AIDS and Cloning Research

[Guest guest]

Dear Forum subscribers,

A piece in the New York Times Sunday magazine(Friday the 10th of

August, 2001) re the recent cloning debate (or lack of it) in the

US. By Dr. Abraham Verghese

A few months ago I visited an AIDS organization called the Freedom

Foundation on the outskirts of Bangalore in South India. The

whitewashed buildings, once part of a chicken farm, had been

converted into a haven for people with HIV infection. By scrambling,

begging and cajoling, the volunteer staff managed to get anti-

retroviral drugs for every child there with HIV infection. So much

was being done with so little, and yet with smiles, with grace and

courage.

For the adult patients the future did not look bright. Though some

looked well, others were wasting away from unchecked HIV infection.

Had they been able to afford the medications, or for that matter, had

they been citizens of the U.S. and patients at my county hospital in

El Paso, Texas, I felt that in no time they would have had flesh on

their bones, the strength to sit up and the prospect of a future.

The patients at the Freedom Foundation and their caregivers could

only look to the horizon and hope that someday, in some research lab,

a scientific breakthrough would result in a novel means of attacking

HIV, something both effective and affordable. If this were to happen —

whether vaccine or drug -- the odds are great that it would come

from an American research lab. The United States has not only been at

the forefront of AIDS research, it has become the de facto biomedical

research wing of our planet, the R & D arm of all nations. All over the

world parents of children with AIDS, with diabetes, with cerebral

palsy and so many other diseases dream of a breakthrough that might

change their child's future—it is to the U.S. that they look for such

a miracle. Quaint as the image might be of a researcher in the field

with a pith helmet, a microscope and a pipette making a Nobel Prize

winning discovery, those days are largely over. Tackling the tough

questions of basic science require well trained scientists,

supercomputers, cell-sorters, and the sophisticated and expensive

tools of molecular biology, not to mention huge amounts of money.

How surprising and embarrassing then that we might be slamming the

door on cloning human embryonic cells (which is what the House of

Representatives voted to do); even stem cell research using the cells

from left-over embryos in fertility clinics may be in jeopardy.

Potential scientific advances that might reverse the course of

Parkinson's disease or diabetes will remain unexplored, at least in

America. The ruling by Congress, in its abruptness and its finality

and the magnitude of its penalties for those who dare oppose it,

contradicts our reputation as a nation committed to excellence in

medicine and research. Indeed the ruling made me think of the Taliban

and their draconian edicts: no sorting out of details, no

distinctions, meaningful debate drowned out by fundamentalist

rhetoric, and then an a priori proclamation of what the truth is,

followed by the order — destroy the Buddhas.

Let me make clear, I am a clinician, not a bench researcher. The

moral and ethical concerns about cloning and stem cell research do

not escape me. Far from it, I know how easy it is to slide down the

slippery slope of abusing technology: amniocentesis and ultrasound

technology in some parts of India are used largely to find and abort

female babies. Still, on the continuum between benefits and risks,

was there not a place where we could have allowed narrowly targeted

scientific research by proven investigators to proceed? No human

versions of Dolly the sheep, thank you very much, but why not a

limited exploration of the potential of these cells to reverse life-

threatening diseases? America, the beautiful, the brave—where is our

courage? The world with good reason expects better of us. Move the

Taliban a notch or two down on the moral ladder and they resemble us

more than we would like to admit.

This is the paradox that I find most curious: we are at once a

sophisticated nation living through an explosion of scientific and

technological advances, and yet at the same time we can display a

surprising backwardness. My patients often know more about their

disease from the Internet than I do. Vicariously, through TV and the

print media we have peeked into bedrooms, operating rooms, boardrooms

and courtrooms and traveled all over the planet. But even though we

live in the era of the new, new thing, the cloning dialogue has never

risen to that level of sophistication. This is what my friends abroad

find most surprising about us: moxy on the one hand (we'll build a

missile shield without any proof that we can) and a puritanical

tendency to retreat to a shaky moral high ground on the other.

In my HIV clinic in Texas last week I saw a young woman—a physician--

who was failing her treatment regimen; the virus she harbored had

learned how to resist the drugs I had her on for the last year. But I

had in my hands the results of a genotype test, a test where her

particular viral strain had been probed to see if it had the gene

patterns that predicted resistance to other drugs, drugs that we had

not as yet used on her. " Wow, " an intern working with me said as he

looked at the genes of her virus listed on a printout that looked

like a felon's rap sheet, " I didn't know we could do this. " Yes, son,

fortunately we can. The ethical debate when it came to gene splicing

and recombinant DNA and cloning genes did not shut down those

techniques.

Whether stem cell and embryonal research can actually live up to

scientists' expectations remains to be seen. But the possibility of

bringing relief to those who are suffering is simply too precious to

pass by. To turn our backs on such research robs patients with

incurable disease of the one thing they cling to--hope.

Osler, the great man of American medicine (who died prematurely in

1919 of a lung infection for which we now have a slew of antibiotics)

said in a statement that has been taught to generations of medical

students, " it is not for you to don the black cap and assuming the

judicial function, take hope away from any patient . . . hope that

comes to us all. "

____________________________

Abraham Verghese is the Grover E. Murray Distinguished Professor of

Medicine at Texas Tech University. His most recent book is " The

Tennis Partner "

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