis C, hereditary
emphysema, cancer (through TIL techniques), cystic fibrosis and even AIDS
(through molecular sabotage’’ or the “mutant mimicry” of “throwing a monkey
wrench into the genetic machinery of AIDS”, as Rick Weiss reports in the
Science News of January 20, 1990 [13].
What about other countries? I am in no
position to give anything like a comprehensive picture, and it is hoped that
a lot of new information will emerge in this conference about what is going
on in other countries.
The British Government set up only in
December 1989, a committee to investigate the ethics of Gene Therapy.
[14] Sir David Weatherall,
Nuffield Professor of Clinical Medicine at the University of Oxford, serves
on this committee. UK Health Minister Virginia Bottomley wants this
Committee to draft ethical guidance for doctors who might consider applying
gene therapy. I expect to be told here how far that has got.
The Swedish Government has set up a
Recombinant - DNA Advisory Committee. They have already organised in
Stockholm (March 11 to 14, 1990) a conference on Trends in Biotechnology.
The European Commission has a $ 17 million
project for Research in Human Genetics in 1990 - 91.
There should be many other projects and
activities coming into being in this field all over the world.
III. WHAT IS GENE THERAPY?
Dr. French Anderson defined gene therapy as
“the insertion into an organism of a normal gene which then corrects a
genetic defect.” That was in 1984. Today we need a slightly broader
definition.
Gene therapy should include genetic disease
diagnosis, genetic pharmacology (and pharmacopeia), the multi-factoral
aetiology and therapy of major diseases like cardiac ailments, cancer,
diabetes, arthritis, Alzheimer’s disease and mental illness, in which not
the disease itself, but only proclivity to the disease may be genetically
inherited. Some 4000 diseases are reported to be caused by congenital
genetic defect. But in some of the diseases like the ones listed above,
genetic endowment provides only some proclivity to the disease (“it runs in
the family”), while its onset may be determined by life-style and
environmental factors. Clear diagnosis of the genetic endowment may help in
adopting a prophylactic life-style and environment as part of the therapy.
Diseases with a non-genetic origin can be
genetically treated, it now seems. Intra-cellular immunisation by gene
therapy is no longer a purely theoretical question. Interferon in cancer
therapy is a clear case. Experiments are now in process on a technique of
bio-molecular sabotage, to which earlier reference was made. The idea is to
alter genetically a patient’s white blood cells, spurring these cells to
manufacture a constant supply of mutant viral components. Invading AIDS or
HIV virus is supposed to contact these mutants and lose its ability to carry
on the replicative or reproductive cycle. This research is now reported as
going on in at least three places: the Duke University Medical Center
(Durham, NC), the St. Louis University School of Medicine, and the N.I.H. in
Bethesda, Maryland. [18]. If this proves to be successful, the present
emotional furor against gene therapy could subside substantially, as AIDS is
brought under control for the first time.
Human Genetic Therapy thus cannot be
narrowly defined as replacing a ‘defective’ gene by a ‘normal’ gene. It must
include any genetically engineered alteration of the human constitution
(somatic or germline), as well as genetically produced ‘medicines’ and
mechanisms, and the techniques used for gene tranplant-retroviruses,
endothelical cells, Iymphocytes and neo-organs or genetically created and
implantable organoids. [19]
There are ethical problems involved not just
in replacing one gene by another but also in the techniques and methods used
to effect such replacement.
There is another question to be raised at
this stage. Since the environment plays a partner role in the onset of
disease along with the genetic endowment, should we include in genetic
therapy also genetically engineered modification of the human environment?
Western medicine is now at the initial stage of the process of moving away
from body centred therapy to a more holistic therapy which includes
psycho-somatic, social and environmental factors. We will leave that
question there for the time being.
IV. THE NATURE OF ETHICAL REFLECTION
The word “ethics” is of ambiguous meaning.
