Prevention - Genetic Engineering: The Future Of Preventive Medicine?

On June 26, 2000, The New York Times reported thus: "In an achievement that represents a pinnacle of human self-knowledge, two rival groups of scientists said in a joint announcement today that they had effectively deciphered the genome, the set of genetic instructions that defines the human organism."

This remarkable achievement resulted from ongoing work by researchers on the federally funded Human Genome Project (HGP) and the private company Celera Genomics. There are genome research centers all over the world, financed by governments, pharmaceutical and other industries, and private investors. They espouse goals both lofty and practical. The HGP Web site states: "Treating gene-related diseases and conditions is a major hope of the Human Genome Project." Somewhat less altruistically, a Clinton-Gore Web site predicted that resulting "sales of DNA-based products and technologies … are projected to exceed $45 billion by 2009."

The graphic shows the U.S. budget for the HGP from 1988 to 2002. The original estimate was $3 billion, with the ultimate goal "to discover all the more than 30,000 human genes and render them accessible for further biological study." The project started with an appropriation of $27.9 million in 1988 and grew to $434.3 million for the year 2002, bringing total spending to more than $3.3 billion. The lion's share goes to the NIH and a smaller amount is allotted to DOE. Why is DOE involved? Ever since the Manhattan Project, which produced the first atomic bombs, the DOE has been interested in learning how radiation affects genes.

The implications of HGP research are profound and far reaching. Philosopher Georges B. Kutukdjian says the project "is giving rise to anxieties that may in some cases be justified but are more often irrational." How to make proper use of the discoveries has been a concern from the very beginning. The DOE and NIH devote 3% to 5% of their genome project budgets to ethical, legal, and social issues.²³

As was true of big projects like the superconducting supercollider, a major criticism of the HGP is that the high cost is not justified where research dollars are finite. Nevertheless, the Clinton and Bush administrations have been supportive of the HGP. Since 9/11, the funding of certain research projects over others has assumed a new urgency. In a government memorandum dated May 30, 2002,²⁴ it was noted that genome research is a priority because: "This basic research is leading to new applications in health care, agriculture, energy, and environmental management. [Genome] sequence data are also critical for homeland security forensic purposes."

The HGP has brought both cooperation and conflict between nations.²⁵ Cooperation is evidenced by the international sharing of data from genome labs around the world.²⁶ Conflict is evidenced by the uproar that arose when NIH applied for a gene patent in 1991. Cook-Deegan wrote of the furor: "Sanctimonious claims were made about direct links between human genes and human dignity." A patent gold rush ensued. John J. Doll, director of biotechnology for the U.S. Patent and Trademark Office, told Scientific American that more than 20,000 patents on genes or other gene-related molecules have been granted and 25,000 applications were pending.

What does the HGP mean to preventive medicine? Gene therapy might be used for diseases ranging from cancer to AIDS and even for aging. Stem cells (generic cells that develop into all parts of the body) might be the answer to previously untreatable ailments.

Sources: Human Genome Project Budget, retrieved June 26, 2002, from http://www.ornl.gov/hgmis/project/budget.html. Nicholas Wade, "Scientists Complete Rough Draft of Human Genome," NYT Update, June 26, 2000, retrieved June 27, 2002, from www.nytimes.com/library/national/science/062600sci-human-genome.html. Georges B. Kutukdjian, "UNESCO and Bioethics," UNESCO Courier, September 1994. Robert Mullan Cook-Deegan, "Origins of the Human Genome Project," retrieved June 27, 2002, from www.fplc.edu/risk/vol5/spring/cookdeeg.htm. "Human Genome Research," retrieved June 27, 2002, from http://www.er.doe.gov/production/ober/hug_top.html. Office of Science and Technology Policy Memorandum, May 30, 2002, retrieved June 27, 2002, from http://www.ostp.gov/html/. Mae-Wan Ho, "The Human Genome Sellout, Third World Resurgence Nov./Dec. 2000. "Talking Gene Patents," retrieved June 28, 2002, from http://www.sciam.com/techbiz/0801patents.html.

