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The first advocate of biotechnology was probably the philosopher-poet Empedocles. In the surviving fragments of his great work he promises to teach us "all the potions there are" to cure sickness and old age, to quiet the wind when it is inconvenient and bring it back again, laden with rain, when the first shoots of wheat are thirsty. Michael Fumento is forced to take back a part of that boast. Biotechnology cannot "stop a typhoon or snuff out an erupting volcano." But on the topics of sickness, old age, and hunger, Fumento makes Empedocles look like a nattering nabob of negativism.
Consider for example his World's Fair-like depiction of life in the year 2025:
People are being fed on less farmland. The rainforests of South America are expanding . . . and crops being grown now require much less pesticides and fertilizer. Toxic waste, including radioactive material, is consumed by voracious bacteria and plants. . . . Disease still exists, but the great infectious scourges such as malaria, tuberculosis, diarrhea, hepatitis and AIDS have been virtually eliminated. . . . The greatest athlete of all time has just retired at age 55, having come off his best professional year. He looks forward to spending the next 50 to 70 years with his wife, grandchildren, and great-grandchildren.
There's more, but you get the drift. Talk is always easy, but Fumento's rich sampling of miracles in the pipeline is largely persuasive. If those of us now in our forties can make it to eighty, there's a good chance we will see a hundred and twenty. This is not something one will want to take lightly when planning for retirement or considering the solvency of the social security trust fund.
If you are looking for a treatment of the ethical and political issues spawned by biotechnology, look elsewhere. Fumento's book is given almost completely to a poetry of potions. His fascination with and enthusiasm for biotech research programs are infectious. To say that he promises a revolution in medicine is to mistake the bow for the boat. Not only will medicine conquer and eliminate most diseases, but many other technologies will be remade in medicine's image.
The promise of biotechnology is based on two theoretical approaches. The first, genetics, is the foundation of biotech for the same reason that molecules are the foundation of chemistry: DNA turns out to be legible. We can learn to read its code and, if not to compose, at least to do a lot of editing. Critics of genetic engineering have long expressed pessimism about this. The natural translation of genes into the structures and behaviors of any actual organism, let alone the human organism, is dependent on a complex sequence of events. Any one change at the level of genes will likely release a cascade of unforeseen problems.
Fumento does not address these critics directly, but his treatment of genetic engineering makes for a powerful answer nonetheless. Consider his brief history of the war on cancer. Cancer was once thought of as a single disease that attacks different parts of the body. This gave way to a view of cancer as a spectrum of diseases, having little in common with one another. The latter view was not wrong so much as hopeless. Each form of cancer now demands its own intensive research program, and we're lucky whenever resources invested in one area are of use in another.
Biotech programs return more or less to the older strategy, and observes that all or nearly all cancers must solve certain problems in order to grow. One of these is to switch off the genetic controls on cell division. Eighty-five percent of cancers depend on an enzyme, telomerase, to extend the life of their variously corrupted cells. Thus a treatment targeting that enzyme may become part of an almost universal vaccine for cancer. Because the genetics of all cells, including cancerous ones, are built with the same code and include much of the same information, strategies developed to solve one problem will in effect anticipate a host of others. Thus biotechnology has a chance to keep ahead of any problems it will create.
Likewise cancers ordinarily encourage angiogenesis, the growth of blood vessels, in order to sustain their cells and to provide a highway by which they can spread to the rest of the body. Speaking of a cancer as if it were trying to feed itself and expand its territory points to the other theoretical approach: evolutionary biology. Fumento is much less explicit about the evolutionary part of "Bioevolution," which is unfortunate because it lies behind much of biotechnology's promise. Cancer emerges as a perversion of natural selection, since the disease does not contribute to the survival of the genes that initiated it. But like autoimmune diseases, every cancer is a package of mechanisms that are preserved by natural selection, and can be reverse engineered in the same way.
Just as a useful trait may be inherited by a wide range of species (forelimbs) or may emerge independently on a number of occasions (wings), so nearly all forms of cancer rely on angiogenesis. Unlike chemotherapy, which targets cell growth indiscriminately and with debilitating and sometimes lethal results, antiangiogenesis treats a cancer as if it were an organism in its own right, and looks for a way to isolate and starve it. And as the mechanism is common, the treatment promises to be so as well.
In the case of more direct products of natural selection, the utility of this approach is even more obvious. The way we usually respond to any inconvenient microorganism, whether it infects a farmer's ear or an ear of his corn, is to find a poison that will kill it off. The trouble with this is that it often merely clears the way for more resistant strains, and all we accomplish is to breed more dangerous enemies. An evolutionary approach suggests an alternative: it may be possible to encourage if not build friendlier strains of the microbe which will by their very success keep their more pernicious cousins in check.
The obvious problem with the evolutionary approach is that it is notoriously slow. One way to speed it up is with "directed evolution." Instead of waiting to see how organisms respond to chemicals in natural conditions, something that can take decades and can be expensive both in terms of suffering as well as money, scientists can speed up the process of mutation in the controlled conditions of the laboratory. Thus they can see in advance what sort of adaptations are most likely.
There are three basic problems addressed by biotech medicine. One is finding treatments that target the actual causes of a disease, and do so without a lot of collateral damage. Another is figuring out how to deliver the treatment to its target. The third is doing all this cheaply, and in ways that can work not only in Southern California but in the huts on stilts along the Amazon basin.
