Sunday, November 18, 2007

Ronald M. Green's "Babies by Design"

Ronald M. Green is Eunice and Julian Cohen Professor for the Study of Ethics and Human Values and Director of the Ethics Institute at Dartmouth College.

He applied the "Page 99 Test" to his new book Babies by Design: The Ethics of Genetic Choice, and reported the following:
Ford Madox Ford's "page 99 test" - "Open the book to page ninety-nine and read, and the quality of the whole will be revealed to you" - seems to work remarkably well when applied to my new book, Babies by Design: The Ethics of Genetic Choice.

My theme on p. 99 is one of the most important of the whole book: that we are entering an era when the human genome has been converted into pure information: a sequence of DNA letters three billion units long. The symbol for this is the "$1,000 genome," which some researchers have promised will make its appearance as early as five years from now. It took ten years (from 1993-2003) and three billion dollars to sequence the first human genome, but automated sequencers are now being developed that will reduce that work to a matter of hours and a cost of around $1,000. What does this mean for the choices that face us?

For one thing, it promises a day when each newborn child could go home from the hospital with its entire genome sequence on a CD. This opens up the era of "personalized medicine," when many decisions about your health care will begin with a glance at your genome. Are you prone to colon cancer? Then start early with a diet high in fiber and low in food toxins. Do you have genes that make you less able to control alcohol? Watch your drinking, or consider one of the new anti-abuse medications likely to be available.

Because the same genomic information will be available at the gamete and embryonic levels, these possibilities also open the door to the genetic selection of our children's characteristics - the main theme of my book. Why should a child or adult spend a lifetime fighting obesity when her parents can either select an embryo with a more favorable DNA sequence or request a simple genetic fix that replaces the obesity-prone gene sequence with one likely to lead to a more balanced metabolism?

Of course, the possibility of embryo selection and gene modification raises many troubling ethical questions. Will gene selection deform parenting, replacing unconditional love with critical appraisal and pressure? Will it produce a "Genobility," as the rich not only get richer but physically and mentally stronger because they are able to buy better genes for their offspring? Does gene modification amount to an arrogant "playing God" that will only end by inviting divine wrath? These are among the questions I examine in this book.

Some fear that human beings' attempts to manipulate the genome will lead to a dangerous reduction in human genetic diversity. Will thousands of parents choose children resembling Angelina Jolie or Brad Pitt? As attractive as this couple is, we risk human health and diversity if we create a "monoculture" of people with qualities that are deemed to be desirable from the limited perspective of our own age. Some also worry that by eliminating disease-related genes we risk losing valuable genetic abilities. The example I mention on p. 99 is sickle cell anemia which, though potentially lethal in its homozygous (2-copy) form, protects against malaria in its heterozygous (single-copy) form.

Here, I argue that the conversion of the human genome into pure information is one protection against this loss of human genetic diversity. We do not have to keep every variant of the human genome alive in some individual, especially if that variant causes disease, when it can be recorded as information for permanent storage and retrieval. We are now developing the ability to reproduce any sequence of DNA and insert it into a cell, sex cell or embryo. We do not have to perpetuate sickle cell to protect against a future malaria epidemic. Instead, we can call on our knowledge of the protective sequence to create new drugs or, if necessary, give our children the genes they need to survive and flourish in new environments.

I am no booster for human gene modification. This book is less an argument for it than an effort to show that panicked arguments against it are not as strong as they seem. Basing myself on a solid footing in the science and ethics of genomic research, I try to ease some of our fears and suggest that they derive from too strong a hold on the genetic status quo.

My brief argument on p. 99 epitomizes the direction of Babies by Design as a whole. Thus, it strongly supports "the page 99 test."
Read an excerpt from Babies by Design: The Ethics of Genetic Choice, and learn more about the book at the Yale University Press website.

--Marshal Zeringue