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Mark Frankel Hastings Center Report


  • pg 1
									          Inheritable Genetic
          Modification and a
          Brave New World:
          Did Huxley Have It Wrong?
          by MARK FRANKEL


              n the fall of 2000, the American Association for                mitochondrial DNA found in the ooplasm of the
              the Advancement of Science called on science to                 donated material was introduced into the recipient
              slow down. In a report it issued on inheritable                 eggs.
          genetic modification, AAAS took the position that                       The clinic reported that the technique had “led to
          no genetic modifications affecting the germ line,                   the birth of 30 babies worldwide.” The clinic also re-
          whether intentional or inadvertent, should be under-                ported that both the donated mitochrondrial DNA
          taken until the technology’s safety, efficacy, and so-              and that of the birth mother were found in all the
          cial implications had been subject to widespread                    cells of those babies born by this method—a modifi-
          public discussion. Further, said AAAS, there should                 cation of the children’s genome, since they inherited
          be no work on inheritable genetic modification until                mitochondrial DNA from two mothers. Presumably,
          a system of public oversight was in place that exer-                they will pass this inherited DNA on to their off-
          cised authority over research in both the public and                spring. The report was met with ethical disapproval
          private sectors.1                                                   in some quarters of the United States,3 and the
              Yet only six months after the report was released,              British reminded us that the procedure would be il-
          a fertility clinic reported “the first case of human                legal in the United Kingdom.4
          germline modification resulting in normal healthy                       In his 1932 book, Brave New World, Aldous Hux-
          children.”2 The work was done through the transfer                  ley led us to believe that when it came to our genes
          of ooplasm, which surrounds the nucleus of the egg                  and reproductive futures, our worst nightmare was
          and is essential for it to thrive, from donor eggs into             government involvement in procreative activities
          the eggs of women who have experienced recurring                    and a society that devalued individual decisionmak-
          implantation failure—fertilization occurs, but the                  ing. But as we begin the twenty-first century, the
          resulting embryo will not implant in their uterus. An               greater danger, I believe, is a highly individualized
          inadvertent consequence of this procedure was that                  marketplace fueled by an entrepreneurial spirit and
                                                                              the free choice of large numbers of parents that
                                                                              could lead us down a path, albeit incrementally, to-
          Mark Frankel, “Inheritable Genetic Modification and a Brave New
          World: Did Huxley Have It Wrong?,” Hastings Center Report 33, no.   ward a society that abandons the lottery of evolution
          2 (2003):                                                           in favor of intentional genetic modification. The dis-

2 HASTINGS CENTER REPORT                                                                                        January-February 2003
coveries of genetics will not be im-        by the private sector, the reported        DNA, leaving the author to warn
posed on us. Rather, they will be sold      successes have been very rare.6            that “any artificially altered genetic
to us by the market as something we             Somatic cell gene transfer came        system . . . must sooner or later give
cannot live without.                        under fire following the death in          rise to unintended, potentially disas-
                                            1999 of Jesse Gelsinger, who was en-       trous, consequences.”11 Yet how
State of the Art                            rolled in a clinical trial that involved   would one design and execute a pro-
                                            the insertion of genetic material.7 A      tocol that enabled us to make such a

