Article in Science / Social Sciences / Philosophy
A review article, highlighting ethical and legal issues relating to the use of proteins derived from bacteria to change the human genetic make-up with the aim of eliminating cancer.
 
 
 

Scientists are not only working on using bacteria to attack rogue cancer cells in the body, they are going a step further and exploring the possibility of using germ line therapy to alter people’s genetic make-up. This would certainly be of benefit to people who are genetically predisposed towards developing cancer at some point in the future, and while the use of biotechnology to try and eliminate cancer is wholly commendable, methods used to achieve this goal idea are both novel and controversial. Emerging technologies could potentially afford the prospect of enjoying a world without cancer, but in order for this to happen it means allowing scientists to make minor modifications to the human genetic make-up, and such steps cannot be taken lightly.

A new book, Bugging Cancer,1 has been written as fiction, possibly because the topic is contentious or perhaps because the science behind it is not well known, but it is nonetheless based on real science. Using story-telling to communicate ideas that have far-reaching consequences is imaginative and allows the public to consider the ideas in a non-threatening way and to think about potential consequences, including the moral boundaries. A 2011 European Court of Justice decision referred to in the book is about fact not fiction,2 and the court took the view that commercial use of stem cells derived from human embryos was contrary to European patent law by reason of threats posed by the science to ‘public order and morals’. This technology may involve the destruction of human embryos, including discarded ones, but there is no evidence to suggest that the court judgment reflects wider public opinion, and because of circularity in the argument it is lacking in philosophical coherence.

Since the adjudication is European it is not applicable in the USA, and the potential exists for patenting all kinds of genetically modified cells or organisms in North America. This is a necessary first step to enable commercial activity and facilitate research, for example, into using human embryonic stem cells to repair an injured organ or avoid immune rejection when patients need an organ transplantation. Applications from these technologies are not limited to treating organ injury or cancer, but without investment from industry it is doubtful that any of them will see the light of day because of the prohibitive costs in going through the various stages of human trials and licensing. Industry will not invest in technology unless it carries a patent, and so this topic raises matters of law and ethics (as well as science).

The science is evolving rapidly, and while it is good to balance risks and benefits associated with taking one course of action as opposed to another, it is wrong to ignore scientific breakthroughs, such as advances in genetic engineering. This is not to suggest that all new science should be accepted without question, but it does mean “let’s talk about this stuff because it’s interesting and could be really important”. The possibility, however remote, now exists for cancers to be prevented by incorporating bacterial anticancer protein genes into the human genome, and radical or not, society ought to consider the implications. In The New York Times last year, 3 Angelina Jolie described her experience of living with the genetic inheritance of susceptibility to breast and/or ovarian cancer, explaining why she chose to undergo a double mastectomy, aged 38. Now in 2014, according to the Huffington Post, she is about to undergo further treatment. 4 This is one person’s approach to living with this threat, and it is certainly not without justification; but if in the future cancer becomes a largely preventable disease, such interventions would simply no longer be needed.

What is at stake here is the idea of using bacterial anticancer genes from the human genome to keep people free of cancer. This could become possible in the not too distant future, and in support of these ideas, there is a small but growing body of scientific literature, some of which is cited in the book. Additionally, these developments could have economic as well as moral consequences, resulting in a long-term reduction in healthcare costs. While many would see this as a benefit, it could have an impact on the pharmaceutical industry, which has a vested interest in protecting a market for cancer treatments worth many billions of dollars worldwide; however, the economic implications are really part of a separate discussion.

In terms of ethics, if these biotechnological possibilities were to come about, then the reduction in the burden of disease would surely be a benefit. Furthermore, utility could be served by making healthcare more affordable, while obviating the need for patients to undergo expensive, painful preventive surgery or going through rounds of debilitating treatment that can sometimes shorten life. It is right to consider means as well as ends, and the issues are certainly complex. Anything that alters the genetic make-up has very long-term consequences, and the science behind it is still surrounded by uncertainty. But certainty in medicine is rarely present, and if such interventions help in avoiding adverse consequences for patients and families where the end result would otherwise be premature death, then they have to be worth considering. Chakrabarty and his team are right in asking whether society should consider accepting advances in genetic science, including an alteration to the human genome using a foreign bacterial gene to try and eradicate cancer. Whatever one’s views, Bugging Cancer puts these topics out in the public domain, and the discussion should begin now.

RPW London, June 2014

Notes

1. A. Chakrabarty, and The Chicago ONCO Group. Bugging Cancer. Logos Press, 2014. ISBN 9781934899366

2. Oliver Brüstle v Greenpeace e.V. (Case-34/10) [2011]

3. http://www.nytimes.com/2013/05/14/opinion/my-medical-choice.html

4. http://www.huffingtonpost.com/2014/03/13/angelina-jolie-cancer-surgery_n_4954496.html


 

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About the Author 

Roger P Worthington
Medical educator and policy consultant based in London (UK). PhD from State University of New York at Buffalo (Philosophy). Adjunct faculty

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