Let us think of it as reflection on the norms of human behaviour. But the
problem begins when we seek criteria for validation of ethical norms. These
norms are not objectively given, but derived from previous human experience,
which includes religious experience and participation in a religious
community.
Anglo-American philosophers used to argue
that no “ought” can be derived from an “is”. In other words objective facts
do not provide norms, according to them. This argument has been called in
question. The statement that no ought can be derived from an is, thought
couched in propositional form, is itself an ought statement. What then is
its philosophical validity?
In fact, some philosophers argue the exact
reverse. Every is derived from an ought. When we see a Japanese Kimono, For
example, we cannot say that this is a Kimono unless we have some previous
knowledge of what a Kimono ought to look like. The ought is already in our
mind, and that is why we can state the is.
There is a third philosophical position
which argues that every ought is derived from an is. For all ethics is
ultimately grounded on some affirmations, religious or secular, about the
nature of reality. If one believes that humanity is created in the image of
God, then certain ethical norms naturally flow from that proposition. If on
the other hand if one’s belief is that humanity is naturally evil and cannot
but do evil, the ethical consequences are different. Let me state quite
clearly from the outset that my position is the former, not the latter, I
believe that humanity is created in the image and likeness of God. This does
not mean that God is corporeal or mortal. It does mean that the most
essential thing about human beings is to be free, good, wise, loving and
creative, like God.
If on the other hand one believes that
humanity is a chance or accidental product of blind evolution, the ethical
values may be derived from concepts like ‘survival of the fittest’ which
includes elimination of the unfit. I submit for your consideration that it
is difficult to derive some of our more lofty ethical concepts from a purely
secular framework: Human Rights, Justice for All. Democracy or the freedom
and dignity of all human beings and the unity of all humanity, to cite four
of the major values which many of us regard as vital to the civilisation of
the future.
V. THE ETHICS OF HUMAN GENETIC THERAPY
Some of the popular animosity against
genetic therapy on humans comes from unexamined assumptions. Since Hiroshima
and Nagasaki many have acquired a bias against, modern technology as such,
that it is basically anti-human and destructive. The powerfulness of the
military factor in our societies today reinforces that bias. Our persisting
inability to eliminate weapons of mass destruction confirms the suspicion
that modern science-technology does not easily come under beneficent human
control. People are therefore often apprehensive about scientists and
professionals acquiring more and more technological and financial power.
There need not be any doubt that advances in
genetic therapy would give the specialist added power to intervene in other
people’s bodies. But this has been the case with every advance in medical or
surgical expertise, and there cannot be anything intrinsically evil about
the process.
Some people argue that altering the
‘God-given’ genetic endowment of a person or an embryo is interfering with
God’s work or nature. They can rhetorically refer to such intervention as
‘playing God’. If gene therapy is thus playing God, then building a dam or
shaving a man’s face should also interfering with the way God has arranged
things.
Some of us from the Eastern Orthodox
Christian tradition would argue that most of humanity’s task in this world
is to act as the presence of God, through freedom and creativity, love and
goodness, wisdom and power, prayer and activity, to transform the whole
world in to something reflecting the glorious goodness of God. From that
perspective one cannot see anything intrinsically forbidden or evil in
genetic therapy, somatic or germ-line. Infinite possibilities of power are
open to humanity. The ethical problem is not in the acquisition of this
power, but in the wise use of it.
Actually all power, whether technological or
otherwise, in a free being, is subject to this ethical requirement, namely
that it be used wisely, in the interest of what is good -- not just good for
oneself, but good for all. Ethics is in fact reflection about this question:
What is good for all and how do we discern that good in a particular given
situation?
Let us put our heads together on a few
hypothetical cases. Lacking technical competence to judge whether a
hypothetical possibility is technically feasible or not, I feel rather free
to hypothesize.
