[tt] WP: Ronald M. Green: Building Baby From the Genes Up

[Premise Checker]

Ronald M. Green: Building Baby From the Genes Up
http://www.washingtonpost.com/wp-dyn/content/article/2008/04/11/AR2008041103330_pf.html
Sunday, April 13, 2008; B01

The two British couples no doubt thought that their appeal for
medical help in conceiving a child was entirely reasonable. Over
several generations, many female members of their families had died
of breast cancer. One or both spouses in each couple had probably
inherited the genetic mutations for the disease, and they wanted to
use in-vitro fertilization and preimplantation genetic diagnosis
(PGD) to select only the healthy embryos for implantation. Their
goal was to eradicate breast cancer from their family lines once and
for all.

In the United States, this combination of reproductive and genetic
medicine -- what one scientist has dubbed "reprogenetics" -- remains
largely unregulated, but Britain has a formal agency, the Human
Fertilization and Embryology Authority (HFEA), that must approve all
requests for PGD. In July 2007, after considerable deliberation, the
HFEA approved the procedure for both families. The concern was not
about the use of PGD to avoid genetic disease, since embryo
screening for serious disorders is commonplace now on both sides of
the Atlantic. What troubled the HFEA was the fact that an embryo
carrying the cancer mutation could go on to live for 40 or 50 years
before ever developing cancer, and there was a chance it might never
develop. Did this warrant selecting and discarding embryos? To its
critics, the HFEA, in approving this request, crossed a bright line
separating legitimate medical genetics from the quest for "the
perfect baby."

Like it or not, that decision is a sign of things to come -- and not
necessarily a bad sign. Since the completion of the Human Genome
Project in 2003, our understanding of the genetic bases of human
disease and non-disease traits has been growing almost
exponentially. The National Institutes of Health has initiated a
quest for the "$1,000 genome," a 10-year program to develop machines
that could identify all the genetic letters in anyone's genome at
low cost (it took more than $3 billion to sequence the first human
genome). With this technology, which some believe may be just four
or five years away, we could not only scan an individual's -- or
embryo's -- genome, we could also rapidly compare thousands of
people and pinpoint those DNA sequences or combinations that
underlie the variations that contribute to our biological
differences.

With knowledge comes power. If we understand the genetic causes of
obesity, for example, we can intervene by means of embryo selection
to produce a child with a reduced genetic likelihood of getting fat.
Eventually, without discarding embryos at all, we could use
gene-targeting techniques to tweak fetal DNA sequences. No child
would have to face a lifetime of dieting or experience the health
and cosmetic problems associated with obesity. The same is true for
cognitive problems such as dyslexia. Geneticists have already
identified some of the mutations that contribute to this disorder.
Why should a child struggle with reading difficulties when we could
alter the genes responsible for the problem?

Many people are horrified at the thought of such uses of genetics,
seeing echoes of the 1997 science-fiction film "Gattaca," which
depicted a world where parents choose their children's traits. Human
weakness has been eliminated through genetic engineering, and the
few parents who opt for a "natural" conception run the risk of
producing offspring -- "invalids" or "degenerates" -- who become
members of a despised underclass. Gattaca's world is clean and
efficient, but its eugenic obsessions have all but extinguished
human love and compassion.

These fears aren't limited to fiction. Over the past few years, many
bioethicists have spoken out against genetic manipulations. The
critics tend to voice at least four major concerns. First, they
worry about the effect of genetic selection on parenting. Will our
ability to choose our children's biological inheritance lead parents
to replace unconditional love with a consumerist mentality that
seeks perfection?

Second, they ask whether gene manipulations will diminish our
freedom by making us creatures of our genes or our parents' whims.
In his book "Enough," the techno-critic Bill McKibben asks: If I am
a world-class runner, but my parents inserted the "Sweatworks2010
GenePack" in my genome, can I really feel pride in my
accomplishments? Worse, if I refuse to use my costly genetic
endowments, will I face relentless pressure to live up to my
parents' expectations?

