DNA Technology in Medicine
The intervention of humans in nature has increased dramatically as the years have gone by. As we start this millennium, a very powerful new technology with much potential is being unravelled that will allow humans to continue unearthing nature’s secrets, and to continue tinkering with them: DNA technology. With the human genome fully sequenced, the possibilities to apply DNA technology in a field such as medicine are tremendous.
Imagine: drugs tailored to your DNA, that work the first time round leaving no side effects; predictive medicine that will tell you what diseases you might some day suffer, and the gene therapy that is best suited to curing them; the elimination of a genetic disease you have even before your birth; medical checks that involve but a blood test. The possibilities are indeed great. The risks are also great as this technology goes through its baby-steps. Will its benefits be accessible to everyone? Is it dangerous to play with nature? Will its use be adequate to our real needs?
Just how far should we go with it? If we go too far, what will the consequences be? These are the types of questions that must be answered in making a judgment on how beneficial DNA technology is, and may prove, for humans. DNA technology in medicine, which in some cases is already being applied, will have immense effects on plausibly every facet of human life while raising many pointed questions in fields such as technology, economic factors of medicine, and ethics. DNA technology has already started benefiting humans in the field of medicine.
A representative example is that of gene therapy and predictive medicine on “Mendelian” diseases (illnesses that are caused by the breakdown of a single gene, and follow the rules of inheritance) and “polygenic” disorders (illnesses where several genes are involved)1. This technology has developed from the findings of the Human Genome Project which has as its primary aim the improvement of human health. The dream is finally becoming a reality. A recent example is that of an eighteen month old baby who was cured of severe combined immunodeficiency (SCID).
By means of gene therapy, a faulty gene on his X chromosome was genetically engineered to produce T cells (which his body was not developing), vital to the functions of the immune system. 2 3 Although this is still a new technology, the procedure will be tried on several more children and provides hope for many more. However, the fact that it is a new technology also makes it a dangerous one. It is only until now that scientists are making gene therapy work. Only a few years ago, the history of this technology was one of failure. In 1999, a boy died undergoing gene therapy for a rare metabolic disease in the University of Pennsylvania4.
In one gene therapy study at Boston hospital, three of the six patients involved died. In another case an error in an operation caused patients being treated for brain tumours to suffer from partial paralysis and speech impairment. 5 Today, the failures far outweigh the successes, but it is only a matter of time before this technology is improved, and people can begin to confidently undergo gene therapy operations. The industry of medicine through DNA technology is based on investigating the human genome, finding genes, and understanding how they work in order to take a line of action against a disease.
Unfortunately, this is no easy task, yet companies are willing to invest billions in these investigations as they believe their investment will turn into profit in the future. The difficulty lies in that 98% of DNA is “junk” (endless lines of DNA that apparently code for nothing; introns). Although many systems have been created to find functional genes in the human genome, they are still extremely expensive and not 100% reliable. To make matters worse, after finding the gene, you then have to identify what its function is, which again, is very difficult.
One technique is to study entire populations to find relevant genes-this is a very tedious and expensive process. Other techniques such as “expressed-sequence tagging” have been used where it is possible to observe diseases at a genetic level. 6 Many systems exist to find genes, all with the same goal: understanding what different types of genes do and how they work together. These investigations are carried out mostly by private pharmaceutical or “genomic” companies investing billions, with the goal of converting their “genomic” knowledge into money.
The idea of many companies in order to make billions in profit is based on finding a specific gene that codes for a disease, patent it, and produce DNA computer chips, pills, or proteins that will identify, prevent, or cure a disease. The result of finding genes that, for instance, cause breast cancer in women will be very useful for both companies and patients. A firm called Myriad Genetics, markets tests for mutations in genes that cause heart disease and cancer. Other companies are devising DNA chips that can distinguish between different types of leukemia or prostate cancer by recognizing mRNA from almost 7000 genes.
