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SHOW 205 TRANSCRIPT
Will Gene Therapy Change the Human Race?

GENE therapy is the remarkable treatment of disease by altering our DNA (deoxyribonucleic acid), the long, complex molecules that carry our genetic information and reside in the nuclei of all our cells. Gene therapy may sound like a normal medical advance. It is not. The restructuring of our genetic material is a revolution. But how far should we go? What are the subtle distinctions between genetic therapy and genetic enhancement--between curing old diseases and creating new bodies? You've heard of designer clothes? How about designer kids? Take your choice: Smart? Tall? Blue-eyed? Beautiful? Musical, mystical, ambitious, ambidextrous? Genetic engineering is power, with the capacity to cure or corrupt, heal or harm. But if we intervene and adjust human genes, do we impact and alter human evolution? We invited five world-renowned experts to examine a volatile medical future. 

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PARTICIPANTS

Dr. W. French Anderson, director of the Gene Therapy Laboratories at the University of Southern California, has been called "the father of gene therapy." French describes clinical protocols for the treatment of genetically based diseases.

Dr. Francisco Ayala, a geneticist and philosopher at the University of California at Irvine, is called the Renaissance man of evolutionary biology. Francisco has deep concerns about the long-range implications of gene therapy, about the potential for very great evil.

Dr. Sherwin (Shep) Nuland, a professor of surgery at Yale, is the author of two remarkable books, How We Die and How We Live. Shep worries about tampering with the essence of our humanness.

Dr. Gregory Stock, a biophysicist and MBA, is director of UCLA's Program on Medicine, Technology, and Society. Greg envisions how germ line engineering will radically change humanity.

Dr. Allan Tobin is director of the Brain Research Institute at UCLA and the scientific director of the Hereditary Disease Founation. Allan explains how advanced technologies treat neurological diseases.

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ROBERT: French, why is gene therapy particularly exciting now? 

FRENCH: Over the next twenty to thirty years, gene therapy will probably revolutionize the practice of medicine. Since the basis of our bodies is in our genes, it's also the genes on which our whole health is based. Therefore it should be possible, once we decipher all the genes and understand what they do, to replace genes that are deficient or weak. For example, if people have a tendency to develop a certain kind of cancer, we'll supply them with a gene that protects them from that cancer.

ROBERT: Francisco, you're an evolutionary geneticist; in fact, you've used DNA as a kind of molecular clock to track evolution. Are you at all concerned that gene therapy might inadvertently interfere with the evolutionary process?

FRANCISCO: I'm concerned, of course, but I'm mostly concerned that gene therapy and gene enhancement may impact humans in other ways. The process of evolution is very slow, and in the scale of human evolution, gene therapy is going to have a very small impact. It's on a different scale. 

ROBERT: But if you change genes in the human population pool artificially, couldn't that cause a rapid acceleration of evolution? 

FRANCISCO: Gene therapy is a slow process. Take a typical genetically based disease, such as cystic fibrosis or muscular dystrophy. The frequency of these genes in the general population is on the order of a few percent. So assume that a disease-causing gene exists in the population at a one-percent level, and you cure everybody who's born with the disease by correcting the gene; it would take you a hundred generations, or some twenty-five hundred years to do that--to go through that one percent of the population. There's very little impact on the gene pool at large, because disease-causing genes have already been kept at a very low frequency, through natural selection.

ROBERT: We're going to get back to this issue. Allan, you're director of UCLA's Brain Research Institute, which, in the spirit of full disclosure, is where I received my doctorate three decades ago. You've been interested in how cell biology and molecular genetics can be used to create new therapies for disorders of the brain. 

ALLAN: We're investigating the use of gene therapies to modify somatic cells--that is, the cells of body tissues and organs, [as opposed to the germ cells, or gametes--the reproductive cells, sperms and eggs]. I've had a long-standing interest in Huntington's chorea, a degenerative disease of the brain, genetic in origin, which causes a loss of coordination and a dancing-like movement. We're looking into ways in which gene therapy can be used to understand and modify the process of neurodegeneration in that and other such diseases--Alzheimer's, Parkinson's disease, epilepsy. 

ROBERT: Greg, your focus on genetic engineering, and you're a futurist. What do you see on the horizon for gene therapy?

