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cells, souls and science

analysis, bbc radio 4, 18 july 2002

KENAN MALIK   Made-to-order David Beckhams; an army of Saddam Hussein clones; a world without disease. Few subjects conjure up more fantastic scenarios or generate more heated debates than the possibilities of biotechnologies such as cloning and genetic engineering. For some people, biotechnology opens the door to a Star Trek-like utopia of perfect beings. For others it threatens a dark dystopia governed by monstrous multinationals and peopled by a genetic underclass. And, as the recent furore over a white couple giving birth to a black twins reveals, many people are beginning to question even long practised and highly-regarded techniques such as IVF.

BRYAN APPLEYARD   We are used to medicine as being a response to a disease whereas I think biotechnology opens up the possibility of more fundamental changes to the human being.

KENAN MALIK   The writer Bryan Appleyard, author of Brave New Worlds, a critique of biotechnology.

BRYAN APPLEYARD  I think it is obvious although many people don't seem to see it, that human beings are incapable of enhancing human beings. We don't know what a better human being is. Of course if somebody's got a disease it's better that they don't have it, all those things, but in terms of making better human beings, what it would be better for a human being to be then I think we can't do that. It's a scientistic delusion that we could make people better, better human beings in any but the most simple practical senses.

PETER GOODFELLOW   One of the difficulties is that techniques which existed for many, many years can be re-labelled as biotechnology and then we have a new discussion about the same technique.

KENAN MALIK   Peter Goodfellow, head of research and development at the pharmaceutical giant, Glaxo SmithKline.

PETER GOODFELLOW  For example, mankind, for as long as mankind has been around have been experimenting with their environment, the crops and the animals in the environment. So was the domestication of the dog, the cow, the chicken, the sheep biotechnology? I think the answer to that is actually yes, it's where we were exploiting, if you like, biological processes for our own good and I see nothing wrong in that at all.

KENAN MALIK   For Peter Goodfellow today's biotechnology is simply the latest version of a age-old technique. For Bryan Appleyard it's something fundamentally new and different. For all his relaxed attitude, though, Peter Goodfellow remains deeply anxious about public perceptions. He refuses, for instance, to talk publicly about cloning for fear that his company, Glaxo SmithKline, will be wrongly associated in the public imagination with images of men in white coats growing humans in the lab.

Underlying such public anxieties is the fear that science could robs us of our humanity, that it could steal our souls, as it were. Here's Francis Fukuyama, the American analyst and academic, whose recent book Our Posthuman Future suggests that biotechnology threatens to undermine the dignity of being human.

FRANCIS FUKUYAMA  The term dignity in Western parlance is essentially a Christian concept which has to do with the idea that man is created in God's image. But I believe that even if you begin from non religious premises, there is a very powerful concept that underlies our Western concepts of human rights that says that if you strip all secondary attributes of people away - things like skin colour, gender, social status, inherited class, these sorts of things - that there is an essential core set of characteristics that define a human being as human and that give that individual political and human rights. They would have to do with things like capacity for reason, for moral choice, a set of uniquely human emotional responses which very much colour our view of who we can relate to, who we deal with in society. And that is something that is universally possessed by all human beings and that is the basis for this very deeply embedded idea that we need to protect human dignity through our political system.

KENAN MALIK   So you see it in a sense as constituting what it is to be human and that is what you wish to preserve from the clutches of science, if you like?

FRANCIS FUKUYAMA   Yes, that’s right. We modify non-essential characteristics through plastic surgery, through aspirin and through a lot of other medical interventions but I think the technology is getting powerful enough that it is beginning to later some more fundamental characteristics.

MARY WARNOCK   Well I think it's a bit of an exaggeration that kind of
argument.

KENAN MALIK   Baroness Warnock chaired the famous Warnock committee which, in the 1980s, explored the ethical issues surrounding IVF treatment and helped established Britain's legal framework for dealing with reproductive technologies.

MARY WARNOCK   We've been capable of messing around with our biology forever. I mean ever since contraception was invented for example. And the fact that women have for years now been able to have sexual intercourse without conceiving a baby. That's messing around with our biology, but it's something we take completely for granted, as a great boon actually. And I don't believe that to move on from there the work that's gone into.. infertility and helping people have children who left to nature wouldn't be able to have children, for one reason or another. I don't think that has undermined the nature of what it is to be human, although it's undoubtedly a biological intervention, and sometime quite a dramatically intrusive intervention.

