Lines of Defence – The Future of Medicine and Man

Until now natural selection and personal health were key factors in determining the survival of a human being faced with a threat. Diseases would appear, decimate a society or community and move on leaving the survivors to recoup and reproduce with newly evolved methods of fighting a recurrence. While societal living had a role to play in terms of affording protection, this was still secondary to the fitness of the individual. However the increasing complexity of the medicines and societal mechanisms man has been developing for his protection are changing this. We have come to the point where there is a noticeable externalisation of our lines of defence to health threats. Our defences are no longer so much within our bodies as outside. A recent article in the BBC (‘Will we all be tweaking our own genetic code?’, Karen Weintraub, 19 Sep. 11) exemplifies this shift in a discussion of the possibility of genetically targeted medicines that will help prevent diseases at their inception. Such a shift seems a natural and probably inevitable outcome of our technological advance. Indeed parts of western society are already grappling with one direct consequence of this advance –increased, and ageing, population. However there is another, increasingly relevant, aspect that arises from this conundrum of externalisation – the question of access. In all likelihood, this question will in the long-term vanish, as the now-new externalised 'natural' defence system settles down after going through its initial upheavals. However it will be worth considering the question if we wish to mitigate the pains of transition.

The question itself is not new. Though ethics in medicine and testing have undergone radical changes in recent decades, poor and under-privileged parts of the world have long been, and remain, testing grounds for new pharmaceutical drugs. It is a not-irrelevant point that several life-giving drugs have probably emerged much faster than they would have otherwise as a result of this inhumane process. How these costs and benefits may be added up, and whether at all they can/should be added up are questions that remain unanswered. However the development of genetic medicine arguably intensifies, by a great measure, the pertinence of the issue and its societal implications. An assumption I make here is that genetic medicine will need, by its very nature, to be tailored to a specific individual. In practical terms, assuming the availability of manufacturing facilities at reasonable prices, this will mean the access of every individual to a facility (and doctor) that will use his DNA sequence to determine the type of medicine he needs and manufacture it. At one level, this is a very welcome scenario – cheap, automated facilities that will not discriminate and be accessible to all. However, in nation-states where medication is privatised and socialised healthcare not available, where will the poor go for their individually-tailored medicines? For – and this is the root of the questions being asked here, the more we externalise our defence systems, the more we will depend on them for our survival. The poor of the future will be far less internally resilient to the viruses living with us today. It is likely that with individually tailored medication, we will also have individual-specific side-effects. Even in today’s relatively simplistic times, pharmaceutical corporations have been known to suppress unpleasant facts about the drugs they develop when they are put on the market. Will it be possible to come up with a free, fair and transparent way of dealing with the possible side-effects of genetic medicine? Also, there is the other, well-known thorn – the testing of such medicine. Surely genetic medicine will need far more rigorous and extensive testing than present-day drugs. Will we find suitable platforms for such testing? And finally, systems that become tighter, more complex and more dependent on centralised protection become more vulnerable to unforeseen external threats. Will this be what homosapiens, as a society, face in future?