B    y inheritable genetic modifica-
     tion, or IGM, I mean interven-
tions capable of modifying genes that
                                            review of the “latest developments in
                                            somatic gene transfer technology”
                                            concluded that “it is not easy to assess
                                                                                       determination, since many of the ef-
                                                                                       fects from IGM may not show up for
                                                                                       generations? Other, even more com-
are transmitted to offspring and to         exactly all these risk factors. . . . A    pelling questions relate to how soci-
generations beyond. IGM includes            number of complex issues must be           ety would assess the potential benefits
interventions made early enough in          addressed to evaluate the probability      and risks of a successful germ line in-
embryonic development to have               of having adverse effects in patients      tervention in the context of various
global effects—that is, to affect all of    related to the treatment, and to estab-    social and ethical considerations.
one’s cells—as well as any interven-        lish the extent of the possible harm           Although we have much to learn
tions targeted at the reproductive          that patients may sustain.”8               about applying IGM techniques to
cells—sperm and ova—or their pre-               A very recent incident has high-       humans, researchers have established
cursor stem cells. It encompasses           lighted other possible harms to pa-        proof of principle in animals, where
modifications both of nuclear and of        tients. In October 2002, researchers       foreign genes introduced into mice
extra-nuclear genomes, and modifica-        reported that a child treated success-     have been transmitted and expressed
tions that are inadvertent side effects     fully with gene therapy in France for      for at least three generations.12 More-
of other, deliberate genetic interven-      an ordinarily fatal immune deficiency      over, recent advances in stem cell and
tions (of, for example, somatic cell        disease had developed a form of            cloning research, which were report-
gene transfer). The only criterion is       leukemia, and that there was persua-       ed after completion of the AAAS
that the modification be inheritable.       sive evidence that the treatment was a     study, will likely provide more op-
    What can one say about the              major contributing factor.9 In Janu-       tions for doing IGM.13 As knowledge
promise and the risks of IGM? Some          ary 2003, another child was discov-        of human genetics grows in the years
light might be shed on this question        ered to have developed leukemia.           ahead, the technical obstacles may fall
by work on somatic cell gene transfer,          IGM poses even greater uncertain-      by the wayside sooner than we ex-
which is designed to treat or elimi-        ties related to risk because the inter-    pect. To what uses, then, might IGM
nate disease through genetic inter-         ventions would be passed on to the         be put? One would be to target IGM
vention only in the person receiving        progeny of those treated. Thus we          toward the alleviation or elimination
treatment. There are different techni-      need compelling evidence that the          of genetic diseases. The other would
cal approaches to such gene transfer.       procedures are safe. [OK?] But as the      be to enhance human traits.
In “gene augmentation or addition,”         AAAS report concluded, that eviden-
new genetic material is inserted into       tiary standard cannot yet be met.10        A Return to Normalcy
the body in order to take over the          How do we assess whether, for exam-
function of a faulty gene. The offend-
ing genes are not removed; instead,
their adverse effects are masked by
                                            ple, in future generations a gene nec-
                                            essary for healthy development will
                                            be accidentally turned off, or a gene
                                                                                       I  n principle, IGM would have the
                                                                                          benefit of preventing the inheri-
                                                                                       tance of genetic diseases in families
the new material. In “gene correc-          that contributes to a certain type of      rather than treating it every time it
tion,” a normal gene segment is             cancer turned on? In a provocative ar-     appears, generation after generation.
swapped for the segment with the de-        ticle published earlier this year, one     And by targeting either germ cells or
fect. Yet another approach is “gene re-     scientist claims that genomic re-          the embryo, IGM could intervene
pair,” in which a normal fragment of        searchers have underestimated, if not      before a condition occurs—before it
DNA is introduced into a cell and           ignored, a phenomenon known as             causes irreversible damage. Some pos-
the cell’s own DNA repair machinery         “alternative splicing,” which involves     sible health-related uses: transferring
permanently corrects the faulty DNA         the formation of new combinations          ooplasmic mitochondrial DNA to
sequence.5 None of these interven-          of gene sequences containing the           avoid potentially lethal diseases and
tions is easy to do; nor is it clear that   building blocks of life—proteins—          problems with repeated miscarriages
any of them will do what we want            each of them different from the un-        that are caused by faulty mitochondr-
them to do—restore health to the            spliced original and each capable of       ial DNA; treating sperm or sperm
person treated. Despite considerable        being inherited. This raises questions     stem cells to helping men overcome
investment by the government and            about the predictability of the inheri-    infertility caused by a genetic muta-
                                            tability of traits based solely on         tion; and treating gametes or early-

