Chicago Tribune Review

May 5, 2002 Sunday, CHICAGOLAND FINAL EDITION

SECTION: Books; Pg. 1; ZONE: C

LENGTH: 2509 words

HEADLINE: Visions of the future;
A lawyer, an economist and a scientist offer their views in the many-sided debate over biotechnology;
Three new books have ventured into the debate over where biotechnology stands, where it should go and what we should do about it.

BYLINE: By Rebecca Skloot. Rebecca L. Skloot is science and medical writer and editor. She is writing a book about the late Henrietta Lacks, who is at the center of a controversy over the use of human biological material.

BODY:

The Terrible Gift: The Brave New World of Genetic Medicine

By Rick J. Carlson and Gary Stimeling

PublicAffairs, 305 pages, $26

Our Posthuman Future: Consequences of the Biotechnology Revolution

By Francis Fukuyama

Farrar, Straus and Giroux, 272 pages, $39.95

Redesigning Humans: Our Inevitable Genetic Future

By Gregory Stock

Houghton Mifflin, 277 pages, $24

In a harsh, cold room in London, 300 Fertilizers stood dressed in white, their hands covered by rubber gloves. They leaned over rows of human eggs, inspecting for abnormalities before plunging them into a vat of sperm. It was a time when embryos grew from test tubes instead of wombs; age no longer mattered, and subliminal messages, hormones and a drug called soma ensured universal happiness and cooperation.

This future, created by Aldous Huxley in his 1932 book "Brave New World," was free from disease, sadness, boredom and social conflict, but far from desirable. Its inhabitants, though happy, ceased to be human. They lived in a cold world, slaves to pleasure, with no concept of pain, inspiration, love or family. Today, opponents of such technological advances as in-vitro fertilization and drugs for treating depression lean on Huxley's new world as a metaphor for our future with such frequency that it has become a cliche.

In the 1970s, Leon Kass, the conservative bioethicist who now heads the advisory President's Council on Bioethics, mounted a campaign against in-vitro fertilization. He called it "a degradation of parenthood," demanding a ban on the technology, painting images of children conceived through the process as monstrous, unnatural specimens. Millions of children alive today were conceived through in-vitro fertilization; none is a monster as Kass predicted, and he has revised his stance on the issue. But now, he and other technological naysayers are repeating the warnings used against in-vitro fertilization, complete with invocations of Aldous Huxley. This time they're aimed at the burgeoning sciences of genetics and cloning.

Arguments about the dangers of rapidly developing biotechnologies aren't new. Since the birth of what's often called the genetic revolution in the '70s, we've heard arguments for and against everything from gene therapy to genetic enhancement to cloning. Bioethicists, scientists and policymakers grapple with enormous questions: Who should have access to our genetic information? Who (if anyone) should profit from our genetic material? Should people alter or select embryos to produce children with high IQs, green eyes or freedom from disease? If so, will it be universally available, or will it benefit only those with money? And how will we regulate it all?

Three new books have ventured into the debate over where biotechnology stands, where it should go and what we should do about it. These books, whose authors range from scientist to lawyer to economist, offer a frightening vision of the future of biotechnology, not by showing how science will cause our demise (though two certainly try) but by standing as examples of how political agendas, religious beliefs and finger-pointing are leading to a complete communication breakdown between scientists and those who hope to regulate them.

Two of these books follow Kass' lead by using "Brave New World" as an extended metaphor for what's to come. In "The Terrible Gift," Rick J. Carlson, a lawyer with socialist leanings, and science writer Gary Stimeling bring the art of apocalyptic prediction to new heights. In the near future, they warn, we may be struggling with questions like this: "[W]hen some superagency delivers its message digitized in proteins dissolved in your mouthwash, along with playback triggers to upload them into memory, how will you spit it out?" They see the potential outcomes of cloning ranging from beneficial to "incomprehensibly weird" to "unequivocally horrific." But they focus on the horrific: the potential for "a new undercaste of slaves and servants," "mindless Mafia muscle" and real live sex toys. "Would they be created with emotions or without?" they ask. "Would crucial mental functions be deleted to prevent organizing or rebellion?" They warn of "mass mind control," where genetics and pharmaceuticals allow doctors to "reach inside one's mind and twist the dials to their liking." Predictions like these may make for entertaining science fiction, but they do nothing to advance discussion of the tangible issues facing science today.