Supposing criminal tendency in a hard
convict is due to some chromosomal defect, and supposing the technology
exists to correct that deficiency, would it be ethically justifiable to
apply such therapy? Obviously you would agree with me that the prior consent
of the convict, who now turns out to be a patient rather than a criminal,
would be a desireable ingredient in the ethical package. But would a public
court be justified in sentencing a convicted criminal to genetic correction
and rehabilitation rather than a death sentence or life imprisonment or
similar heavy penal measure? Would such a sentence be an encroachment on
human rights? To me it seems it would be no more a violation of human rights
than execution or imprisonment. You may disagree.
At the moment we do not have enough
practical experience in human gene therapy to know what its side effects
might be. Suppose some gene therapy which corrects some somatic or germ-line
defect brings on a syndrome which we do not know how to handle clinically;
we would then have to do a new cost benefit analysis before deciding whether
such therapy is desirable. Some such vague apprehension is in the
unconscious minds of many who have seemingly irrational fears about gene
therapy. I myself suspect that questions of this kind cannot be handled a
priori. A certain amount of clinical experience alone can adequately expose
the ethical and technical problems in this line.
An important ethical question will always be
the cost/justice factor. It seems obvious now that gene therapy is unlikely
to be inexpensive. This will put such therapy beyond the reach of large
numbers of people. Such is already the case with so many aspects of
diagnostic and therapeutic medical technology. How far can be ethically
justify using public funds for research intended to reap benefits not
available to all who need them?
Using the broader definition of Gene Therapy
as including pre-natal as well as post-natal genetic diagnosis and
screening. Should we make genetic screening compulsory for all pregnancies,
at public cost or at individual expense? A question like that needs a great
deal of public discussion especially by the taxpayers.
Statistics indicate that 5% of all infants
born in the USA carry genes that guarantee some form of sickness or
suffering - pain, crippling, mental retardation, severe disability, an early
death, the onset of some disease like Huntington’s chorea in late adulthood,
and so on. What are the options after pre-natal detection? Gene Therapy is
not likely soon to advance to the stage where pre-natally detected genetic
diseases can be treated in utero. The other possibility is abortion of the
embryo, and this raises a host of ethical questions.
First there is the issue of the legitimacy
of any kind of abortion in any circumstances. Here cultures which have a
long history of martial killing may find it easier to make decisions in
favour of abortion whenever needed. Also cultures where the individual is
supreme, can argue about a woman’s rights over her on body. Other cultures
may want to hold that abortion is killing and cannot be justified at all.
This is the Eastern Orthodox Christian position adopted by St. Basil the
Great in the 4th century. In practice, however, even more conservative
cultures sanction abortion of the fetus if the mother’s survival is
imperilled. But when a genetic defect is prenatally diagnosed, the option is
first whether to have the baby anyway, or to abort the fetus, Who should
make that decision: parents on their own, with some consultation with a
pastor in the case of religiously oriented parents?
Second, there is the question of what
constitutes a ‘defective’ gene. Defects are measured over against some given
standard. To be blind or lame constitutes a defect or handicap for a human
being, but that does not certainly make such a person less than human. Why
should a genetic defect make a person less than human and deny that person
the right to live? Once the principle is adopted that a genetically
defective person is less than human and therefore does not deserve to live,
the logical conclusion would have to be drawn that person now existing
should all without exception be genetically screened and defective persons
put to death.
As for germ-line therapy, people have more
complex apprehensions, not about the first test cases, but about how
eventually in the long run the technology will be used. Would governments
make it obligatory for people carrying defective genes to undergo genetic
therapy in the interest of so-called positive eugenics? Would laws emerge
which require genetic therapy before such people can have children at all?
Genetic screening may bring out information
about genetic disease or predisposition to disease, which can be used
against one by one’s employer or by the insurance people.
The gap, likely to persist, between genetic
diagnosis and genetic therapy, creates another ethical issue. Why should we
make so much progress in genetic screening before we have made more progress
in research on how to cure genetic defects?
Even more important is the question: who
should fund and control genetic therapy research? Should we leave it to
private enterprise? If it is controlled by a bureau, scientists are
apprehensive that such control would hamstring progress. Others feel that
since genetic technology touches the deepest sources of human identity,
there should always be an extended public discussion before important
research is undertaken. The consequent delay costs less than the risk
involved in developing new genetic thrapies and techniques, some would say.