January-February 2003                                                                           HASTINGS CENTER REPORT           3
   stage embryos [RIGHT?] to allow            yond what is needed to maintain or        transfer to strengthen the muscles of
   couples in which both partners share       restore good health. Examples could       children with muscular dystrophy,
   a recessively inherited disorder to        include increasing height, improving      but the same technique could be used
   have a genetically-related child free of   intelligence, altering behavior, or       to increase an athlete’s strength and
   the disease. All of these cases, it        changing eye color, all of which have     endurance. An even more revealing
   should be pointed out, are relatively      been shown to have some underlying        example concerns the use of Human
   rare, and all of them require some         genetic connection. IGM offers the        Growth Hormone, or HGH, which
   form of assisted reproduction.             promise that genes associated with        is genetically engineered to supple-
       There already exist, however,          characteristics found to be undesir-      ment natural growth hormone.
   other, better-tested techniques to         able (or less desirable) could be re-     While originally approved to treat
   avoid passing on mutant genes. These       placed by those linked to desired         children deficient in natural growth
   include genetic screening and coun-        traits.                                   hormone, it could be used to make
   seling, prenatal diagnosis and abor-           There are promises and perils as-     normal children taller, and indeed
   tion, egg or sperm donation, and           sociated with genetic enhancement.        one newspaper has reported that
   adoption either of a child or an em-       On the one hand, we know that             some parents have requested HGH
   bryo. Another technique, known as          some people are born more “geneti-        for children within the normal height
   pre-implantation genetic diagnosis,        cally fit” than others, giving them       range for their age because they want
   combines in vitro fertilization (IVF)      certain advantages. The promise of        to improve their chances in competi-
   with pre-implantation diagnosis and        enhancing the capabilities of those       tive basketball.14
   selection of embryos. Individual cells     who are genetically less fortunate is         Further complicating matters is
   are removed from an embryo, fertil-        an exciting and noble prospect for        that distinguishing between treat-
   ized outside the body, and tested for      some people. And by increasing, for       ment and enhancement may get in-
   the presence of genetic mutations (to      example, the intelligence of individu-    creasingly difficult. The line where
   the extent that tests are available).      als, all of society may gain from the     one ends and the other begins may
   Embryos without known mutations            knowledge they generate or from the       become blurred as our experience
   are then implanted in the woman via        better choices they make in the           with IGM expands. Hence, interven-
   IVF. This approach could have wide         course of their lives. [OK?]              tions which now give us pause may
   application, although it would not             On the other hand, genetic en-        become more acceptable in the fu-
   work in those cases where both par-        hancement could also lead us to de-       ture. Surveys have shown that 40 to
   ents have identical versions of the        value various social and environmen-      45 percent of Americans approve of
   same mutant gene.                          tal factors that influence human de-      using genetic technologies to bolster
       With these techniques available,       velopment in concert with genes.          their children’s physical and mental
   and in light of the enormous difficul-     There might be less appreciation for      traits.15 I suspect that as more people
   ties associated with determining risks,    productive social interaction in a        get used to the idea, it will become
   why bother with IGM? The answer            classroom, for example, or for the        even more appealing. Americans al-
   lies in its possible use for genetic en-   hard work traditionally required to       ready avail themselves of cosmetic
   hancement.                                 become a successful professional.         surgery to make them look better,
                                              These conventional methods of en-         drugs to make them more alert, and
   Beyond Normalcy                            hancement may have some intrinsic         herbs to promote sexual perfor-
                                              value that could never be duplicated      mance. And we expect and praise

   I  t is this prospect, I believe, that
      generates the most excitement over
   IGM, and the most uneasiness. I will
                                              by a genetic intervention. In fact, a
                                              preoccupation with genetic enhance-
                                              ment may place too much emphasis
                                                                                        parents for doing all that they can to
                                                                                        enhance their children’s well-being; it
                                                                                        is “the natural expression of parental
   argue enhancement applications             on the genes and ultimately prevent       affection.”16 For many Americans,
   more than medical uses determine           us from solving problems that are re-     IGM will merely be seen as a logical
   the scope, direction, pace, and accep-     ally embedded in the structure of our     extension of what is commonplace
   tance of IGM in the United States.         society.                                  throughout America today, and it will
   And it will be the market and free             Another complication is that the      be increasingly difficult to draw a
   choice, not government, that pushes        technology developed for therapeutic      clear line between the use of genetics
   it along. But I am getting ahead of        purposes will be the same as that used    for therapeutic purposes and its use
   myself.                                    for enhancement. So while we might        for other ends.
       By “genetic enhancement” I mean        approve of IGM for medical treat-             Yet enhancement by genetics is
   improving human traits that without        ment, its availability will likely pro-   also qualitatively different from en-
   intervention would be within the           mote creeping enhancement applica-        hancement by other means. Existing
   range of what is commonly regarded         tions as well. For example, scientists    methods of enhancement, from phar-
   as normal, or improving them be-           are now testing the use of [OK?] gene     macology to advanced music lessons,