GREG: When we start to do more profound genetic manipulations and enhancements, it's going to have very, very dramatic effects on human evolution. This slow process that Francisco [Ayala] was talking about is being supplanted. Technology is rapidly reshaping the world, at a pace orders of magnitude faster than anything in the past. These technologies are becoming so powerful that we can redirect them back upon ourselves.

ROBERT: Are you worried about that?

GREG: No, I'm not worried about it.

ROBERT: I'm worried.

GREG: That's not surprising. Genetic engineering is going to change life as we know it, and this can be very disturbing at a number of levels. Other technological developments are also going to have a marked impact on us, such as artificial intelligence and the way telecommunications knits us all together. Human life is going to change dramatically in the short-term future, I believe.

ROBERT: Shep, you teach bioethics [at Yale]. What concerns do you have as you look at the human condition, as it might be affected by the dramatic changes in gene therapy?

SHEP: I'm always skeptical of words like "revolutionary" and "dramatic." It hasn't happened yet, I'm not sure it's going to happen, and perhaps I can be a little bit of a dissenting voice here. But if genetic engineering goes as predicted, and in such a way as to "change life as we know it," the question obviously is, Do we want to change life as we know it? Have these 3.6 billion years of evolution since the first life appeared on earth meant anything? And is there a guiding biological purpose? If so, do we really want to play with it?

ROBERT: A fundamental question.

SHEP: The fundamental question really is, What is humanness? Is it our spiritual sense? Is it our sense of mystery? Is it our ability to love, to be altruistic in ways that animals can't be? Do we really want to run the risk of changing this? Do we know the consequences of what we're doing? It seems to me that a technology that's potentially revolutionary--that can change the world--should demonstrate first that unambiguous benefits will come from it, before we start applying it. 

ROBERT: We'll get back to fundamental questions. For now, let's stick to individual people with specific problems. French [Anderson], take a real-world situation, where I come to you as a patient, with a disease that may be treatable by gene therapy. I don't know anything about the procedure, but my physician has recommended your experimental protocols. What would you be telling me in that first office visit?

FRENCH: The first thing I emphasize is that gene therapy is an experimental procedure and there are no fully successful gene therapy treatments yet. Certainly in future years there will be successful treatments. But there are over three hundred approved clinical protocols for gene therapy. As a possible patient in this experimental program, you would need to understand and sign an informed consent. That's a document that ensures that you understand what your disease is, or what your child's disease is, what the procedure is, what the risks of that procedure are, what the possible benefits are, and what the likelihood is that there will be any benefit at all.

ROBERT: What diseases might I have?

FRENCH: At present, about seventy percent of the clinical protocols are for one form of cancer or another: brain cancer, breast cancer, colon cancer.

ROBERT: These would usually be at advanced stages of the disease, where the risks of your procedure are less relevant?

FRENCH: At the present time, yes. Probably the most successful gene therapy currently--aside from therapies for some rare genetic diseases--is for heart disease. A physician at St. Elizabeth's Medical Center in Boston, Jeffrey Isner, has succeeded in injecting, directly into the hearts of patients who are bedridden, normal genes for a factor that causes the growth of blood vessels, and a number of these patients are now back to leading a perfectly normal life. The procedure--if I were Jeff Isner and you were referred to me as a cardiac patient--involves the same process of informed consent, going over the risks, the potential benefits, and so forth.

ROBERT: What's the clinical procedure? 

FRENCH: There are dozens of ways in which gene therapy is carried out. If it's an attempt to treat cystic fibrosis, the fluid carrying the replacement genes could be put in a bronchoscope and actually dripped into the lungs. In the brain tumor protocols, we inject a "suicide gene" directly into the tumor, which causes the cancerous cells to die. In many cases, we take cells, such as blood cells, out of the patient's body, insert the replacement genes into these cells, and then return the genetically engineered cells to his body.

ROBERT: How are the new genes inserted into the cells?

FRENCH: We use what we call vectors, which are molecules that carry the genes into the cells. The usual vectors are special viruses, but sometimes it's simply the DNA itself.1 

{FOOTNOTE}1 A number of people have died during gene therapy trials, but they have been terminally ill cancer patients. In late 1999, the first true gene therapy death occurred after a patient with a non-life threatening liver disease was given a genetically engineered adenovirus--a virus similar to those that cause colds. Adenovirus may be abandoned in favor of other delivery systems. {/FOOTNOTE}

ROBERT: Allan, are these gene therapies really much different from traditional medical procedures?