Third, many critics fear that reproductive genetics will widen our
social divisions as the affluent "buy" more competitive abilities
for their offspring. Will we eventually see "speciation," the
emergence of two or more human populations so different that they no
longer even breed with one another? Will we re-create the horrors of
eugenics that led, in Europe, Asia and the United States, to the
sterilization of tens of thousands of people declared to be "unfit"
and that in Nazi Germany paved the way for the Holocaust?

Finally, some worry about the religious implications of this
technology. Does it amount to a forbidden and prideful "playing
God"?

To many, the answers to these questions are clear. Not long ago,
when I asked a large class at Dartmouth Medical School whether they
thought that we should move in the direction of human genetic
engineering, more than 80 percent said no. This squares with public
opinion polls that show a similar degree of opposition.
Nevertheless, "babies by design" are probably in our future -- but I
think that the critics' concerns may be less troublesome than they
first appear.

Will critical scrutiny replace parental love? Not likely. Even
today, parents who hope for a healthy child but have one born with
disabilities tend to love that child ferociously. The very intensity
of parental love is the best protection against its erosion by
genetic technologies. Will a child somehow feel less free because
parents have helped select his or her traits? The fact is that a
child is already remarkably influenced by the genes she inherits.
The difference is that we haven't taken control of the process. Yet.

Knowing more about our genes may actually increase our freedom by
helping us understand the biological obstacles -- and opportunities
-- we have to work with. Take the case of Tiger Woods. His father,
Earl, is said to have handed him a golf club when he was still in
the playpen. Earl probably also gave Tiger the genes for some of the
traits that help make him a champion golfer. Genes and upbringing
worked together to inspire excellence. Does Tiger feel less free
because of his inherited abilities? Did he feel pressured by his
parents? I doubt it. Of course, his story could have gone the other
way, with overbearing parents forcing a child into their mold. But
the problem in that case wouldn't be genetics, but bad parenting.

Granted, the social effects of reproductive genetics are worrisome.
The risks of producing a "genobility," genetic overlords ruling a
vast genetic underclass, are real. But genetics could also become a
tool for reducing the class divide. Will we see the day when perhaps
all youngsters are genetically vaccinated against dyslexia? And how
might this contribute to everyone's social betterment?

As for the question of intruding on God's domain, the answer is less
clear than the critics believe. The use of genetic medicine to cure
or prevent disease is widely accepted by religious traditions, even
those that oppose discarding embryos. Speaking in 1982 at the
Pontifical Academy of Sciences, Pope John Paul II observed that
modern biological research "can ameliorate the condition of those
who are affected by chromosomic diseases," and he lauded this as
helping to cure "the smallest and weakest of human beings . . .
during their intrauterine life or in the period immediately after
birth." For Catholicism and some other traditions, it is one thing
to cure disease, but another to create children who are faster
runners, longer-lived or smarter.

But why should we think that the human genome is a
once-and-for-all-finished, untamperable product? All of the
biblically derived faiths permit human beings to improve on nature
using technology, from agriculture to aviation. Why not improve our
genome? I have no doubt that most people considering these questions
for the first time are certain that human genetic improvement is a
bad idea, but I'd like to shake up that certainty.

Genomic science is racing toward a future in which foreseeable
improvements include reduced susceptibility to a host of diseases,
increased life span, better cognitive functioning and maybe even
cosmetic enhancements such as whiter, straighter teeth. Yes, genetic
orthodontics may be in our future. The challenge is to see that we
don't also unleash the demons of discrimination and oppression.
Although I acknowledge the risks, I believe that we can and will
incorporate gene technology into the ongoing human adventure.

Ronald M. Green is a professor of ethics at Dartmouth College. His
most recent book is "Babies by Design: The Ethics of Genetic
Choice."

Richard Hayes, executive director of the Center for Genetics and Society, 
will reply to this article on Tuesday at 
http://www.washingtonpost.com/outlook.