Digital Matters - Issue 29

But everything else in the health-care industry will change. The genetic code of every patient will be known, and it will be digitally imprinted on his or her genetic-identification card. That card will spit out reams of data regarding the patient's genetic predisposition toward certain diseases and illnesses, and that information will enable the patient to know well in advance that he or she is at risk for breast cancer, alcoholism, high blood pressure, or heart disease. And genomics-based medical specialists will use that information to prescribe a program of preventive medicine to keep such diseases at bay. In the near future, health care will be organized around genomics-based preventive medicine.

All of which raises enormous moral and political questions. But for the moment, let's keep following this trail. Think about the impact that genomics will have on the insurance business, which most people believe drives the health-care business. The insurance business is all about math: actuarial tables, probability studies -- all combining to set a price on a policy that gives you "coverage." With genomics, that kind of math becomes irrelevant. It doesn't matter if you're 45 or 55; what matters is your genetic makeup. In the future, coverage decisions will be based on your genetic code.

That, too, raises enormous political and moral questions -- but the trail continues. Consider the pharmaceuticals business. Not long ago, the big idea that was supposed to change the industry was the development of generic drugs. Genomics-based medicine will turn that idea upside down: Pharmaceutical products will be designer drugs, targeted to individual genetic codes and prescribed to fight diseases for which people are specifically at risk.

These designer drugs will overturn the drug-approval process. Today, pharmaceuticals companies spend hundreds of millions of dollars on drug development. Once a drug has been developed, it is tested on a sample population. If the drug proves safe and effective for most people in the sample population, and if the potential benefits outweigh the risks, then the FDA approves it. Otherwise, the FDA rejects it. But just because a drug doesn't work for one person, or because it makes 10 other people feel nauseated, that doesn't mean that it isn't the right drug for you or me. The use of genomics to prescribe medication will mean that drugs can be genetically targeted to "fit" individual patients. As a result, pharmaceuticals companies around the world will be able to recoup billions of dollars' worth of drug research. Which is why so many pharmaceuticals companies are becoming "life sciences" companies.

Follow the string: If you can design pharmaceuticals for individual patients, it stands to reason that genomics will soon usher in genetically engineered agricultural products that can double as pharmaceuticals. If you know that you have a genetic predisposition toward stroke, you'll be able to buy and eat agriceutical broccoli or spinach -- which, over time, will lower your blood pressure.

All of this affects perhaps one-fourth of the U.S. GDP -- and it's just one exit ramp off the road of genomic knowledge. Remember the bigger picture: By understanding, re-creating, and modifying the instructions that make life, humans will soon be able to influence -- directly and deliberately -- their own evolution and that of other species. Think about what that means. Think about the moral issues that it entails. And recognize that there is no turning back.

There is no turning back for three reasons. First, as a matter of national security, sequencing and decoding the human genome is as important as the Manhattan Project was during World War II. Biological warfare has become a terrifying threat. As Enriquez writes, "Gene technology is creating nightmares for military officials throughout the world. . . . As bioweapons become stable, easy to disperse, and have specific and limited time effects, some nations may be tempted to develop them as strategic weapons. Technology is increasing their military value, particularly since they can be dispersed quietly and are hard to trace. . . . If gene research can target medicines to particular individuals, it can also target weapons. Conceivably, specific ethnic groups could become targets."

The only antidote to this national-security nightmare is genomics research. As Enriquez argues, "Non-military genetic research will provide critical insights into how to prevent and cure deadly threats. . . . George Vande Wounde, of the National Cancer Institute, has, in the course of unrelated research, found the key to anthrax' toxicity. This could eliminate any threat from these [biological] weapons."

The second reason why genomics will become a central fact of modern life is more mundane: money. Genomics makes possible the extraordinary creation of wealth. The information-technology revolution created vast pools of wealth in a very short period of time. Genomics will create the same kind of wealth in even less time.