These diagnostics are pointing to the development of new small-molecule drugs based on identified and patented genes. Millennium Pharmaceuticals is concentrating on making a pill to treat obesity. Another company called Human Genome Sciences is basing their studies on making therapeutic proteins, which would prove to be much more effective than small-molecule drugs. Therapeutic proteins already exist, but with genomic knowledge, the market which was valued at around 20 billion dollars in the year 2000, will boom. Research commissioned by The Guardian shows that pharmaceutical companies, biotech firms of all sizes, government institutes and universities have filed patents on a staggering 127,000 human genes or partial human gene sequences. 8 Many companies and universities are striving to patent as many genes as they can, without even knowing their function, so that in the future they might prove to be a gold mine. It costs around 250,000 dollars to keep a patent alive, so the magnitude of these investments is quite large.
All these investigations that represent investments by the billions will with time find cures to many of the diseases that flog human life, but will they only have positive effects? If medicine based on genomic knowledge proves to be as powerful as it seems, then the roles of doctors might be minimized; why need a doctor when a DNA computer chip will tell you what you have, and then prescribe a tailored drug that will work only for you? Many people won’t be able to afford these “genetic services” as the private companies own the patents on them and will put prices on the medicine inaccessible to most of the worlds population. Patented medicines are between 7 and 10 times more expensive than generic ones; the question is if there will be anything such as generic medicine in DNA technology.
However, in rich countries like the UK, health services like the NHS are already providing genetic tests for diseases like cancer as part of a 30 million pound investment; it is highly unlikely that poor countries will be able to meet the demands of such high investments to provide the population similar benefits. 0 The pathway to DNA technology based medicine may lead to many cures of diseases but ending up helping only a select few, making many companies even richer, while in most of the world millions will be left without access to the new technology. Before even discussing the effects the expenses this technology will bring to people, is it even right to patent a gene? One view is that to claim exclusive rights to commercial exploitation of something everyone is born with is to abuse the patent system, which was set up to reward the people who actually invent, not someone who discovers something.
Even if a gene is patented, it might still remain in the public domain because it was done by someone who wishes it to, but most private companies put restrictions on the genes they patent. Many people believe this is wrong. As early as 1993, the American organisation NIH (National Institutes of Health) patented the cell line of a man from the Solomon Islands. 11 The information they patented might prove to be the path for the cure of a disease, but will the indigenous man get any economic benefit from the “genetic makeup” he provided that will be used to save lives?
Some agencies believe such companies have no intention of sharing their profits with the people whose genes are being patented. There is even a deeper, more important question that has to be dealt with. This science might advance so much that humans will be seeking perfection through the modification of our genes. Francis Fukuyama is a writer who sees biomedicine and genetic science as a threat. 2 He sees something like embryo research slipping into the seek for intelligence, or the choice of what sex your child should be, choosing their personality, and in the end making designer babies; these are not the targets of something like the Human Genome Project. Biochemistry might end up serving ego driven self enhancement of humans, and not medicine for illnesses. If our way of being comes from our genes, and we modified them, would we be pretending to play god?
The use of DNA technology in such ways goes against religious belief and the morality of millions of people. There are other people who have the exact opposite view than that of Fukuyamai?? s. Richard Dawkins quotes poet A. E. Housman in his book “River out of Eden”: “For Nature, heartless, witless nature will never care nor know”, he then moves on to saying himself, “DNA neither cares, nor knows. DNA just is, and we dance to its music”13. Comments like these try to show that DNA technology is just another facet of nature to be explored, used, and enjoyed by human beings.
Of course this technology has its risks (just as nuclear energy has been used to kill people, it has also benefited millions in the form of medical treatments and as an energy source), but has to be used wisely. These are complicated issues where people have many opposing views. DNA technology is a topic where a lot of interests and a lot of money are involved, and if we overlook the ethical issues involved we may create a society where humanity as such (with its imperfections) will be despised, due to the necessity to seek “perfection”.
DNA technology has shown that humans can benefit from it greatly. I believe the problem lies on how it will be controlled and who will actually benefit from it. Watchdogs like the World Health Organisation, The World Trade Organisation and civil society organisations are going to play important roles on how the technology advances to new levels. The potential benefit we can receive from it is very great, but if this benefit isn’t maximised around the whole world, and we end up misusing it, I believe it will not be as valuable to the world as it could be.