4 HASTINGS CENTER REPORT                                                                                   January-February 2003
are aimed at the current generation of     gene transfer suggests that, if left to     cessfully used to treat his sister.22
adults and children. They are not bi-      its own, IGM is likely to follow the        Within days of the story appearing in
ologically intrusive in a manner that      push and pull of the market, as appli-      the popular press, authorities in Eng-
will significantly shape our evolution-    cations for treating disease are either     land received more than a dozen re-
ary course. Inheritable genetic en-        limited or more efficiently handled         quests for approval to undergo the
hancement would have long-term ef-         by other means, as Americans be-            same procedure. In response, the
fects on persons yet to be born. Thus      come more accustomed to the notion          British government subsequently ap-
we have little, if any, precedent for      of enhancement, and as businesses           proved use of a pre-implantation
this way of using IGM. We would be         offer commercially attractive prod-         technique that detects a range of ge-
venturing into unknown territory,          ucts.                                       netic abnormalities,23 and earlier this
but without any sense of where the                                                     year a British couple gave birth to a
boundaries should lie, much less with      Genetics and Reproduction                   baby born with a desired genetic
an understanding of what it means to                                                   characteristic—cells capable of saving
cross such boundaries.

To Market, To Market
                                           A     dvances in reproductive technol-
                                                 ogy have given thousands of in-
                                           fertile couples the chance to have a
                                                                                       her older sibling from leukemia.24
                                                                                           Who among us would not want to
                                                                                       avoid passing on mutant genes to fu-
                                           child. But merging these advances           ture children or help existing children

T     here are good reasons to believe
      that market forces are more like-
ly than other factors to determine the
                                           with those in genetics promises to ex-
                                           tend choices beyond whether and
                                           when to have a child to what sort of
                                                                                       overcome serious diseases? What
                                                                                       these examples show is a willingness
                                                                                       on the part of people to select future
path we take on IGM. Science in            child to have. Greater knowledge of         children for specific genetic traits. A
general is increasingly valued for its     genetics now enables people consid-         technique that was originally created
commercial promise, and some re-           ering pregnancy to use new reproduc-        to help people screen out certain
cent developments reinforce the spe-       tive technologies to ensure [OK?]           characteristics has crept in a different
cific connection between genetics          that their child has a certain genetic      direction, now enabling people to
and the market. In the case of somat-      makeup.                                     screen in desirable characteristics. For
ic cell gene transfer research, the            Until very recently, that typically     now, the latter has been for the noble
focus of the field has shifted from rare   meant avoiding a genetically related        purpose of saving the lives of exiting
genetic disorders, now viewed as of-       disease that could be passed on. For        children. But where does one draw
fering limited profits, to more com-       example, in 2001 doctors reported on        the line? Should we screen out for
mon ailments that promise greater fi-      the use of PGD to identify human            short stature? Or screen in for eye
nancial gain. As one observer of the       embryos that lacked a specific cancer-      color?
field noted, “The whole concept of         causing gene mutation. They im-                 Poised to help meet, if not fuel,
gene therapy for genetic diseases          planted only embryos without the            parents’ desire to make their offspring
doesn’t fit the business model.”17An-      disease gene into a woman’s uterus,         healthier, and perhaps prettier,
other foresees movement in the direc-      and she gave birth to a baby free of        smarter, and more athletic as well, is a
tion of “the most profitable human         the cancer syndrome that runs in the        cottage industry that has sprung up
conditions because there is even           father’s family.20 It was also an-          in the past two decades in assisted re-
[MARK: is “even” right? Perhaps we         nounced in early 2002 that the same         productive technology. What began
should replace with ellipses.] far more    procedure had been used to help a           as an effort by fertility clinics to help
money to be made in curing baldness        woman who has the gene for early-           infertile couples have a child is now a
and wrinkles than there ever will be       onset Alzheimer’s disease have a baby       growth industry offering a range of
in cancer of HIV/AIDS.”18                  free of that mutation.21                    services no longer confined to the in-
    To some extent, that is what is oc-        But the technology has now gone         fertile.
curring now. For example, the presi-       well beyond that limited purpose.               Some infertility clinics are offering
dent of Anticancer, Inc., a San Diego      Two years ago in the United States,         couples the opportunity for “family
company working on a genetic cure          IVF and PGD were used to produce            balancing” via techniques that can
for baldness, has publicly stated that     a child whose genetic make-up made          virtually assure parents a child of a
FDA approval will be sought for mar-       possible a life-saving treatment for an     particular sex.25 The idea is to use
keting the product for hair regrowth       older sister. Several embryos were cre-     PGD to distinguish between em-
in cancer patients who become per-         ated and tested to ensure that they         bryos with the Y chromosome and
manently bald due to chemotherapy,         were genetically similar to the older       those lacking it, and then implant the
but that once such approval is grant-      sister yet lacked mutant gene that had      “right” embryo or embryos. In Octo-
ed, the product will be marketed to        given the sister a fatal disease. The re-   ber 1999, in a statement declaring
all those experiencing baldness.19 The     sult was a healthy baby boy, from           that the use of solely for sex selection
experience so far with somatic cell        whom umbilical cord cells were suc-         “should be discouraged,”26 the Amer-

