Having considered the legacies
of the twentieth century, we might peer into the twenty-first
century to see how medicine and medical theories will differ
from the germ-based practices of the past hundred years.
In fact, no crystal ball is really
needed to see where modern medicine is heading. In the
last few years, there was a mad rush to identify all segments
of the DNA strand. So intense was this quest that the
DNA was divvied up among many researchers who rushed to patent
their parts of the whole, often on the flimsy basis that what
they had been assigned to study might be useful in determining
the the nature of some other segment. After only 13 years,
the Genome Project completed its study of human genes in 2003
and spawned a whole new biotech industry seeking medical applications
for the research.
So, just as "progress" in
the twentieth century depended on research into germs and hefty
grants fueled the study of viruses, we can be absolutely certain
in this century will be a euphemism for patents based on manipulation
of DNA, probably some mixture of splicing, removal, and other
tampering with genetics.
Rarely in the annals of mankind
has such a relatively new discovery taken off with such speed.
At the time this page was first written, only one drug based
on the new genetic sciences had FDA approval, Herceptin. It
was approved on the basis of the incredible promise of a new
technology, not its cure rate nor even its success in clinical
trials. It appears to have received approval so as not
to discourage biotech companies from their mission to redefine
medicine via gene technologies.
Herceptin purports to address
genetic predispositions to cancer. When it was approved in
1998, clinical trials involving 900 women had been conducted
and new prescriptions were allocated by lottery. The first
two patients I knew who used it died (as had the women in the
The Present Skill Level
As I understand the present state
of knowledge, we homo sapiens share genetic material with other
species. What makes us unique constitutes only 1-2% of our
genetic make-up. You might say the rest of our genes are generic.
This is humbling. When I take time to contemplate the ramifications
of this fact, I feel my kinship with all life, not just with
the wingeds and four-leggeds but with flowers and trees.
Experts can apparently harvest
precisely the gene sought, but it is not at this time possible
to splice a harvested gene into the desired place in the DNA
sequence. Therefore the modification of genetic material involves
a very large element of chance.
Through study of the complicated
double helixes of the DNA code, scientists believe they can
ascertain an individual's predisposition to virtually any disease.
Using cancer as an example—and I admit my information
may already be sorely out of date—there is something
called an oncogene, a gene that if left unchecked would tend
to cause cancer sometime during the course of the patient's
life. In addition, there is a tumor suppressor gene, a gene
whose task it is to hold the oncogene in check. There are also
a host of other genes that are specific to certain tissues
and that would explain why one person develops brain cancer
and another liver cancer.
Very early in the Genome Project,
experts had identified 33 factors that compromise the efficiency
of the tumor suppressor genes. These included such variables
as sick building syndrome and specific personal factors that
affect mood and happiness. In other words, even if the new
science becomes very Star Trekky and almost trans-Earth-like
in dimension, we humans will still be affected by vicissitudes,
both external and internal.
In theory, if the experts are
right—and we have yet to see sufficient evidence that
they are right—a day will come when an oncogene could
be removed or rendered harmless; or it could be replaced with
a gene that inhibits the tendency for malignancies to form.
However, as matters stand today, what happens when a gene is
transplanted is random and unpredictable.
years have passed since Herceptin was approved; and I now know
quite a number of patients who have had Herceptin prescribed
for them. Most of them have suffered very severe side effects.
So, while we always hope that there will be something new to
relieve suffering, genetic strategies have a long way to go
before becoming reliable. This said, there is much more
to the Genome Project than oncogenes and tumor suppressor genes.