Jonathan asked me the other day if I thought we could get to a point in medicine when we could make people immortal, or cure them of all disease, or at least extend life by another hundred years or so. At first I quickly dismissed those as possibilities, at least for the general population. Well, I have been in my genetics and genomics unit for the last week and now I am not so sure.
A lot of people in medicine right now are really pushing the idea of personalized care, meaning that we can sequence everyone’s DNA genome and therefore know exactly what disease they have, what kind of medication would work best, in what amount, and what kind of effect it will have. There are some great benefits to this! It means that we could know if a child has the genes for a disease that will develop later in life that could be prevented or at least lessened. It means that medication could be given effectively (a surprisingly large number of people die or are made worse due to medication complications) because doctors would know exactly how much they need, of what, and how their body will react. Treatment like this would significantly decrease a lot of health care costs, number of unneeded tests and medications, and would decrease time spent figuring out what is wrong and how to fix it.
There are also some potential drawbacks, or at least strong ethical concerns. Parents could know the exact genetics of their child while it is still in the womb, and could choose to abort if they don’t like what the genome shows. With gene therapy, parents could “fix” the genes of their in-womb child. Individuals could do that for themselves as well, though to a slightly less degree given our current technology. People could request to see the genomes of their girlfriend or boyfriend before deciding to marry and have kids. Sites like match.com could start to include a section for “genetic profile.” Ok, so that is a light-hearted example, but the point is that people who have some hidden genetic mutations, or just not “ideal genes” could be intentionally selected out of the mating pool. Here are some questions this raises for me:
-who would have access to the genomic info of another person?
-what effect would this have on insurance, if a genome showed that a person was predicted to get, or at high risk for a particular disease?
-what would the psychological impact be on society if people were able to know all of their different genetic mutations?
-what effects would this have on procreation, choosing spouses, and abortion?
-would we turn into a standardized society with a definition of “ideal” or “perfect” genes that people will preferentially select for? (ironically, diversity in the gene pool is actually considered a sign of a “healthy” population that is of low risk to severe mutation, but even that would change if you could control or fix mutations)
Right now these techniques are too expensive for the average person, but that is predicted to change over the next 10-20 years, so getting your genome sequenced could be as routine as getting your basic childhood vaccines. So this isn’t as far-fetched and distant as I initially thought.
So to return back to Jonathan’s initial questions, having your genetic sequence and using gene therapy wouldn’t definitively cure a person of all disease, but it has potential to cure a lot of the deadly illnesses.
Suddenly, an important question arrises: Is mortality an illness? If the role of scientists and doctors is to heal and cure the sick, and if we generally say that saving someone’s life is the goal of a medical procedure, then it seems to follow that trying to extend peoples’ life would be a good goal (I don’t mean just keeping old people alive forever in a state of sickness). That has certainly been the trajectory of medicine so far. One of the key methods of analyzing health of a country is to look at the average life span, and almost all countries have increased their avg. length of life over the last 100 years. But what if we have the technology to make people double their life span? No, that isn’t immortality, but it would have HUGE consequences on daily life and the core philosophy of life as we know it.
For me, this brings up the core question of what the goal of medicine and scientific research is. I think that technology has many great benefits, and I think that healing people is a good and valid life profession (or it would be hard to be in med school). I think that giving people the physical experience of going from sickness to wellness is a way of helping people experience the gospel, and a God who is all about giving health to the sick in the most holistic and eternal way possible. But I internally squirm when I think of us being immortal, or even living two or three times as long, here on Earth because of our advanced technology. I do think we are meant for eternal life. But isn't there a difference between the eternal life with God that scripture talks about and eternal life that we could give ourselves? How much does God inform and move forward our technological advances? How can we tell? The goal of life and health is similar to God and scientists/doctors, but do they move towards them in the same ways? Does God use doctors and scientists to do this? Are we even able to comprehend what God means when he talks about eternal life and health, or are our thoughts and definitions too feeble and small to really have any idea what He intends for us?
Questions that I do not have answers to, but that I think will persist thoughout med school.
2 comments:
Great questions and great thoughts, Stef. A lot of them have depths I am not very comfortable plumbing.
I am skeptical though that we will succeed to the kind of measure you mention in the near future. It's always easy to glimpse theoretical possibilities with new technologies without realizing other important limitations. Example: I read in a book in seventh grade that by 1960 the United States would have thirteen colonies on the Moon.
Also, the puzzle of the genome isn't as useful as we think it to be. The simple fact that one gene can code for more than one protein has thrown into question the usefulness of the entire Human Genome Project.
Doubtless, though, as technology continues to develop, our capabilities will increase. I do not doubt that if current trends and values remain unchecked, people will find new atrocities to commit, especially with regard to conception and birth or non-birth. I pray our culture may wake up before its potential for destruction grows too large.
Yeah, I was skeptical at first too. But really, this techology has already been invented, just not implemented or in some cases fine tuned.
And as for the fact that the one gene-one protein hypothesis is null, that actually has made knowing the whole genome code significantly more useful. Without it, there would be no way to know exactly how each gene would be expressed, but when you can look at the code as a whole, you actually can know what that gene will be expressed as because you can see the other genes in the sequence that will determine that expression.
So the code made gene expression more complicated, but also gave the answers to the newly created comlpications.
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