KENAN MALIK   So does Mary Warnock think that anything is permissible as far as biotechnology is concerned?

MARY WARNOCK  I think that there are ethical limits, which are to do with the way in which at present a child is, has genes equally from both parents, but in a random way. And therefore the, the child is in a sense unpredictable, each child is unpredictable. I think there should be an ethical barrier to trying to take away the randomness in the genetic make-up of every child.

KENAN MALIK  Even staunch supporters of biotechnology acknowledge that such techniques require ethical restraint. What then are the worrisome ethical issues, and how should we deal with them?

Three techniques cause particular concern. The first is reproductive cloning, the artificial creation of new humans genetically identical to the parent. Then there's therapeutic cloning, the use of special stem cells to grow human tissues, such as brain, heart or kidney. This could potentially help treat a myriad of disorders from Alzheimer's to heart disease. But it's controversial because it requires the creation, manipulation and destruction of embryos. And finally, there's genetic engineering and gene therapy. What particularly concerns critics is germ-line therapy, the modification of genes in the sperm or egg, or in a fertilised egg. Any such modification would affect not simply one individual, but also all of his or her descendants.

In Britain therapeutic cloning is legal, though strictly regulated. Reproductive cloning and germ-line therapy are illegal. In most of Western Europe all three techniques are banned. In the USA, a presidential committee is currently debating whether to allow federal funds to be used to support therapeutic cloning. At the moment no federal funding can be used for any kind of embryo research, though there is little restriction on privately funded biotechnologies.

So, there's no universal approach to the legal and ethical dilemmas thrown up by biotechnology. What's more, most of the debate is about techniques that don't yet exist and which, if they did, would most likely be illegal, at least in Europe and America. Yet, it is the very uncertainties about biotechnologies that raise hairs on the back of the neck

TOM SHAKESPEARE   I think that there are all sorts of abuses that happened in the past with very straightforward technologies. We are in a space where vast claims are being made for biotechnology and therefore I think we have to approach it with corresponding caution.

KENAN MALIK   Tom Shakespeare, director of PEALS, the Policy, Ethics and Life Sciences Institute at Newcastle University, and a disability rights campaigner. What he most fears are techniques such as germ-line therapy which seem to impose on future generations our conceptions of what is biologically good.

TOM SHAKESPEARE   I think that we don't know what will happen to society in the future. We don't know what the consequences of our collective actions may be, and we don't know how the person who, for whom we are choosing will feel about what we've chosen for them so I think we need to have care and caution in intervening in the future. If we enable parents to manipulate their children to a greater extent in the womb or prior to conception, then we are stoking up problems for ourselves. We're stoking up the potential of immense resentment against parents by children who blame them for intervening and undermining their choices, their autonomy.

KENAN MALIK   But I can't see the fundamental difference between making choices for a child when that child is an embryo or a foetus, and making choices for that child when that child is a sentient being in the outside world. And we make all sorts of choices for that child in terms of education, in terms of where they live, in terms of all sorts of aspects about their future.

TOM SHAKESPEARE   Well I'll say two things in response to that. One, I think we should respect the rights of children far, far more. We're not in a world where the pater familias says you will do this, and you have no choice, so you know yes we should listen to children more. But I think that the sort of schools that we send to children to, or the clothes that we buy for them, or the holidays and other opportunities that we provide for them, are one thing. But designing their physical or emotional or mental characteristics as we may be able to do in the future is vastly more damaging because you know your school, at the end of the day, doesn't actually make a hell of a lot of difference but your genome could do and you cannot reverse it.

JOHN GILLOTT   Not changing the genome of the future also affects the future. Anything we do affects the future so I think in that sense it's just obviously a false argument.

KENAN MALIK   John Gillott of the Genetic Interest Group - a pressure group campaigning for families with genetic disorders. Changing the genetics of future generations may be unwise. But equally, he suggests, refusing to eliminate, say, the gene that causes cystic fibrosis may condemn future generations to continue suffering from those disorders unnecessarily.

JOHN GILLOTT   I think what's really been said behind the argument is that we should privilege leaving things as they are and there's something ethically superior about not intervening compared to intervening. I think the only sensible way to approach that debate… is really to do our best now to expand our knowledge now to do what we think is right now and then in the future we will build upon that. We may make mistakes but then we may make bigger mistakes by doing nothing. You've really got to do what you think is best now, open up the possibilities for the future and then let the future decide what it wants to do with the changes that you have made.

