2005. Awaiting revision 2008

MEDICINE IN THE NEXT 100 YEARS  

Part 2

Will GENE THERAPY produce a FRANKENSTEIN FUTURE?

Gene therapy is now in the ascendant. Last month I covered the story behind the discovery of the human genome. This month - some of the practical results of this work.


WHAT IS THE POTENTIAL OF THE MAPPING OF THE GENOME?
The government Human Genome Project completed the first draft of the map of chromosomes 5, 16, and 19 in mid April 2000. This is extremely useful for researchers, who know these particular chromosomes are involved in schizophrenia, diabetes, some cancers, and hypertension. They now know where to focus their attention in looking for treatments for these conditions.

This does not mean that the cure for, say, diabetes is around the corner; but it does mean that, in time, a cure will probably be available for the disease, for most people, through gene replacement.


To put the future in some perspective...

...LET'S TRAVEL BACK 100 YEARS...
In the Spring of 1900 - precisely 100 years before Craig Venter announced his mapping of the human genome - one William Bateson was talking to the Royal Horticultural Society.

The previous year, Bateson had said that detailed testing must be carried out into how various characteristics of plants were passed on from generation to generation.

He then discovered - funnily enough, at the same time as three other researchers independently discovered it - the remarkable work of an Augustinian monk called Gregor Mendel.

Mendel had observed and recorded the transmission of various characteristics of pea plants down the generations. By 1863, Mendel had tested 28,000 plants, and carefully recorded his results - a treasure-store of data for the hungry researchers - Bateson, as well as Hugo de Vries, Carl Correns, and Erik von Tschermak.

A PATTERN?
Mendel had been intrigued by the differing characteristics of peas, and felt there must be some pattern. He had discovered that certain characteristics - such as the shape of the seed pods - were 'dominant' ie. they took precedence over other characteristics which were 'recessive'.

Recessive characteristics did not necessarily disappear, however; they could remain hidden, to re-appear in a future generation.

APPRECIATED ONLY AFTER HIS DEATH
Mendel's 'Experiments in Plant Hybridisation' was published in 1865. He died in 1884, never knowing how much his work would be appreciated. Sad, eh?

Bateson said of Mendel's discoveries, "That we are in the presence of a new principle of the highest importance is, I think, manifest. To what further conclusions it may lead us cannot yet be foretold."

GENETICS 'AS IMPORTANT AS THE LAWS OF CHEMISTRY'
He declared that Mendel's work was, "Worthy to rank with those that laid the foundation of the atomic laws of chemistry."

Bateson devoted the remainder of his scientific career to what became known as 'Mendelism'.

Now, exactly 100 years after the re-discovery of Mendel's work, we have made the next huge leap forward in the science of genetics - the mapping of the genome.


WHAT DOES THE MAPPING OF THE GENOME MEAN - IN PRACTICAL TERMS?
Perhaps by 2025 - give or take a few years - you will be able to go to a pharmacy and easily obtain a tape or disc of your own personal genetic code.

Walter Gilbert, a key figure in the Human Genome Project, predicts that possessing a genetic map, and the DNA sequence of an individual will revolutionise medicine. In 20-25 years, we could be looking back on the drugs of today in the same way that today we look back on the barbarism of using mercury, sulphur, and other poisons in an attempt to treat sickness in previous centuries.

"We are entering an era when disease will be predicted before it occurs," says William Haseltine, who is also involved in the Human Genome Project. "Medicine is basically going to change from a treatment-based to a prevention-based discipline."

Well - hooray to that! It sounds as if gene therapy, combined with natural therapy just may have something to offer.


WHICH DISEASES WILL BE CURABLE?
It is estimated that between about 2020-2050, a significant, and increasing, number of diseases will be treatable through gene replacement. About 5,000 diseases are known to be capable of being inherited. Between about 2050 and 2100, the majority of these inherited diseases may be completely avoidable thanks to genetic therapy.

This would include many cases of:

In time, nearly all of these 5,000 inherited diseases will be treatable. A child being born in 50-100 years will grow up with this reality. Try explaining to today's children what living without TV or microwaves was like. It will be the same for genetic treatment.

The major causes of early death - heart disease and cancer - would be greatly reduced.

It used to be rare to live to 100. Today it's not that unusual. By 2100 it will be common - or even usual - to break the century barrier.