¹The act of defining alternative medicine and CAM is politically charged. The scientific medical establishment contends that there cannot be two kinds of medicine — there is only medicine that has been adequately tested and that works. The Alternative Medicine Home Page informs us that "In 2002, the Medical Subject Headings (MeSH) Section staff of the National Library of Medicine classifies alternative medicine under the term complementary therapies. This is defined as therapeutic practices which are not currently considered an integral part of conventional allopathic medical practice. They may lack biomedical explanations but as they become better researched some, such as physical therapy, diet, and acupuncture, become widely accepted whereas others, such as humors or radium therapy, quietly fade away, yet are important historical footnotes. Therapies are termed as Complementary when used in addition to conventional treatments and as Alternative when used instead of conventional treatment" (definition retrieved May 31, 2002, from http://www.pitt.edu/~cbw/altm.html.

²Supplementquality.com. See Sources notes.

³ Caution: St. John's Wort may interact with other drugs and render them ineffective.

⁴ A Centers for Disease Control report issued in June 2002 found that Americans visited doctors 823 million times in 2000 and those doctors ordered or provided alternative medical care in 31 million visits.

⁵ Merriam-Webster defines osteopathy as "a system of medical practice based on a theory that diseases are due chiefly to loss of structural integrity which can be restored by manipulation of the parts supplemented by therapeutic measures (as use of medicine or surgery)."

⁶ Merriam-Webster defines chiropraxis as "a system of therapy which holds that disease results from a lack of normal nerve function and which employs manipulation and specific adjustment of body structures (as the spinal column)."

⁷ See (http://www.aoa-net.org).

⁸ See http://massage_cpt.com.

⁹ Acupuncture is defined by Merriam-Webster as the "Chinese practice of puncturing the body (as with needles) at specific points to cure disease or relieve pain (as in surgery).

¹⁰ For more information, go to http://acupuncture.com/StateLaws/StateLaws.htm

¹¹ Quoted in Villarosa, New York Times; see Source notes.

¹²Health information is available at http://www.surgeongeneral.gov/sgoffice.htm.

¹³ The USDA releases Dietary Guidelines every five years. The 2000 version is available at http://www.nal.usda.gov/fnic/dga/. Go to http://www.nal.usda.gov:8001/py/pmap.htm for a look at the Pyramid. A nongovernmental group has put forth its own "food pyramid," based on the traditional Mediterranean diet. Absent from this pyramid is milk, and red meat appears in the tiny point at the top, to be eaten in very small amounts only a few times a month.

¹⁴ Representative low-income cities were Scranton, PA; Charleston, WV; Shreveport, LA; and El Paso, TX.

¹⁵ Representative high-income cities were New York, NY; Chicago, IL; Miami, FL; and San Francisco, CA.

¹⁶Bioterrorism is the most recent food scare; go to http://www.usda.gov/homelandsecurity/response.html for the government's response.

¹⁷ Survey size was about 147,000 people aged 18 and over. Recommended activity level for purposes of the survey was physical activity at least five times a week for 30 minutes, or vigorous physical activity for 20 minutes at a time at least three times per week.

¹⁸ The International Health, Racquet & Sportsclub Association reported that the number of health clubs reached a record 17,807 facilities as of January 2002. There was a 41% increase in the number of clubs from 1992-2002: http://www.ihrsa.org/

¹⁹Obesity and exercise may "have little in common" suggests Gary Taube s in The New York Times Magazine, July 7, 2002: "What If It's All Been a Big Fat Lie?" He notes that obesity rates climbed in the 1990's but exercise activity remained unchanged from the 1980s.

²⁰Dr. Jeffrey Taubenberger, chief of molecular pathology at the Armed Forces Institute of Pathology, reported in 1997 that the 1918 flu virus "does not match any strain of influenza virus isolated since, but it is most related to the kind of influenzas that infect swine, suggesting that this influenza entered the human population after being passaged through pigs." He said: "this kind of thing could certainly happen again" (http://www.pbs.org/newshour/bb/health/march97/1918_3-24.html).

²¹ Now The Center for Health and Health Care in Schools at George Washington University.

²² Data from CDC, Youth Risk Behavior Survey, 1999. Included were students in grades 9-12 in 42 states, 16 large cities, and 4 territories. The average sample size was 2,200.

²³ See ELSI (Ethical, Legal, and Social Issues) Web page: http://www.ornl.gov/hgmis/elsi/elsi.html.

²⁴ From the Office of Scientific Policy; see Source notes.

25 Some companies are accused of keeping their own human genome data secret while benefiting from freeaccess to the public database; Mae-Wan Ho, see Source notes.

²⁶ Access the data at http://www.ncbi.nlm.nih.gov/.