They describe their book as "an aggressive, in-your-face look at what we must do to reap the benefits of biotechnological medicine," but in the process of getting in readers' faces, they forgot to take care with their science. "The Terrible Gift" is loaded with risky assertions and exaggerations about where biotechnology is and what it will soon accomplish, with no evidence or explanations to support these claims. The authors predict cures for liver disease, emphysema, blindness and numerous other diseases by 2020 but don't say how this will happen.

Francis Fukuyama, in his book "Our Posthuman Future," presents a slightly more balanced view, though he often leans on similarly unsupported assertions and apocalyptic predictions. Fukuyama, a conservative economist and member of the President's Council on Bioethics, is sometimes referred to as a Kass clone. He relies heavily on Huxleyan images of a hypothetical future to argue the dangers of biotechnology and the need for governmental regulation of its application and an all-out ban on cloning. His motivation for these recommendations is the threat he sees biotechnology posing to democracy. Fukuyama argues that, through genetic manipulation, cloning and the use of Prozac, Ritalin and other, yet-to-be-created drugs, biotechnology will alter human nature and perhaps nullify the foundation of democracy that says all humans are created equal. "Human nature," he writes, "shapes and constrains the possible kinds of political regimes, so a technology powerful enough to reshape what we are will have possibly malign consequences for liberal democracy and the nature of politics itself." This is a provocative argument that raises the nature-versus-nurture debate and questions about the role biology plays in human nature.

Fukuyama makes the balanced point that neither extreme is "tenable in the light of currently available empirical evidence." This is in line with the views of many scientists, who believe that behaviors result from a mixture of biology and environment and that it would be simplistic to say it's one, not the other. But Fukuyama then mounts what reads like an argument for genetic determinism of everything from criminal tendencies to intelligence, with little consideration for the role of environment. Though he leans toward the idea that biology plays a large role in behavior, he minimizes its role in so-called behavioral disorders like attention deficit-hyperactivity disorder, or ADHD, which he says "isn't a disease at all."

He likens Ritalin to "an overt instrument of social control," and Prozac to a "happiness pill," something that "looks uncomfortably like the soma of Aldous Huxley's 'Brave New World.' " Because Ritalin helps improve concentration and performance, and Prozac improves self-confidence, Fukuyama worries that they and similar drugs may result in "behavior control that will have significant political implications." He uses Caesar and Napoleon as examples, questioning whether popping Prozac might have kept their conquering tendencies in check and changed history. His largest concern is recreational use by those looking to feel

" 'better than good,' " but he blurs the distinction between use and abuse.

Fukuyama blames the recent surge in ADHD diagnoses and Ritalin use on a lack of discipline and attention from parents and teachers, but he qualifies this by saying some children's "hyperactivity or inability to concentrate is so extreme that one would grant that biology is the primary determinant of their behavior." He offers no clear distinction between those he sees as biologically impaired and needing treatment versus the environmentally impaired seeking only enhancement. Instead, he says, "This is . . . a classic case of the social construction of pathology: ADHD was not even in the medical lexicon a couple of generations ago."

Arguing that there's a problem with overdiagnosing and overmedicating ADHD is one thing, but arguing that it's not biological because we didn't know about it 20 years ago is flawed. Chronic fatigue syndrome, AIDS and many other disorders now known to have biological causes weren't in the medical lexicon a few decades ago either, but they're pathologies nonetheless.

"Our Posthuman Future" and "The Terrible Gift" steer clear of explaining the science behind the technologies they fear. In several cases, like intelligence enhancement and mind control, this is probably because the science doesn't exist. But in "Redesigning Humans," Gregory Stock, director of the Program on Medicine, Technology and Science at UCLA, focuses on science. He explains the technologies of cloning, embryo selection and genetic modification, making clear what seems possible in the near future (such as engineering embryos without certain diseases) and what doesn't (such as finding a gene to enhance intelligence).