January-February 2003                                                                            HASTINGS CENTER REPORT            5
   ican Society for Reproductive Medi-        cially desirable outcome. In the           get used to them without fully con-
   cine said, “Those who argue that of-       meantime, the larger moral and social      sidering their consequences.
   fering parental choices of sex selec-      climate can be changed in ways that        In the book Future Shock, Alvin Tof-
   tion is taking a major step toward ‘de-    make applying the brakes difficult.        fler wrote that the future arrives too
   signing’ offspring present concerns           An editorial in the St. Louis Post-     soon and in the wrong order. If the
   that are not unreasonable in a highly      Dispatch articulated the problem           future occurred in the right order, we
   technologic culture.”27 Web sites have     nicely:                                    could understand changes before
   sprung up where persons can market                                                    they happened, rather than after, and
                                                private entities tend to be profit
   their gametes and couples can assess                                                  could better prepare. That is not, of
                                                driven—which should be the last
   the height, weight, hair and eye color,                                               course, the way it works. But the fu-
                                                consideration in how we alter the
   education, and musical and athletic                                                   ture is not fixed, either. The question
                                                human race. . . . [T]he . . . critical
   abilities of potential suppliers of eggs                                              with regard to IGM is whether we
                                                question is whether government
   or sperm.28 Some egg donors “are be-                                                  will shape it or be shaped by it.
                                                should set rules for both public
   coming shrewd businesswomen, ask-
                                                and private genetic manipulation
   ing top dollar for their high IQs or                                                  References
                                                of the species. If there continues to
   good looks.”29 And all this is occur-                                                    1 M.S. Frankel and A.R. Chapman,
                                                be no public oversight of the pri-
   ring in an industry where there are                                                   Human Inheritable Genetic Modifications
                                                vate entities, there will be nothing
   strong economic interests in expand-                                                  (Washington, D.C.: American Association
                                                to stop fertility clinics from offer-    for the Advancement of Science, 2000).
   ing services under the banner of en-
                                                ing whatever genetic manipulation           2 J.A. Barritt, C.A. Brenner, H.E. Malter
   hancing consumer choice, and where
                                                becomes possible and mar-                and J. Cohen, “Mitochondria in Human
   choice is reinforced by the very high
                                                ketable.31                               Offspring Derived from Ooplasmic Trans-
   value that our society places on repro-                                               plantation: Brief Communication,”
   ductive freedom.30 It will be difficult    So what do we do? The 2000 AAAS            Human Reproduction 16, (2001): 513-
   to overcome the resistance of con-         report recommended several steps           516, at 513.
   sumers to any effort to restrict their     that remain important. Most impor-            3 E. Parens and E. Juengst, “Inadvertent-
   access to such technologies.               tant among them was that no IGM,           ly Crossing the Germ Line,” Science 292,
       The market is now poised to take       whether involving intentional or           (2001): 397.
   advantage of the increasing power of       “reasonably foreseeable” inadvertent          4 David Whitehouse, “Genetically Al-
                                                                                         tered Babies Born,” BBC News, May 4,
   genetic technology, producing finan-       transmission, should go forward at         2           0          0         1         ;
   cial profit for some and giving par-       this time. In a subsequent article ap-     http://news.bbc.co.uk/hi/english/sci/tech/n
   ents the “best product” for their          pearing in Science following the re-       ewsid_1312000/1312708.stm.
   money. In the vernacular of the mar-       port by the fertility clinic of mito-         5 T. Friedmann, Approaches to Gene
   ketplace, people are not parents; they     chondria DNA transmission, my co-          Transfer to the Mammalian Germ Line, in
   are consumers, and distinctions long       author and I stressed the urgency of       Designing Our Descendants: The Promises
                                                                                         and Perils of Genetic Modifications, ed.
   recognized between reproduction and        moving more quickly to put in place        A.R. Chapman and M.S. Frankel (Balti-
   production begin to fade.                  a system of public oversight with au-      more, MD: The Johns Hopkins University
                                              thority over IGM efforts in both the       Press, 2003).
   Whither Policy?                            public and private sectors.32 Accom-          6 Ibid.
                                              panying this oversight mechanism              7 J. Brainard, “Citing Patient Deaths,

