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Therapy versus "Enhancement"

Proposed Genetic "Enhancements"


Therapy versus "Enhancement"

The difference between non-heritable (somatic) and inheritable (germline) genetic modification is technical and clear-cut, but another crucial distinction—that between genetic modifications meant to treat medical conditions, and genetic enhancements of appearance or performance—is inherently blurry.

Most people would agree that genetic modifications to treat cystic fibrosis or muscular dystrophy would fall into the medical category. Genetic changes to endow musical talent, superior strength, or increased intelligence, or to choose the color of skin, hair or eyes, are fairly clear examples of enhancement.

But would genetically engineered resistance to disease be considered medical treatment or enhancement? It's a gray area.

Confronted with the difficulty of deciding where to draw the proper lines, some people react by asserting that no lines can or should be drawn at all, and that we should resign ourselves to accepting whatever the market will bear.

Such a response is uncalled for. Societies make difficult decisions all the time.

There is widespread agreement that germline engineering should be banned for both therapeutic and enhancement applications. The fact that preimplantation diagnosis and screening is available to address the sorts of preventative medical applications that some people propose for germline modification makes such a policy easier to support than it would be if this were not the case. This is the policy adopted, for example, by the 41 nations of the Council of Europe in their Convention on Biomedicine and Human Rights.

There is also widespread agreement that somatic genetic modification should be limited to clearly medical applications and that "enhancement" applications should not be allowed. The Council of Europe's Convention adopts this position. Most recently, the World Olympics Anti-Doping Committee issued a policy statement saying that "enhancement" applications of somatic gene transfer technologies should be banned from use by athletes. See the policy statement at
http://www.wada-ama.org/asiakas/003/wada_english.nsf/Home?OpenPage
.

Because the technical lines between therapeutic and enhancement applications of somatic gene transfer techniques are not sharp, there will always be some contention over the acceptability of a small range of particular somatic applications. Most decisions about what to allow and what to disallow will likely need to be made by national authorities.

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Proposed Genetic "Enhancements"

The vision of the human future anticipated by advocates of germline engineering is suggested by the following excerpts:

From The Ethics of Human Gene Therapy by LeRoy Walters and Julie Gage Palmer (New York: Oxford University Press, 1997). Walters and Gage were appointed to an American Association for the Advancement of Science (AAAS) panel to review the ethics of human genetic technology.

  • Size: "[T]he germline insertion of a growth hormone gene could enhance the stature of a child who is otherwise destined to be short, or even average in size."
  • Sleep: "[A] gene for an agent that could reset the circadian clock or reduce the need for sleep would be transferred."
  • Aging: "Genetic engineering may ultimately provide the key to prolonged youth."
  • Memory: "The ability to remember words, names, facts, and experiences is one thing many people might like to improve for themselves and their offspring."
  • Aggression: "Aggression is often cited as an example of a prime candidate for genetic manipulation, although it is not clear whether the desired change would be an increase or decrease in aggressive tendencies"
  • General cognitive ability: "A…potential target of genetic enhancement is 'intelligence.'"
  • Moral enhancements: "[I]t seems likely that additional genetic markers associated with impulsive, aggressive, or violent behavior will be discovered."

From Engineering the Human Germline: An Exploration of the Science and Ethics of Altering the Genes We Pass to Our Children, edited by Gregory Stock and John Campbell (New York: Oxford University Press, 2000)

From Remaking Eden: Cloning and Beyond in a Brave New World by Lee M. Silver (New York: Avon Books, 1997). Lee Silver is professor of molecular biology at Princeton and serves on the faculty of the Woodrow Wilson School of Public Policy.

  • Eliminate "[p]redispositions to obesity, diabetes, heart disease, asthma, and various forms of cancer."
  • "[A]ddition of new genes that serve as genetic inoculations against various infectious agents, including the HIV virus."
  • Elimination of "[a]lcohol addiction…along with tendencies toward mental disease and antisocial behavior like extreme aggression."
  • Enhance "[v]isual and auditory acuity…to improve artistic potential."
  • Addition of "[r]elatively simple animal attributes…includ[ing] the ability to see into the ultraviolet range or the infrared range."
  • "Other possibilities include light-emitting organs (from fireflies and fish), generators of electricity (from eels), and magnetic detection systems (from birds)."
  • "Another possible sensory enhancement is four-color vision."
  • "[A]s the years go by over the next two centuries, the number and variety of possible genetic extensions to the basic human genome will rise exponentially…Extensions that were once unimaginable will become indispensable…to those parents who are able to afford them."

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Related Articles

Anne McLaren and Jonathan Ewbank, "Problems of Germline Therapy," Nature (Vol. 392, April 16, 1998)
Resources >> Items >> "Problems of Germline Therapy"


More Information

Analysis: Examine the social, cultural, and economic landscape

Perspectives: Explore various communities' concerns regarding human genetic technologies

Policies: Read about existing and potential regulations

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