BAZELL: Isn't it in the interest of the sponsors of these drugs and the companies that are making them to do what Bob is talking about and make them available? We're seeing AIDS drugs that we were talking about only a few years ago as something nobody could afford. Now almost every person with AIDS in the United States is getting them, and we're starting to see them, amazingly, get into the Third World, despite what naysayers were saying. With the case of AZT for pregnant women, it's going to happen very soon, and it will probably happen with other drugs as well. And the reason it's going to happen, I would posit, is that people are going to make a profit. Isn't it in the interest of people who sell these things to make that happen?
GRIFFIN: I'm not sure I wanted to be seen as a supporter of that sort of activity. That's certainly not my personal background. I think we've got a confusion here. If you want to introduce access to health care, access to employment, access to good education, these are all things which influence health. Again, I'm not quite sure why you should select a particular drug treatment as one that is going to distinguish between those people who can afford it and those who can't. Presumably, all those additional issues, good nutrition and education and so on, influence people's health. You mentioned socialism; there is more of it about in Europe than there is here, and I personally feel reassured by the fact that I have access to health care--not free access, but free at point of access. Irrespective of what I have inherited from my mother and father, genes which have predisposed me to illness or not, I have the same access as everybody else. I think that's a sensible part of national insurance. The idea that we're going to start distinguishing between people according to the genes that they inherit, I think, is a trend which should be resisted. I think each of us should be valued for what we are as an individual, not the genes that we carry.
BLOOM: I think there are really two issues, and I would like to ask the question and not answer it. To what extent does biotechnology have, in fact, an influence on the issue of equity? The numbers, I would hope, would outrage you. The country in the world with the longest life expectancy, just to take the simplest numbers, is Japan, with a life expectancy in 1990 of about 79 to 80 years. The country with the shortest is Sierra Leone, which has a life expectancy of 35 years less. So if you are born in Japan, you're going to live 35 years on average more than if you happen to be born in Sierra Leone. So we sit back and say we could guess that. The exact numbers aren't important. And we say, "That's the Third World's problem. It's not our problem." Let me tell you: It is your problem.
There is a study released by CDC last week, the U.S. Burden of Disease and Injury study,2 in which Christopher Murray at the Harvard School of Public Health has analyzed life expectancy, not in Sierra Leone, not in Mali, but in the United States of America by county. The bottom line is that if you are born in a rural county in Minnesota or Wisconsin or Colorado, your life expectancy will be 20 to 25 years more than if you're born in the county of Baltimore, or in the county of Washington, D.C., or in six counties in Mississippi, or a dozen counties in Alabama, or four counties in Idaho with the American Indians. That's a 20-year disparity in life expectancy in the richest country in the world. I think Bob Pollack's argument is right, and how do you get to be able to rectify that? First, you have to understand why there's a difference in life expectancy; we haven't a clue, because no one has done that kind of research, and my guess is the Indians in Idaho will be dying of things very differently than the people in Baltimore or in Washington.
I think the second question which I don't have the answer to is, Can you drive the equity when you have drugs that deal with all kinds of diseases, and in such numbers that everybody would profit if they were made available to the vast majority of people in the vast majority of counties? That's what I see the biotechnology revolution--if greed doesn't overwhelm it--to be able to contribute. Because the imagination and the opportunities are there. How they will be used and made available around the world is our problem.
BAZELL: But isn't part of the problem that people are dying of gunshot wounds in some of those counties? People are dying of alcoholism in some of those counties, and it becomes fanciful to think that biotechnology has anything whatsoever to do with those deaths.
BLOOM: There's a great geneticist named David Botstein, whom I think we all have known, a really marvelous geneticist, and once many years ago my school wanted to recruit him, because he was actually born in the Bronx. (We didn't have much luck; he's now head of genetics at Stanford and doing spectacularly well.) He came 15 years ago, when there was the excitement of finding out what genes caused Huntington's chorea and a whole slew of obscure neurologic and other diseases. I said: "That's not really very interesting. What do you really want to do with genetics?" And he said, "You know what I want to do? I want to do the genetics of the battered child syndrome." That is to say, Bob may resist it, but there is some genetic component to alcoholism, probably to violence, to illness and everything. Not that there is a gene for it; these are multiple traits; but we can gain some insight, and maybe some pills that would help control that for society, if we had more scientific knowledge.
POLLACK: Why would I want to resist that? What I would resist is the idea that such information be made available at a time when there is profit to be made by sorting out the risk if you are an insurance company. So long as you can use that information to set premiums, you can box out people and put them on a positive feedback loop, a downward spiral of absence of support. My argument is that any genetic information about our species has to be framed by reinforcement of the rights of a person, regardless of their secrets. Privacy and the meaning of the secrets to one's pursuit of happiness have to be protected explicitly, because they are implicitly not protected. So I think, terrific, if there's a genetic component to any aspect of human behavior, it can't be hidden. It will be known. The issue for technology, and the issue for any citizen of any civilized country, is to protect one's citizenship from bad consequences of knowledge of what one has been born with. This is not an argument for not knowing. It's an argument for not merely knowing.
BAZELL: But merely knowing is, as you said, where we are.
POLLACK: You called it pessimistic; I think we're in an early enough time for us to deflect this in a more positive way by acknowledging the problem. I'm not pessimistic; I'm concerned. It's an amber light I am trying to shed, not a red one.
BAZELL: Do you think that there's profit to be made, Harry, in complex trait analysis? You are trying to put proteins into mammary glands; you're not trying to find out why somebody becomes a compulsive gambler, with Dolly the sheep.
GRIFFIN: No, but part of our other work is to identify complex traits like growth or milk yield or behavioral traits in farm animals. And I think what's mildly amusing about some of the coverage in the press is the idea, for example, that people have found a gene that gives you perhaps two or three percentage points on the IQ test. I think most of you would think that in fact people have identified the gene from that sort of report. The reality is that the statistical methods used perhaps will indicate that there is a gene somewhere on chromosome number 27, perhaps towards this end rather than that end. There may be two or three hundred or perhaps a thousand genes in that region. And most of the traits that people are interested in, in this sort of context, are much more complex than is commonly presented.
2. Murray CJL, Michaud CM, McKenna MT, Marks JS. U.S. Patterns of Mortality by County and Race: 1965-1994. U.S. Burden of Disease and Injury Monograph Series. Cambridge and Atlanta: Harvard School of Public Health and Centers for Disease Control and Prevention, 1998.
Photo Credits: Alan B.Shepard: NASA Apollo 11: NASA / Photo by Neil Armstrong Crick and Watson: Cold Spring Harbor Laboratory Archvies