ALLAN: These therapies simply multiply a patient's existing cells. When French talks about injecting DNA to stimulate the growth of blood vessels in a diseased heart, or into a brain tumor to stop the tumor from growing--or as I might think of supplementing the ability of an epileptic patient's brain cells to quiet neural activity--these procedures are not so different from other medical and surgical procedures. They're not going to have any impact on evolution. They're not going to be revolutionary in the sense that Shep [Nuland] worries about. 

ROBERT: I'm not sure that's right, because we have to envision the technological extensions of these first early efforts--we'll explore this further. To continue: What's the Human Genome Project--a massive effort and an example of "big science"--which is expected to form the foundation of future gene therapies?

ALLAN: The Human Genome Project is a nationwide effort to determine the sequence of all three billion nucleotides, the building blocks of DNA located in the nucleus of every cell in our bodies. That is, the double helix of DNA in each cell carries two complete copies of these genetic instructions, and each set of instructions is composed of three billion nucleotides. But only about five percent of those three billion nucleotides are actually genes--sequences that code for specific proteins, which are the business end of a cell. It's estimated that there are about a hundred [to a hundred and forty] thousand genes in human DNA.

GREG: It's not just the sequencing that's important in the Human Genome Project, but also understanding all the polymorphisms, or variants, that exist--what makes you different from me. And being able to identify which clusters of those genes are associated with various human traits, by means of genomics, which uses computers to analyze all this complex data. By coupling this genetic understanding with new technologies, like DNA chips, we'll be able to generate a genetic profile of an individual very cheaply and very quickly. DNA chips aren't science fiction; they're analogous to computer chips and they'll identify various polymorphisms on perhaps some hundred thousand genes eventually. When you start getting this kind of information, then it becomes feasible to imagine the alteration of genes at a more fundamental level--for instance, in the first cell of the embryo. 

ROBERT: We've now entered into the brave new world of human germ-line engineering. Please explain.

GREG: Germ-line engineering involves the germinal cell, which is to animals as a seed is to plants--the original source of germination. There's an important difference between germ-line genetic engineering and the somatic-cell genetic engineering that French [Anderson] is doing. Gene therapy with somatic cells is intervention--just like any other medical procedure--in the existing cells of the adult. Germ-line engineering is qualitatively, radically different. Here you go back and alter the genes in the first cell, the first cell, of the early embryo. As a result, you're changing all the genes [in the body that will develop from that embryo and that will be passed on to subsequent generations], making very profound changes that are essentially the beginnings of human design. This kind of procedure will have enormous impact.

ROBERT: Francisco, this impact gets bigger than one percent? This guy is scaring me.

FRANCISCO: OK, now I am worried. I'm much more worried right now than when we started. Listening to Greg [Stock], I understand that he goes beyond curing the disease somatically, for an individual. He wants to correct the genes in the germ line, so that future generations will not have the disease. This can protect the descendants of the people who've been cured of cardiac disease--but who decides what human beings should be? Who has the wisdom for that?

ROBERT: Can germ-line engineering be stopped? When has technology not been applied? Look at nuclear weapons--

GREG: That's not a good example.

FRANCISCO: It's a very good example, because the efforts to design new human beings, in my book, are as destructive as atomic bombs. And it's easier to stop atomic bombs.

ROBERT: To build nuclear weapons, you need a large infrastructure. But to do germ-line engineering, all you need is a small laboratory. It will be like making bootleg liquor during Prohibition. 

GREG: There's a major difference between using atomic weapons and doing genetic engineering. As long as decisions are made by the individual who's being treated--or by parents who are trying to do the best for their children--then innocent others are not at risk in the same way they would be with atomic weapons. An accident by some madman with atomic weapons can destroy vast numbers of human beings. The only way that germ-line genetic engineering--or any kind of genetic engineering--can be used broadly enough to have significant impact is if it's wholeheartedly embraced by masses of people, because they see it as being for their benefit. 

ALLAN: You're assuming a nontotalitarian society in everything you've said. You're talking about free choice as if it were a given. The history of the twentieth century says otherwise.

GREG: Any technology can be perverted by a totalitarian regime. But totalitarian regimes have at their disposal all sorts of low-tech technologies to perpetrate evils. If you look at what Hitler did with eugenics, you'll see that he did evil on a much greater scale with other technologies.