   F   or society, deciding the fate of
       IGM will be among the most
   profound decisions it ever faces. For-
                                              should be a national public dialogue
                                              on whether and, if it is deemed ac-
                                              ceptable, how such research and its
                                                                                         Key Senator Urges Better Oversight of
                                                                                         Gene-Therapy Trials,” The Chronicle of
                                                                                         Higher Education, (February 3, 2000);
   mer Senator Daniel Moynihan once           applications should proceed.               000020301n.htm.
   remarked that while it was important           These proposals are premised not          8 G. Romano, P. Micheli, C. Pacilio and
   in the development of civilization for     on a belief that IGM should never be       A. Giordano, “Latest Developments in
   someone to have invented the wheel,        tried, but that it must pass the test of   Gene Transfer Technology: Achievements,
   it was equally important that soon         public discourse, undergo rigorous         Perspectives, and Controversies Over Ther-
                                                                                         apeutic Applications,” Stem Cells 18 (Janu-
   thereafter someone invent the brake.       assessment of its potential impacts,       ary 2000); http://stemcells.alphamed-
   We must balance our scientific efforts     and receive explicit public approval.      press.org/cgi/content/full/18/1/1.
   with a better understanding of where       [OK?] There should be no back-                9 E. Marshall, “What to Do When Clear
   they are leading. Not all social values    doors, whether due to gaps in public       Success Comes with an Unclear Risk? Sci-
   are well served by the push and pull       policy or an aggressive marketplace,       ence 298, (2002): 510-511.
   of commerce. Individual decisions re-      through which IGM inches its way              10 See ref. 1, Frankel and Chapman,
   garding the use of these genetic tech-     into our lives. These technologies are     Human Inheritable Genetic Modifica-
                                                                                         tions,” p. 7.
   nologies may be personally beneficial,     highly seductive, and we could easily
   but they may not lead us toward a so-