Would there be a social opprobrium attached
to gene therapy treatment, as there is in the case of mental illness? To me
this seems a minor ethical consideration which should not stand in the way
of genetic therapy research.
Conclusion
The real fear deep under in the minds of
people relates to the encroachments of technology on the human person. We
have such a high regard for our human genetic constitution that we are not
sure about allowing technology to monkey with that endowment. This
uncertainly is not totally irrational, but based on past experience in which
technology has helped make such a mess of our human environment, about which
we knew so little before we started so stupidly meddling with it.
Uncertainty demands caution, but does not
mandate inactivity. Some things humanity learns only the hard way, but trial
and error, and at times by such colossal errors like developing weapons of
mass destruction. In some cases it seems almost impossible to undo the
damage once the error is made. There was no public discussion about the
rights and wrongs of atomic and hydrogen bombs before they were made. We
should be grateful that such a discussion is now in process of starting
before clinical use for genetic therapy goes very far.
NOTES
1. Anderson, W. French: “Prospects for Human Gene Therapy” in Science, vol
226, October 26, 1984, pp 401- 409, discussion vol. 228, May 10, 1985 p.
650.
2. New Scientist, Vol 103, September 27, 1984, p. 15: “Gene Therapy is still
a distant Prospect”.
3. Budiansky, Stephen: “Gene Therapy: U S Clinical Trials Imminent” in
Nature: Vol 312, Novr 29, 84 p 393.
4. Baskin, Yvonne: “Doctoring the Genes” in Science, 84 vol. 5, Decr
84, pp 52-60.
5. Beardsley, Tim, “Gene Therapy: NIH/FDA dispute likely to delay research”
in Nature, Vol. 316. Aug 15, 85, p. 567.
6. Marx, Jean L: “Gene Therapy - So Near and Yet So Far Away” in Science,
Vol. 232, May 16, 86, pp. 824-825.
7. Roberts, Leslie: “Human Gene Transfer Test Approved” in Science,
Vol. 243, January 27, 89 p. 473.
8. do. : “Ethical questions Haunt New Genetic Technologies” in Science,
vol. 243, Mar 3, 89, pp. 1134-36.
9. Vol. 122 p. 29.
10. Vol. 262 p. 16.
11. Vol. 244 pp. 1275 - 81.
12. Vol. 245 p. 1325.
13. Vol. 137 p. 43.
14. New Scientist, vol. 124 Decr 9, 89, p. 22: “Britain Examines Ethics of
Gene Therapy”.
15. Peason, Karl: The Life, Letters and Labours of Francis Galton,
Cambridge, Cambridge University Press, 1914/1930. cited by Daniel J. Kevles:
“Genetic Progress and Religious Authority: Historical Reflections” in Byrne,
Kevin, ed., Responsible Science: The Impact of Technology on Society, Harper
and Row, San Francisco, et alibi, 1986. pp. 31-48.
16. Kevles: op. cit. see note above.
17. American Eugenics Society, A Eugenics Catechism, 1926, cited in
Kevles, op. cit.
18. Reported in Science News, Jan 20, 1990. See Rick Weiss: “Mutant
Mimicry”, p. 43.
19. Reported in Pamela L. Schwartzenberg, Stephen P Goff and Elizabeth J
Robertson: “Germ-line Transmission of c-abl Mutation Produced by Targeted
Gene Disruption in E.S.Cells”, Science, 10 November 1989, Vol. 246, pp.
799-802. Rats have been implanted with fibres of polytetrafluoroethylene (Gortex)
coated with collagen, heparin binding Growth Factor 1 (also known as acidic
fibroblast growth factor), and hepatocytes. After several months, implanted
structures acquire a continuous blood supply from the liver, contain
structures that resemble nerves, and grow to half the size of the liver. |