FRANCISCO: I have to say that the proposal you're making has the potential for very great evil. There are so many problems in creating human beings. Who makes the choices as to what we are going to select for? Do we get taller people, or more people with blue eyes? What about selecting for those who can make the most money?

ROBERT: Or ambidextrous people, who can pitch or fish, write or draw, with either hand?

FRANCISCO: When I raise this question, many people tell me that they would select for greater intelligence. Well, I'm not sure of that. I don't think the problems that humankind faces today will be solved by having more people of greater intelligence. In fact, the definitions of intelligence or high IQ may change in future environments. I'd rather have people who are more morally responsible or more sensitive to other people's needs. 

ROBERT: Those genes will be harder to find.

SHEP: But Francisco, we've already been told. Did you listen to that list of supposed enhancements that Robert referred to in his introduction. Every one of them was not just a positive attribute but an egotistical positive attribute. I keep thinking of the year that my daughter was about to go off to a secondary school. The headmaster sent us each a form that included the question, "Is your child a leader?" And I wrote down, "No, but she's a great follower." The answer I got back said, "Dear Dr. Nuland: This is wonderful. We have 399 leaders in the class and one follower." What's the free choice? Who will get these genetic enhancements? Think about the differences in medical care we already have in this world. When we start adding genetic enhancement, we'll magnify that problem.

ALLAN: While genomics, gene therapy, and germ-line manipulation are important to discuss, I think that some of the human qualities we're talking about are unlikely to result from genetic determination. I find it curious that society has embraced the idea that things like mysticism or morality or ambidextrousness might be genetically based rather than cultural. To hear professors proclaim that their cleverness is genetically determined--present company excepted, of course--reminds me of Max Weber's argument about Calvinism: that somehow, by proving we're among the elect--proving we have good genes--that justifies us.

ROBERT: No one here claims that genetics completely determines morality or mysticism or other such human qualities--though ambidextrousness probably does have a greater genetic component. I would think that genetics provides a predisposition--a bell-curve distribution of proclivities--over which the more powerful influences of family, culture, and society are layered. French, does this discussion concern you? The rest of us are up in the balcony kibitzing, commenting, and complaining; you're the one in the lab and the clinic helping people.

FRENCH: I first started to raise these issues about thirty years ago, when that kind of concern was considered weird--like worrying about property values on Mars. Why fret about such things? But our growing ability to practice not just gene therapy, which is good, but also gene enhancement, which is fraught with complexities, is what we're really talking about.

ROBERT: The line between practicing gene therapy and practicing gene enhancement is a thin one.

FRENCH: It won't be possible to change human beings in the next ten, fifteen, or twenty years--but fifty or a hundred years from now is quite another matter. My very strong feeling is that the only way to prevent the misuse of this technology is public education, an aroused population that understands the potential problems and won't allow the subtle encroachment of doing this-or-that little enhancement. 

ROBERT: Where would you draw the line?

FRENCH: We can't dictate what our society might want to do a hundred years from now. That society might want to take genes like we take vitamins, but that would be their business. Our duty is to go into the era of genetic engineering in as responsible a way as possible, and that is to use genetic engineering strictly for the treatment of serious disease and for no other reason. Now, what's a serious disease? What's a minor disease? What's a cultural discomfort? We'll have to deal with this spectrum of issues. But everyone can agree that there are serious diseases that cause significant suffering and premature death, and treating these diseases is the only way, I believe, that genetic engineering should be used, until we develop the higher degree of the wisdom this society needs. 

FRANCISCO: French, I agree with your limiting genetic engineering to the treatment of severe diseases. But would you allow germ-line genetic engineering to eliminate these diseases from subsequent generations?

FRENCH: That's a very good question.

ROBERT: Somatic genetic engineering changes just the genes of the individual, while germline genetic engineering changes the genes of all future generations. Somatic gene therapy cures the person without affecting the offspring. Germline gene therapy alters the future forever.

FRANCISCO: We don't know what will happen a hundred years from now, so perhaps we shouldn't make these choices now.

ROBERT: Has that ever happened? Has technology ever stood still because of possible moral problems in the future?

FRANCISCO: Oh, yes--and I hope it will in this case. I do think we can control this. 

