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The Biotech Future

Isaac Rabino

The Fading "Great Promise"

Possibly the greatest promise of medical biotechnology is its ability to reduce human suffering by eliminating genetic diseases such as Huntington's disease, cystic fibrosis or sickle-cell anemia, not just for a given individual but for successive generations. Genetic repair that would have such an effect is called germ-line therapy. Although such therapy is controversial and at best a long-term goal of biotechnology, it was advocated by the scientists in my 1995 U.S. survey by a margin of 2:1, provided a technique becomes available.

Yet consider the obstacles to achieving this goal. One is purely financial. Progress on germ-line therapy surely depends on broad advances in basic biomedical research, but basic research is exactly the area suffering most from loss of funding. Even if one could imagine early applications, what industry would be a likely sponsor of the research? Successful germ-line therapy might well be against the interests of the pharmaceutical industry, for example, since it would threaten its profits from therapies for chronic diseases. (Such issues already have arisen in agricultural biotechnology, where, for instance, techniques to reduce pests by using genetically engineered seed lines might be seen to threaten future demand for pesticides.)

The outlook becomes even dimmer in view of the shift to managed health care, which my respondents expected by a margin of 3:1 to reduce funding for recombinant DNA research. As some investigators noted, managed-care companies want to pay only for care and tend to neglect the costs of medical education and scientific research. Perhaps specific cost-saving bioengineered vaccines or drugs could stand up to such a short-term cost focus, but something as remote as germ-line therapy must fade into the dim future.

Another obstacle to germ-line therapy is, of course, the science itself. Most of the detective work remains to be done; also, much effort will have to go into understanding possible long-term side effects on individuals and the species, as well as any selective benefits of inherited diseases. But perhaps the greatest barriers are public resistance and the lack of rational public debate. It is in this area that scientists can make valuable contributions to help society reach well-balanced decisions.

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