For now, scientists can identify and isolate useful strands of genetic material DNA - quite easily. The problem lies in getting the body to accept it.

The most successful method has been by putting the DNA into a genetically altered cold virus, and injecting it. But this is far from a perfect method - research is continuing.

For the moment, much better results are promised by using bacteria to integrate strands of DNA with their own DNA, and producing valuable proteins. Such proteins are often the key in disease treatments.


WILL EVERYONE AUTOMATICALLY BE HEALTHY?
No! Many people will still be stuffing down junk foods, overeating, and carrying on bad habits - so that doesn't mean everyone would be healthy! But we will certainly be living much longer on average.

Some genetic treatments will be purely symptomatic - and so will not lead to the holistic health we advocate. Producing proteins to treat disease, for example, sounds rather like producing drugs to treat disease. But let's see exactly what is on offer before deciding what is, and what is not, a good idea.

Our world is soon going to be a dramatically different place. Health will be more an area which we 'manage' rather than 'worry about'. And it's no good saying 'I don't care - I won't be here'. The whole point is - you are much more likely to be here!


TWO EARLY SUCCESSES OF GENE THERAPY

These results need to be confirmed by further testing, but they indicate the sort of successes which are probably possible.

ONE FAILURE

RESEARCH WILL CONTINUE
Scientists need to be cautious. But they won't stop the research.

Better methods will develop as they learn. There will be no shortage of volunteers for treatment. Many people who have no other choice for treatment would choose to have the gene therapy.

Some results of treatment will be absolutely fantastic. Especially if it's for you or a loved one!

In the early days there are bound to be more failures - or even disasters. But the successes will outnumber the failures; and gene therapy will become commonplace.


MIGHT THERE BE ABUSE OF GENETIC THERAPY?
Of course, there are concerns regarding gene therapy. New choices will be available to us which many will find difficult - or objectionable. Emotive issues about whether to permit or deny life itself will have to be confronted head-on.

But life-and-death decisions have been made by doctors - covertly - ever since medicine began. The exact time to turn off a life-support machine, for example, is an unenviable, and often purely subjective, choice for the medical profession. The choice is made even more difficult because occasional cases of completely unexpected emergence from coma have occurred.

Soon, though, we will have the ability to manipulate human life more than ever before. Yes, we will be able to replace disease-producing genes before, or just after, birth. Obviously, if we could choose between our baby having a particular birth 'defect' or not, most of us would prefer our child to be free of it.

But also we will have the ability to introduce genes to make 'improved' humans. These could include raising IQ, choosing hair colour, or deciding the size of particular muscles, for example. Most governments will ban the obviously distasteful options; but society has to decide exactly where to draw the line. And will some of the more secretive governments of the world be more lax in their regulations?

In the 1960s and 70s, some Eastern European countries persuaded their sportsmen and women to use anabolic steroids from a dangerously early age, to boost athletic performance. This risked their lives and health. Will some athletes of the future be genetically 'bred for success' by the unscrupulous?

THE SECRET OF ETERNAL LIFE?
And what about old age? No reason has been found for the aging process. The body re-creates nearly all of its cells within seven years. Why doesn't it create brand new ones each time - so that aging would not occur? We know some of the mechanisms which produce aging - but why are these mechanisms in place? Nobody really knows.

Some genes are certainly involved in producing aging. The genes which produce aging of the skin have already been identified. By manipulating these and other genes will we eventually be able to choose the length of life we enjoy/endure? Scientists have already made human cells live for double their normal lifespan. They have lengthened the lifespan of simple organisms. This type of science will certainly be applied to man.

One thing is certain - genetic therapy is going to throw up some brand new questions. We have no choice but to confront them head on.


GENE THERAPY IS HERE TO STAY
We must focus on the good that gene therapy will bring - while accepting that it will not all be good. We have to take things very slowly while we decide on the safeguards which will be necessary.

We have to keep our fingers crossed - but then the human race is used to that.

The human race is about to take a huge step into gene therapy. It is almost with us. There is now no going back.

LINKS:
Resources about all aspects of genetics:
www.kumc.edu/gec/

Longevity:
pcbs042.open.ac.uk/future/Millennium/842.htm

Aging and Genetics:
www.biorap.org/rg/rgagepd.html

______________________

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