GREG: First of all, germ-line engineering would have to become safe and reliable, which it isn't yet. No responsible person would speak about doing these things today. But let's assume that genes do matter--that there are meaningful human traits that can be altered by altering the genes. Enormous interventions are going to happen. Look at what parents do for their kids--sending them to computer camp and so forth. If you could insert an extra gene, or a cluster of genes on an artificial chromosome, safely and reliably into your child, and you could thereby virtually guarantee increasing your child's IQ by 10 points, do you think parents would not select that? 

FRANCISCO: They would; this is what worries me. At a simpler level [of social engineering], this is what's happening in China. Boys are preferred over girls, so right now among children under the age of ten there are twenty percent more boys than girls. What will happen twenty years from now, when all those boys are looking for girls to marry? We don't have the wisdom to anticipate what future societies are going to want even within the range of a single generation. We could create a catastrophe!

GREG: Absolutely. We don't have the wisdom to foresee the implications of powerful technologies like genetic engineering. Therefore one approach is to use these technologies in a tentative way at first, and make our mistakes while there are still small numbers of people involved. We should try to learn from these mistakes and gain wisdom in the process. The other approach is to think that we can figure it all out in advance--but we can never figure it all out in advance. And when the technologies become very powerful, there will always be the risk that some exuberant country is going to apply them on a broad scale and create huge problems for the world.

SHEP: Have we finally reached the point in the evolving history of science where the implications for society are so enormous that society as a whole, and not science in isolation, should be determining the directions and applications of research? Perhaps it's time that scientists by themselves should no longer be allowed to make such independent judgments.

FRENCH: I absolutely agree with that. Just look at the advances--we call them advances--over the last several years in human biology: cloning, the Human Genome Project, human genetic engineering, in-utero gene therapy. The implications for society are profound. Scientists are human beings, and human beings have their weaknesses. The only way for society to protect itself from perfectly well-meaning scientists is through institutional review boards and regulatory committees. We have to prevent the kinds of misuse that could unintentionally result from a not-well-thought-out implementation of these technologies.

ROBERT: Would you make it illegal for scientists to do proscribed research?

FRENCH: No. "Illegal" implies a law, and legislating is the worst thing you can do, because then you drive the outlawed technology underground and to other countries. Sunlight is what's needed. Public exposure. Encourage scientists to speak publicly about what they're doing. I've certainly done this many times. Let all the people look at the implications, like those of us on this panel, and point out the issues.

FRANCISCO: Let me put it in a different light. Although I do agree with you, the way I understood Shep's question was much more general. The last thing I want in this world is a society in which anyone dictates to scientists what kind of research they should be doing. Most of the major discoveries in the basic sciences would not have been mandated by committees. Consider the invention of the transistor, the laser, the discovery of the structure of DNA. Basic science has to go on its own. It's applied science that has to be regulated.

ROBERT: Is such a distinction clear?

GREG: Yes. These technologies did not become controversial because someone set out to do questionable things; certainly that's not the case with human germ-line engineering. The technologies developed for very good reasons, such as medical and pharmaceutical applications. It's easy to talk about society taking control, but who actually makes the decisions? I agree that it's the applications we have to regulate, not the basic research. 

ROBERT: If you speak with scientists privately, you may get a less gracious view. Many scientists feel that they should be the ones making the broader decisions for all sectors of society, not the other way around.

ALLAN: As educators as well as scientists, we have a responsibility to bring these debates not only to our students in the universities but also into the public domain. It's important that there be adequate coverage in the media--in programs like this one, for example--so that a larger segment of society gets involved. We need the informed, thoughtful opinions of a broader public.

SHEP: You're talking about an informed society. I'm talking about a deterministic society. I'm going to disagree with Francisco [Ayala], since I think that times have changed. The enormity of these implications means that we've gone beyond the old sciences--that something has to change dramatically. Maybe we should revolutionize the directions of research. 

ROBERT: How?

GREG: Exactly. "How?" is indeed the operative question. And I think that it's precisely because the possibilities are so profound that these technologies are inherently unregulatable. They emerge from a highly complex process that cannot be controlled. The development of technology has a dynamic of its own; we can guide it a little, but that's all.
SHEP: I'm not going to agree with that. There are institutional review boards. There was the presidential committee that decided there should be a five-year moratorium on attempting to clone a human being. These are the beginnings of society's input, and the mere fact that we don't know how to clone a human being at this moment doesn't mean that we'll never be able to.

ALLAN: But the cloning of human beings is an application, not fundamental research that opens up the potential for cloning human beings. The borderline is fuzzy. 