6 HASTINGS CENTER REPORT                                                                                      January-February 2003
   11 B. Commoner, “Unraveling the DNA           19 See ref. 15, Weiss, “Cosmetic Gene          26 Ethics Committee of the American
Myth,” Harper’s Magazine, (February           Therapy’s Thorney Traits,” p. A1.              Society of Reproductive Medicine, “Sex Se-
2002): 39-47, at 47.                             20 Y. Verlinsky, S. Rechitsky, O. Verlin-   lection and Preimplantation Genetic Diag-
   12 M. Nagano, C. J. Brinster, K. E.        sky, K. Xu, G. Schattman, C. Masciangelo,      nosis,” Fertility and Sterility 72, (1999):
Orwig, B-Y Ryu, M. R. Avarbock and R. L.      N. Ginberg, C. Strom, Z. Rosenwalks and        595-598, at 598.
Brinster, “Transgenic Mice Produced by        A. Kuliev, “Preimplantation Diagnosis for         27 Ibid., p. 597.
Retroviral Transduction of Male Germ-Line     P53 Tumor Suppressor Gene Mutations,”             28 For one such site, see
Stem Cells,” Proceedings of the National      Reproductive Biomedicine Online 2,             http://www.conceptualoptions.com/Extra-
Academy of Sciences 98, ( 2001): 13090-       (March/ April 2001); http://www.rbmon-         ordinaryDonors.htm.
13095.                                        line.com/4DCGI/Article/De-                        29 C. Cleary, “Altruism, Money Moti-
   13 See ref. 5 Friedmann, “Approaches to    tail?38%091%09=%2055%09.                       vate Egg Donors: More Young Women
Gene Transfer to the Mammalian Germ              21 Y. Verlinsky, S. Rechitsky, O. Verlin-   Aiding Infertile Couples,” The Seattle
Line.”                                        sky, C. Masciangelo, K. Lederer, and A.        Times, (4 November 2002); http://seattle-
   14 R. Rubin, “Giving Growth a Synthet-     Kuliev, “Preimplantation Diagnosis for         times.nwsource.com/cgi-
ic Hand, Use of Hormone Sparks Debate,”       Early-Onset Alzheimer Disease Caused by        bin/PrintStory.pl?document_id=13456894
Dallas Morning News (July 7, 1986): A1.       V717L Mutation,” JAMA 287, (2002):             6&zsection_id=268448406&slug=egg04m
   15 R. Weiss, “Cosmetic Gene Therapy’s      1018-1021.                                     &date=20021104.
Thorny Traits,” The Washington Post (12          22 L. Belkin, “The Made-To-Order Sav-          30 O. D. Jones, “Reproductive Autono-
October 1997): A1.                            ior,” New York Times Magazine, (1 July         my and Evolutionary Biology: A Regulatory
   16 R. Cole-Turner, “Do Means Matter?       2001): 36 passim                               Framework for Trait-Selection Technolo-
Evaluating Technologies of Human En-             23 A. Ferriman, “UK Approves Preim-         gies,” American Journal of Law and Medi-
hancement,” Report from the Institute for     plantation Genetic Screening Technique,”       cine XIX, (1993): 187-231.
Philosophy & Public Policy 18, (Fall 1998);   British Medical Journal 323, (21 July             31 Editorial, “Altering Man: Who De-
http://www.puaf.umd.edu/ippp/fall98/do_       2001): 125.                                    cides,” St. Louis Post-Dispatch, (21 Sep-
means_matter.htm.                                24 J. Meek, “Baby with Selected Gene        tember 2000): C16.
   17 Quoted in A. Pollack, “Gene Thera-      Born in Britain,” Guardian Unlimited, (16         32 M. S. Frankel and A. R. Chapman,
py’s Focus Shifts from Rare Illnesses,” The   February                             2002);    “Facing Inheritable Genetic Modification,”
New York Times (4 August 1998): C6.           http://www.guardian.co.uk/Archive/Arti-        Science 292, (2001): 1303
   18 M. S. Langan, “Prohibit Unethical       cle/0,4273,4357446,00.html.
‘Enhancement’ Gene Therapy,” statement           25 L. Belkin, “Getting the Girl,” New
delivered at NIH Gene Policy Conference,      York Times Magazine, (25 July 1999): 26
Bethesda, MD, 11 September 1997.              passim; also see http://www.centerforhu-

January-February 2003                                                                                  HASTINGS CENTER REPORT              7

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