Amid the worries over advances in technology, scientists are often cast in a negative light; Stock hopes to remind readers that the majority of researchers intend to help rather than destroy humanity. "[T]he reshaping of human genetics and biology does not hinge on some cadre of demonic researchers hidden away in a lab in Argentina trying to pick up where Hitler left off," he writes. He brings in the voices of patients waiting for genetic therapies, using human stories of disease to remind readers why researchers started pursuing this technology in the first place. Scientists, he says, worry over future applications and their ethical challenges, too, and many are developing technologies to prevent foreseeable dangers. He points out that, of course, there are fringe groups whose motivations aren't so pure. The Raelians, a New Age group that believes aliens spawned humanity, announced recently that aliens have shown them how to clone humans and they intend to do so with a team of scientists and volunteers. At best, he says, legal bans like the one Fukuyama proposes on cloning would not stop technological development but would push it out of the public eye and nearer to the hands of "the least responsible among us," like the Raelians.

According to Fukuyama, a ban on cloning is just the beginning; the next step in monitoring biotechnology is clear: "We need institutions with real enforcement powers." Projects like the National Bioethics Advisory Commission and the President's Council on Bio-ethics are outdated, he says, because they can't enact legislation. This is an interesting and legitimate point. In recent years, the National Bioethics Advisory Commission has recommended policies to address the question of who profits from human tissues, whether research can be conducted on embryos and many other issues central to the current debate over biotechnology. Because these organizations have no legislative authority, their recommendations remain advisory and are often not acted upon.

Both Fukuyama and Stock avoid any discussion of regulating the way scientific research is now conducted on patients and their biological materials. Such a discussion isn't necessary, they say, because we already have a system that handles those issues. But in fact we don't. The current research-oversight system has been under heavy scrutiny in recent years because of loopholes and regulation failures. This scrutiny has increased with recent high-profile lapses in research oversight--several resulting in patient deaths or other damages--and major research institutions are calling for an overhaul of the current system. So before focusing any lawmaking powers on far-off, fictional technologies like biological mind control, a legislative body like the one Fukuyama proposes needs to ensure that today's research climate stays safe and viable.

Like Fukuyama, the authors of "The Terrible Gift" try to address their worries about biotechnology through umbrella governmental and policy changes. They blame the problems of biotechnology on capitalism in general and propose shifting to a socialized system and cultivating "altruism" as a solution. (Ironically, anti-capitalist Carlson is the founder of a company that retrieves and organizes patients' medical records.)

Stock, however, believes in a hands-off approach. He emphasizes the role of commerce in science, the influence financial interests have on the conduct of research, and recommends leaving regulations to the marketplace. Of course, this leaves big unanswered ethical questions, such as how we'll ensure patient safety when testing the technology, and who will have access to it. And it assumes that the debate over who should profit from research on human genetic materials has been settled, which it hasn't. The authors of "The Terrible Gift" rightly question current regulations in this area: Scientists can patent people's genes, yet people can't patent their bodies; patients can sell plasma and sperm, but not their tissues or organs. But besides recommending that we abandon capitalism, they offer no ideas for addressing current conflicting laws and practices.

While Stock encourages everyone to focus on science and "deal with actual rather than imagined problems," "The Terrible Gift" and "Our Posthuman Future" rely largely on politics, but from opposite ends of the political spectrum. Fukuyama, with some serious overgeneralizations, believes that "natural scientists are either apolitical" or are self-righteous liberals, and that the debate over biotechnology is "polarized between the scientific community and those with religious commitments" (he refers several times to scientists' supposed lack of religion). He often separates the debate into conservative versus liberal and religious versus non-religious, while the authors of "The Terrible Gift" break the issue down as capitalist versus socialist. Fukuyama warns that without close governmental regulation of science, we may end up with a socialist regime, while Carlson and Stimeling believe governmental involvement would be tantamount to risking a eugenic society.

In the end, though they come from disparate political positions and argue for near-opposite solutions, the authors of these two books have one important thing in common: They believe that biotechnology may destroy humanity as we know it and that we have to prevent this through radical political means. But it doesn't seem that their positions are explained entirely by left, right, socialist or capitalist; rather, they appear to stem largely from fear of the unknown and a simplified understanding of today's science and its goals for the future.

Gregory Stock Redesigning Humans