FRANCISCO: The kind of basic science that most of us do cannot be directed, because it springs from individual creativity. My work depends on my creative imagination and no one else's.

ROBERT: If you as a scientist think your research is important, and others decide that you should stop, you're probably going to figure out some way to circumvent the edict.

FRANCISCO: In basic science, yes. 

ALLAN: Society goes though a selection process by making financial decisions about what areas of research they think need attention and therefore funding. As scientists, we have a responsibility to make sure that the public is aware of these issues.

SHEP: Historically, scientific advance has been energized by creative imagination.

ROBERT: Historically, the most revolutionary discoveries have been made without major funding. 

ALLAN: That's certainly not true of the Human Genome Project, and I'm not sure that it's generally true. The development of the laser by Bell Labs wasn't done in someone's home shop, though perhaps Bell's management didn't appreciate its significance. It is true that major discoveries have not been predictable. 

FRANCISCO: One should distinguish between not funding research and trying to direct it. The process works best when funding is provided while facilitating the creative initiative of scientists.

ALLAN: It works for basic research. But what about, say, fertility research? That's a problem. Much fertility research has been driven underground [such as on embryonic stem cells]--as French said, because of the ban on government support. So here's a field where both the science and the application are almost completely unregulated. Millions of dollars are being spent on increasing the population, at a time when the population explosion is a serious worldwide problem. 

GREG: Who are you to tell people who are infertile that they can't spend money to try and have a child, just because you think that globally there's some problem with overpopulation?
ALLAN: We have a fundamental issue here between liberals and conservatives about what's more important, equality or freedom? For a couple to spend millions of dollars--literally, in some cases--to have a child seems to me as questionable as if they were spending the same amount of money on their own private jet plane. It's the same issue for society.

SHEP: Scientists are now starting to make money out of some of these applications and are even taking ownership in research factories. We have to put this new factor into the equation. 

ROBERT: Let's make predictions. Looking back a hundred years from now, will we think that gene therapy has been positive or negative for human history. 

FRENCH: I sincerely hope and believe that gene therapy will be a positive benefit for humanity, but we certainly have to be cautious about its gross misuse.

SHEP: What we're going to find is that the benefits of gene therapy are limited, that they will be used in conjunction with other therapies. The great revolution that's predicted and worried about won't happen. Even the narcissism of our society will prevent it from happening. 

GREG: There will be limited applications of gene therapy that will be very powerful, and it will be viewed as just another arm of medicine. But people will be even more worried than they are now about the larger implications of these technologies.

ALLAN: Society will look back at gene therapy as really powerful and clever medicine developed by scientists in the 1980s and 1990s, starting with French [Anderson]. But I'm afraid that a hundred years from now people will ask, "Why did our ancestors spend so much money doing these foolish things while they allowed the environment to degrade, while they permitted the quality of life to decline, and while they tolerated society becoming a less friendly and less enriching place?" The enrichment of IQ is not going to come from gene therapy; it's going to come only from the richness of personal experience. 

FRANCISCO: I'm much in agreement with most of what has been said. Gene therapy, on the whole, will be seen as a beneficial component of human life, because it will cure diseases in much more efficient, effective, and benevolent ways than we cure them now. Like French, I encourage the therapeutic application, not the attempt to produce better human beings. Genetic manipulation has risks that we cannot even comprehend.

ROBERT: CONCLUDING COMMENT

GENE therapy is not just remarkable--it is revolutionary. Numerous diseases will be cured when defective genes are replaced or repaired. Nothing in medicine will be as powerful or beneficial. The treatments could even be economical, reducing health care costs for all of society. But the ultimate impact of gene therapy may go beyond healing, and beyond financial efficiencies--far beyond. Somatic genetic engineering alters only the genes of the individual, while germ-line genetic engineering--the deliberate modification of the initial embryonic cell--alters the genes of future generations. Somatic gene therapy cures the individual without affecting his or her offspring. Germ-line gene therapy has the potential to alter the human species permanently. Reworking the genetic structure of our human cells may reset the evolutionary future of our human race. Human germ-line engineering will soon be easy, cheap, and safe enough to be widely available, even if illegal. Medical ethicists may speculate and postulate, but the long-term transformation is unpredictable, unknowable, and unstoppable. Appreciating the ramifications of such change--and the alert monitoring of every advance--keep us closer to truth.

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