Hamburg (dpa) – Genetic testing, genetically modified drugs and medicines that repair gene defects are already an established part of medicine, even if genetic intervention is still in its early stages.
Medics are placing great hopes in genetic technology, but others fear ethical and legal encroachments on human rights and say these issues have not yet been sorted out.
Nearly 70 licensed medicines in Germany already originate from genetic organisms, according to the VFA, the German association of drug manufacturers involved in research. They include insulin for diabetics, inoculations against hepatitis, and erythropoietin, which is taken for anaemia and as a performance-enhancing drug in sports.
Genetic medicines totalled 1.8 billion marks (820 million dollars) in sales in Germany in 1999 – only a 3.5-per-cent share of the market, but double the turnover of three years ago.
Medics believe genetic tests offer exciting possibilities, even if there is still a big gap between diagnosis and treatment.
If people have knowledge of genetic problems or weaknesses, they can adjust their lives to remain healthy, said Professor Karsten Held, an expert in human genetics and chairman of the Ethics Commission of the Hamburg general medical council.
For example, a young woman who discovers she has a genetic predisposition toward thrombosis would know she has a five times as high as normal risk of the illness, he said. She would know that if she took the contraceptive pill that risk would be 35 times higher, and if she smoked it would increase still further.
Similarly, if doctors knew a patient carried the gene for hereditary colonic
cancer, they would be able to advise regular cancer tests from the age
of 10 to ensure early detection and treatment of a possible cancer.
If genetic tests on a pregnant woman reveal that her unborn baby has the
haemophilia gene, she could choose a maternity clinic specialising in this
problem. Unborn girls carrying the gene for adrenogenital syndrome can
be treated in the womb with medication to prevent the masculinization of
the sexual organs.
But Professor Wolfgang Engel, of the Institute of Human Genetics at Goettingen
University, Germany, nevertheless fears antenatal genetic tests could also
pose a danger to society.
“The danger exists that being born disabled is no longer allowed as an
alternative to health, and the individual family are no longer able to
decide whether they wants an ill child or not.”
Professor Held believes genetic diagnosis in adults raises the prospect
of patients being tested without their knowledge.
“The greatest danger is of thoughtless diagnosis and lack of information
for patients.” The legal consequences of genetic tests in Germany have
not yet been sorted out, he said.
“I do not know of a case of someone being refused a job as the result of
a genetic test,” said Professor Gerhard Wolff of Freiburg University. But
many professions such as the police force or air traffic control already
refuse employment to people purely because of physical differences.
People should not be denied certain jobs or insurances simply on grounds
of their predisposition to certain genetic illnesses, he said.
Professor Engel said individuals must retain the right to refuse a genetic
test. “He must not be refused insurance or jobs for that reason,” he said.
But doctors place great hopes in tailor-made medicines in future.
“When you are prescribed a medicine from a doctor today, there is a 20
per cent chance that it does not work or has serious side effects,” said
Professor Held.
This is not because it was a bad medicine, but because it was not specific
enough. One patient might metabolizen it too quickly, another not at all
and suffer side effects.
At the end of August a new medicine called herceptin to fight breast cancer in women was licensed by the EU. It is aimed at a specific gene and is only effective in 30 per cent of breast cancer patients.
It is not a tailor-made drug, but a test for this specific gene defect is obligatory.