KENAN MALIK   For Francis Fukuyama there is a broader concern with germ-line therapy – we should not do to human nature what we seem to have done to the Amazon rain forest.

FRANCIS FUKUYAMA  You can make an analogy with ecosystems. We don't do a lot of engineering projects that we used to, big hydro-electric projects for example, as we simply did not anticipate the very complicated chain of consequences that would flow from damming up big rivers. And so that is something that we choose not to do in the developed world today. And I think something very similar is likely to happen should we proceed too incautiously in this area as well.

KENAN MALIK   So do you suggest there's a particular relationship between humanity and nature and that one should not upset that relationship to too great a degree?

FRANCIS FUKUYAMA   Yes, I think that's the basic argument.

JOHN GILLOTT   Nature has not created perfect organisms, there isn't such a thing in nature. The long evolutionary history of animal species and the human species is one of making do.

KENAN MALIK   John Gillott of the Genetic Interest Group.

JOHN GILLOTT   We know that, operating blindly, nature has given us recessive human genetic diseases whereby the possession of two of the wrong genes leads to many serious and crippling diseases. On the other side, though, because nature has had a long time there is obviously a great deal of mutual interdependence within the genes and the genomes and there are some very sophisticated regulatory mechanisms and it would be foolish to go blundering in there. The ultimate goal will be intelligent design. Something like germ line genetic engineering should be an ultimate goal.

KENAN MALIK   Nature in other words is a bad designer because it is a blind designer. We only need medicine, and hence biotechnology, because evolution has left us with jerry-built bodies that constantly break down with headaches and backaches, cancers and coronaries, schizophrenia and depression. So why shouldn't we interfere with nature's creation and try and improve our genome?

This debate about germ-line therapy is important, but it's also a bit abstract. Germ-line therapy is both technically difficult and illegal. What gives most anxieties to critics of biotechnology are simpler - and legal - techniques that can do the same job. One such technique is pre-implantation genetic diagnosis, or PGD. Used during IVF procedures, PGD is a technique that allows doctors to test an embryo for genetic disorders prior to its transfer to the uterus. It makes it possible for couples or individuals with serious inherited disorders to decrease the risk of having a child who is affected by the same problem - such as cystic fibrosis or Tay Sachs disease. But it's controversial because it can be used to test the embryo for many other things - such as its sex and maybe eventually in the future, some people fear, its sexuality.

BRYAN APPLEYARD  It encourages for example the belief that we might medicalise a lot of things that we don't currently medicalise. The medicalisation is a very important point because it brings in areas of human life which people feel discontented about but have never previously been thought as medical problems. I mean it extends the definition of disease, it extends the definition of disability because we can, we now feel we can change these things at the genetic level. The obvious problem with that is that these things are not diseases. It is not a disease to be short, it is not a disease to be homosexual. We know that. That is the way we construct our attitudes to diseases. But if we start thinking that those things that can be put right, corrected, then that extends the idea of what medicine is for.

KENAN MALIK   Bryan Appleyard. The tendency to view human differences in terms of medical disorders is certainly troubling, and the possibility of consumer choice in genetic intervention raises important questions. Should the individual have autonomy to choose their child's sex, sexuality or eye-colour, or should society define the limits to such choice? Even simpler methods than PGD, though, allow people to impose choices upon future generations. Recently, a lesbian couple in the US, both of whom are deaf, created a deaf child by insisting on sperm from a deaf donor. Many people were appalled. But this is arguably more a debate about questions of identity and disability, of individual autonomy, and about how we look upon children, than it is about the ethics of biotechnology as such.

Tom Shakespeare has other worries about the impact of genetic interventions on perceptions of disability.

TOM SHAKESPEARE   Research recently showed that the availability of screening for Downs Syndrome has changed the ways in which many people regard children with Downs Syndrome so if you see a family with a Downs Syndrome child, in the street, you now think well why didn't they avoid that? Why were they irresponsible? What went wrong? It's their fault and maybe you even think well the welfare state or the insurance company shouldn't have to pay. So although in theory this research may not have negative implications to disabled people, in practice the social consequences may be less tolerance.

JOHN GILLOTT   I think empirically the argument fails, I think that we are in a society now which is more sympathetic and supportive of disability and even actually of the values of the disability rights activists whilst at the same time there is clearly an interest in genetics.

KENAN MALIK   John Gillott, with a very different argument about perceptions of disability.

