Individualized Treatment for Human Development

How nano-bio technologies will be applied in the most beneficial ways is dependent on the underlying basis for human performance. It is very likely that most of the underlying basis is genetic in origin (Wexler 1992; Ridley 2000). While this may still be widely debated and resisted for other reasons, it will (when proven) have profound implications, and it certainly needs to be considered in any planning on new technology application in human biology. The following is an example, which will hopefully not trivialize the issue.

Many individuals greatly enjoy a variety of sporting activities. However, a vast majority of individuals who do any of these sporting activities cannot approach the capabilities of a professional player, even with all the best new technology, instruction, and personal motivation. While some might feel this unfair, most people accept it and keep it in perspective. After all, people in general usually have something they do well, even if they never develop the desired trait. Not only is this true for athletic capabilities, but this is widely observed for other capabilities such as talent in art or music. Until recently, these perceptions were not based on any real scientific evidence. Now, with the first phase of the human genome project complete and a new geomics revolution occurring, good evidence is appearing that many human performance traits do indeed have a genetic basis.

This may also hold true for human behavior (Chorney et al. 1998; Dubnau and Tully 1998). Just a few years ago psychiatrists and psychologists would have doubted the genetic basis for many of the important mental illnesses. Today, there are few diseases left that are not known to be directly or indirectly genetically based (Kamboh 1995; Corder et al. 1994). Even infectious diseases are not really an exception to this premise, as there are always individuals who have a positive genetic component that provides varying degrees of resistance to the infection (Hill 1996).

A particularly relevant example of the importance of understanding the true basis of "cause and effect" in determining technological strategy now comes from the pharmaceutical industry. The new area of phamacogenomics is now proving for one drug after another that so-called drug toxicity is really based upon individual genetic polymorphisms. Usually, for any given drug, there are always a small number of individuals for whom that drug is toxic or less effective. As the genes and pathways for drug metabolism are better understood, this drug toxicity is usually found to correlate in some fashion with single nucleotide polymorphisms (point mutations) in the affected individuals. Not too long ago, most drug companies were investing huge amounts of money looking for "safe" drugs. Today, most accept or will soon accept the fact that patient stratification (via either genotyping or phenotyping) will be necessary to determine drug toxicity.

This represents a key example of how important it is to properly identify cause and effect in relation to technology development. The pharmaceutical industry spends enormous amounts of money developing new drugs, and many potentially useful drugs are being delayed or not used because they have serious toxicity for a small number of individuals. This also presents a view of how genetic determination is misunderstood. If we were to look at just a single drug, genetic testing of potential drug recipients would seem totally unfair and appear that genetic testing is being used to exclude some individuals from a potential benefit — even though some individuals truly don't benefit from that particular drug. However, at least in the area of therapeutics, we do not have to look at too many drugs until we find that, in general, the vast majority of humans will always have one or two important drugs that are not beneficial or are harmful to them. The lesson here is that it does not do a lot of good to pump enormous amounts of money into developing technology for new drug discovery without patient stratification — and this is genetics.

We should probably expect the same scenario to develop for human performance, and also, whether we like it or not, for human behavior.

Thus, now is really the time for scientists to put this issue into proper perspective. The misconception and fears about genetic determination are so misguided that we are delaying technology that can actually help improve existence for everyone. In medical diagnostic areas, we accept without any reservations tests and assays that try to determine if we have a disease or the state of that disease. However, many people view with great concern genetic testing that is more direct and provides earlier detection. There are most certainly very important ethical issues relevant to the genetic determination. But even these are in some sense clouded by misconceptions, due to past behavior by groups who misunderstood the real meaning of genetic determination and/or intended to misuse it. It is time to correct this and gain the full benefits of our technology for everyone.

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