Saturday, February 26, 2005

Biotechnology and lifespan

I was curious about a google hit which arrived at my site via "Condolezza Rice boots" (I had indeed misspelled her name). I went to look at the hit list and ended up at the Claremont Institute's Writings page, and Ken Blanchard's post reviewing a book, Bioevolution: How biotechnology is changing our world about the coming wonders of biotechnology. Biotechnology researchers are working hard on solutions to pollution, cancer,and infectious disease, and people today who turn 80 in 2025 may be able to live on to 120.

Ken Blanchard rightly points out a pair of objections to this very optimistic view. First, it is a very long and rocky road "from the bench to the bedside," meaning from research to when a doctor can actually help a patient, or a waste dump can be remediated. The two anti-cancer strategies mentioned, anti-angiogenesis and anti-telemorase approaches, are at least 5 and 15 years from a publicly available drug, respectively, and I'm not so sure anti-telemorase strategies will be free of side effects.

Secondly, if a disease can be cured or managed, does it cause people to behave less responsibly? Blanchard chooses the example of liver cancer and alcoholism: If it becomes possible to buy a new liver, why not piss away the one you have? (Short answer: Anyone heard of rabies in transplants? ) I think the more germane example would be HIV+ people having unprotected sex. However, I don't think the existence of life-saving technologies will increase mortality by inspiring mass bad behavior.

But my strongest reaction relates to the ongoing and really tragic differences in life expectancy worldwide, due to infectious diseases that could be treated with existing technologies. This is only touched upon by Blanchard, but I cringed when reading this quote from the book, looking forward to 2025:

Disease still exists, but the great infectious scourges such as malaria, tuberculosis, diarrhea, hepatitis and AIDS have been virtually eliminated.

I don't know where the book's author lives, but people are dying, worldwide, preventably, from this stuff. And it's getting WORSE with time. It is ironic that the book's title invokes evolution, because antibiotic resistance and other recombination events are being selected for precisely via the "directed evolution" (the author's phrase; Darwin called it "unconscious selection" ) that the author trumpets as a method for discovery of new treatments. Unconscious selection is making the "known" microbial diseases more deadly with time, even in places where treatments are readily available. A further irony, given the book's praise of the powers of biotech, resides in the many solvable diseases which receive almost no attention from the biotech world. These will still be killing people in 2025. Please, please read this discussion in PLOS medicine on how to change the rules. I do not claim to have an answer to the economics of setting research priorities, nor do I think that researchers should tackle everything just because it's doable. I just think that infectious diseases are going to be a nasty fact of life and death for a long time yet.

UPDATE: Blogger's spellchecker suggests replacing "Condolezza" with "gondola."

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