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COMMENT: Henry I. Miller, Hoover Institution (415) 725-0185

AAAS '96: Session 2:30 p.m. Saturday, Feb. 10:
"Ethics of Human Genetic Enhancement"

Gene enhancement not so different from a nose job, says Hoover scholar

STANFORD -- Should laws or regulations prohibit people from using gene therapy to cure baldness or to add a few extra inches of height? What about adding a gene that codes for a hormone that suppresses appetite, or one that makes a brain chemical to enhance memory? Some of the leaders in gene therapy research have argued that it should be used only to cure severe disease - that tinkering with genes for "enhancement engineering" would take society into new and dangerous moral territory.

On the contrary, says Hoover Institution research fellow Henry I. Miller: Gene therapy for enhancement is no different on a scientific, legal and ethical basis from plastic surgery, liposuction or the use of drugs to suppress appetite or age spots. Speaking at a session on the ethics of human genetic enhancement at the American Association for the Advancement of Science meeting in Baltimore on Saturday, Feb. 10, Miller said that the prospect of altering genes to enhance human looks or potential does raise a number of important issues - but none of these issues is unique to gene therapy per se.

Miller is the Robert Wesson Fellow of Scientific Philosophy and Public Policy at the Hoover Institution, and a consulting professor at Stanford University's Institute for International Studies. From 1979 to 1993, he was responsible for biotechnology policy at the Food and Drug Administration. He previously presented his arguments for genetic enhancement in the July 30, 1994, issue of the medical journal The Lancet.

Somatic cell human gene therapy may become one of the major medical advances of the next century. Doctors someday should be able to insert normal or modified genes into cells to correct medical disorders - for example, to discourage cholesterol from clogging arteries. Because only somatic cells, not germ-line cells, will be altered, the changes will not be passed on to the next generation.

Gene therapy has potential dangers, Miller told the AAAS session. Like any new drug, it introduces a foreign substance into the body. The inserted gene might have unintended consequences - for example, it might inactivate a cancer suppressor gene and trigger the start of a tumor. But these types of dangers also occur with other medical procedures. Miller said that before a gene therapy is approved or even tested, it must be reviewed by a plethora of oversight regimes at research institutions themselves and at both the Food and Drug Administration and the National Institutes of Health.

Gene therapy poses special risks because it may be irreversible. However, Miller said the technology exists to introduce genes that can be removed or can be blocked from expression if they turn out to be dangerous.

Genetic enhancement also poses some moral and social questions, Miller said. Who would have access to the treatment - those with the most acute need, or those with the ability to pay? Would pressure be exerted on workers to have genes inserted to make them less susceptible to workplace toxins? Would some people seek gene therapy to change skin color or some other trait as a treatment for discrimination? Who would define whether a patient's condition is serious enough to warrant treatment - would improvements on a "fat gene" be limited to the medically obese, or available to anyone who wants to look thinner at the beach?

None of these questions is unique to gene therapy, Miller said. "There have been numerous clinical trials of appetite suppressants, memory-enhancing drugs and human growth hormone for hormonally normal but shorter-than-average children." And people seeking enhancement do not regard it as trivial. "It is certainly not trivial to an adolescent boy who is six inches shorter than anyone else in his class, or to many people of either sex who suffer hair loss."

American society already has the mechanisms in place to evaluate the medical risks and benefits of gene therapy, Miller argued. Individuals can be given the information they need to decide if the personal benefits of enhancement outweigh the risks.

"If society is to realize the full spectrum of benefits from human gene therapy, it cannot be considered in a philosophical vacuum," Miller said. "It must be judged in the broader context of what people want and what society permits."



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