JOHN GILLOTT   Essentially it seems to me what some disability rights activists are arguing when they make the argument that changing genes leads to a devaluing of people with those genes is in a sense to identify the person with the genetics which I want to resist, you know. From a broad humanist point of view you want to treat people equal as human beings and consider biology as separate from that. But in a sense the disability rights critique is almost pushing the two together and it's claiming a link between identity and genetics and I think it's far preferable to try and step back from that, try and consider people as equal but consider some people as having genetic disorders and some people broadly speaking as being healthy.

KENAN MALIK   The questions about biotechnology raised by Tom Shakespeare, Bryan Appleyard and Francis Fukuyama are important, not least because they demonstrate how opposition to biotechnology draws together many diverse political and personal strands - a religious distaste for undermining the sanctity of God's creation; a secular defence of the dignity of Man; a radical critique of the social consequences of biotechnology. But how much of this is really new?

THE TIMES   It is not fanciful to say that at this stage... the end of human beings as a wild breeding race could be in sight.

KENAN MALIK   That's a response not to cloning or to genetic engineering but to in vitro fertilisation. It comes from an essay in the Times in 1969, in the days when many people viewed IVF with the same abhorrence which now greets the prospect of cloned humans or designer babies.

THE TIMES   The cheapest and surest way for any small impoverished country to improve its wealth and influence would be to concentrate on breeding a race of intellectual giants... and as soon as one nation adopted a policy of effective selective breeding... others might feel compelled to follow suit. The threat that this might pose to accepted human values would be extremely grave.

KENAN MALIK  Even heart transplants were once seen as ethical dubious, as Peter Goodfellow points out.

PETER GOODFELLOW   When people first did transplantations it was believed that there were all sorts of questions about identity which were being raised and I think for the most part those questions have gone away as people have become comfortable with the idea.

KENAN MALIK   Today we have lost most of our anxieties about transplants and even about IVF, the black and white mix-up notwithstanding. Perhaps in 10 or 20 years' time we will have lost our anxieties about cloning and genetic engineering, too. And, if 30 years ago we had been as squeamish as we are now urged to be about today's biotechnologies, we might still be living in a world without transplants and fertility treatments.

The history of medical advances suggests, then, that pragmatism might be the best approach: take ethical considerations seriously, but don't allow them to obstruct the development of might be very useful technologies. Such pragmatism does not necessarily mean a free-for-all. John Gillott, for instance, can't see an ethical objection to germ-line therapy, but he does have safety worries.

JOHN GILLOTT   I think there is a sensible argument for saying that we should be cautious about germ line engineering because of the permanency of the changes. There's a very sensible argument at present for not doing it which is simply that the current state of knowledge does not allow us to have a proper understanding of the effect of all the changes that we might make.

KENAN MALIK   What pragmatism does allow us to do is to separate the ethical and the safety questions, to have a broad ethical debate about the meaning of human dignity and the social role of science and medicine, while at the same time taking practical decisions on biotechnology according to criteria of safety.  The trouble with such pragmatism, though, is that it does not address the absolute ethical objections that many people have to some biotechnologies.

BRYAN APPLEYARD It seems to me that the question of experimentation on embryos is pretty clearcut.

KENAN MALIK   Bryan Appleyard.

BRYAN APPLEYARD   I mean if you say, fine, experiment on embryos, then I can't really see why you don't experiment on foetuses and on handicapped newborn babies. I don't see the distinction really to be honest. I mean you can make distinctions about feeling pain and things like that but I think that is pretty marginal and actually we don't really know when these things feel pain or whatever. But if you say well actually we don't want to do that because we as a society feel strongly about the human, the sacred or sacrosanct nature of the human self. We think it begins here. You know scientifically this may be difficult to establish but I don't see that there is any problem with that.

KENAN MALIK   In practice, though, most people tend to moderate such absolute ethical injunctions, however deeply felt, in response to practical needs. Most people, for instance, whatever their views on embryo rights, accept the ethical legitimacy of in vitro fertilisation, despite the fact that for every successful IVF pregnancy, many embryos are created and destroyed. Similarly, there is widespread acceptance of women's right to abortion, even if many consider it a distasteful practice. In other words, even if you accept that embryos have a special status, in practice you tend to adopt a pragmatic approach, unless you are willing to reject such things as abortion, IVF, and so on. There is no evidence that this pragmatism has led to a diminished respect for human dignity - 20 years of IVF has not made us more willing to experiment on the handicapped. So, can't we take a similar pragmatic approach to the use of embryos in, say, cloning procedures?