An example of the first is the cataloging of SNPs, or single nucleotide polymorphisms. A snip is a one nucleotide difference in the genetic sequence that occurs in at least 1% of the population. SNPs are useful markers for the more complex genetic conditions but they may also allow doctors to predict which particular patients will respond to certain therapies and, more importantly, who will suffer adverse side effects. This would allow us both to macro and micromanage our approaches to a disease. As genetic databases become available for specific populations (Estonia, Tonga, and especially Iceland are gathering this information) we will be able to allocate our medical resources years in advance. And as testing gets quicker, cheaper, and more accurate, doctors will be able to tailor their therapies to each patient's genetic predispositions. Instead of trial and error (error here meaning if the disease doesn't the kills the patient the drug does) physicians will often know in advance what medicine is right for what patient.
The sexiest means of delivering genes or medicines is probably to use some existing microorganism to insert them directly into the target cells. Viruses have been conscripted for this work, and bacteria likewise have their means of swapping genetic material with a host's cells. Or maybe we don't need such partners at all. Some enterprising Brits are experimenting with microbubbles containing DNA that can be injected into a patient and then exploded into cells with ultrasound.
But in many ways the most innovative means of delivering medicine is also the oldest: just swallow the damn stuff. What's new is that genes coding for the production of various medicines can be inserted into plants that already on someone's menu. Antibodies and antigens can be delivered this way, and dietary deficiencies might be supplied by redesigning the local crops to produce the missing substances. Mice and men eating genetically engineered potatoes not only developed immunity to a virulent strain of E. Coli, but developed it where it could do the most good: the throat and esophagus. You don't want fries with that antigen? The same genes are being tried in bananas.
This points to a solution to the third problem: the expense of production. Researchers are looking to use plants as pharmaceutical factories, producing copious quantities of wonder drugs at Wal-Mart prices. Manufacturing proteins using mammalian cells costs about $5,000 a gram. Presently unemployed bacteria, yeast, or fungi will do the job for $500. But the real biotech work horse may be plant roots, which promise to secrete that same gram for less than it will cost you to see the next Harry Potter movie. And I'm talking about the matinee.
Fumento expresses doubt that medical costs will decline due to biotechnology, but I think this is a rare case of excessive pessimism on his part. The money saved as existing treatments become cheaper will be partly offset by the constant arrival of new and better medicines on the market. We see the same thing in personal computers. Nonetheless, the hottest new microprocessor is cheaper than its counterpart was a few years ago. A more significant problem is that healthier people will live longer, and so demand that biotech work its magic against old age. The second part of Fumento's book deals with that technology.
Old age, like cancer, looks like a by-product of natural selection: something that slows and then kills us only after we have had a decent shot at reproduction. But the essence of geriatrics is the reverse of oncology: here the problem is to overcome the existing limitations on cell growth. Fumento focuses here on mostly familiar technologies. One is to imitate cancer and extend the telomeres that serve as feeder tape at the beginning of strips of DNA. Another would be to create new lines of replacement cells from the infamous stem cells. The cells are not yet committed to any specialized function, and unlike the old dogs that make up mature nerves and tissues they can be taught new tricks. Corneas, for instance, have been successfully cloned and used in eye surgery.
But it isn't lost on Fumento that the most important requirements for health and longevity are a balanced diet and a healthy living space. In the last two sections of his book, he shows how medical technologies can be adapted to agriculture and sanitation. Rice, for example, contains iron but also a molecule preventing the body from using it. Inserting a gene to counteract that molecule may remedy iron deficiencies where rice is a dietary staple. If you want more rice on the same land, wild rice genes can shorten the stalk and so increase the yield. Stacking a third gene on these two results in a rice crop that requires half the water.
The same technologies also promise a cleaner agriculture. Giving plants and animals better weapons against diseases, bugs, and weeds will reduce the need to spray oceans of pesticides on the fields. Where pollution has already occurred, the problem is usually how to get it out of the soil or water cheaply, and without doing more damage. Nothing is better at extracting some specific substance and modifying it than a rooted plant. Pigweed can remove 3% of radioactive cesium from soil in one season. Arabidopsis, a weed related to cabbage, has been modified to extract mercury from hazardous waste sites and convert it to a less toxic form. With the insertion of a couple handy E. coli genes it can also extract naturally occurring arsenic. Once a pollutant has been extracted by bioremediation it can be removed, destroyed, sequestered, or even recycled.
If even a fraction of the programs discussed in the book pan out, biotechnology will make good on Empedocles' boast, and will do so at a reasonable cost with a diminishing risk of adverse consequences. Fumento seems unreflective regarding the larger consequences of this, but this is because he remains strictly within the confines of common sense. Human beings do not ordinarily ask whether it would be better to live longer and be healthier, they take this for granted. At the same time, they do not look to science or magic to give them wings or x-ray vision. The ordinary perspective serves both safety and sobriety.
Conservative critics wonder whether advances against disease and death will not relieve us of the struggles that are essential to our humanity. The environmental Left suspects that any improvement in man's lot must come at nature's expense. Whatever the merit of such higher criticisms, they are unlikely to have any political effect. We aren't going to choose decrepitude or the grave so long as we have a choice. There are however concerns that should be addressed within Fumento's common sense perspective. If the lab can grow me a new liver and cure cancer of the esophagus, why should I worry how much whisky I have for breakfast? In spite of the novel context, this is a very familiar sort of question. And the answer to it will be moral rather than technological.