Perhaps we can. But perhaps, also, the most difficult set of questions relate to how this tension between ethical concerns and pragmatic needs should be reflected in legislation.

FRANCIS FUKUYAMA   I think that regulation is inevitable in this area. I think there are many areas of technology, for example information technology, that are much more genuinely morally neutral, most of their effects are relatively positive. But biotechnology is an area that is so pervaded by human values and in which there is going to be such societal disagreement over those values that it is I think unbelievable that you can proceed very far down this road without fairly strict rules.

KENAN MALIK   Francis Fukuyama, who's a member of the committee advising President Bush on how to regulate biotechnology. Mary Warnock, who chaired a similar committee in Britain in the 1980s, suggests that regulation should provide not so much ethical guidance as reassurance.

MARY WARNOCK   No legislator, presumably, and no head of a laboratory, can afford to disregard entirely what people see as that dangers, hazards, unacceptable nature of what they're doing. And therefore there is this element that regulation is to reassure people who might be hostile to what's going on. That it isn't allowed at any rate to be a free-for-all. It is a kind of compromise. I don't like particularly saying that the point of regulation is reassurance. But I think the other side of it is that the, if there were no regulation of the permissible, permitted experiments using human embryos, then I think the scientists and doctors would be perpetually be having to look over their shoulder and see who was going to sabotage their lab and who was going to expose some malpractices, or what were thought to be malpractices. I think scientists themselves feel more secure when they are sticking to the regulations.

KENAN MALIK   John Gillott, of the Genetic Interest group, pleads for still less restriction.

JOHN GILLOTT   I think it's completely legitimate for parliament, for societies to say we don't want to see this happen. That's a kind of debate that should be had. It could then be resolved in a couple of ways really. It could be resolved by a kind of majority, majoritarian kind of decision, a vote, or - and this is probably what I would prefer - you could try and resolve it in a more kind of libertarian way. You could try and make the argument to people that OK you personally don't want this. Other people do. If you can't show a great harm to people through this procedure, then you should really back off and you should allow this to proceed so that we can examine the results of this kind of innovation, this kind of inquiry and we could see the results of it.

KENAN MALIK   For Francis Fukuyama, the fact that society is deeply divided on ethical issues demonstrates the necessity for strict regulation. For Mary Warnock, it reveals the need for official reassurance. For John Gillott, it suggests that such conflicts are best resolved through public debate rather than through government legislation. But the argument that regulation should ignore ethical objections in favour simply of safety considerations is itself, Francis Fukuyama suggests, an ethical stance.

FRANCIS FUKUYAMA  I think that if you simply choose safety as your only criteria you're making an implicit ethical judgement about this technology. That's not an ethically neutral choice. What you're saying is that the ability to intervene in the genetic construction of human beings is something that's simply up to the free market or individual choice or some combination of the two. You shouldn't kid yourself that that's an ethically neutral position.

KENAN MALIK   It's true that the pragmatic stance is not ethically neutral, but we can, I think, view this more positively than Francis Fukuyama does. Part of the problem with the biotechnology debate is that we tend see it in terms of a conflict between hard, rational scientists hellbent on progress whatever the cost and those who wish to put morality into the picture. Yet, what could be a more moral activity than the pursuit of scientific and medical progress?

MARY WARNOCK   It's always thought that scientists are without any ethical considerations at all. It seems to me that the profession that's most manifestly motivated by a moral imperative is the medical profession. And the scientists are working hand in hand with the medical profession. The aim to alleviate suffering is a, genuinely a moral aim and it, it's part of human nature, fortunately. I think that it would be ethically totally unacceptable to bring down a barrier and say, doctors may not go any further than this.

KENAN MALIK   Mary Warnock. The real debate is not about science versus ethics, but about the kind of ethics that we want. Do we wish to be guided by an absolutist morality or a pragmatic one rooted in concrete human needs - such as the need for a solution to Parkinson's, Alzheimer's and Aids? Imposing arbitrary ethical injunctions will make for neither a more moral nor a healthier society. Ethical fears about heart transplants and IVF melted away as people saw the real benefits of these techniques. The same is likely to be true of cloning and gene therapy. Why not regulate to prevent maverick scientists pursuing harmful projects - but otherwise give them a free hand and see what benefits they can produce?