If you want to live forever, change your skin color, or just firm up those abs from the comfort of your own couch, you might be in luck: Gene therapy is on its way--and it's coming fast.

From: Issue 103 | March 2006 | Page 88 | By: Ramez Naam

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You wouldn't think that creating old, pumped-up mice would pose much of an ethical dilemma. But University of Pennsylvania professor Lee Sweeney was invited to speak before the President's Council on Bioethics a few years ago because that's exactly what he does. The commission, created by George W. Bush to map out the moral and ethical consequences of advances in medicine and biotechnology, heard Sweeney describe his research into ways of turning back the rodents' biological clock, reversing the deterioration of muscle caused by aging and even degenerative diseases. The treatments, Sweeney explained, had all but halted, and in some cases reversed, the age-related decline in mouse muscle. Essentially, he'd given a 27-month-old mouse (age 80-plus in human years) the body of a 6-month-old.

But Sweeney is not building his buff little Mus musculus with a new drug or physical therapy. He's injecting them with genes, extra copies of the very gene that causes our own bodies to develop muscle mass. And his research points the way not only toward a possible slowing of diseases like Lou Gehrig's but to a way of giving perfectly healthy men and women bigger and stronger muscles--permanently, after just a single dose. As Sweeney puts it, one of these days you could "just take a few injections of the virus [that delivers the genes] and a month later, while you're watching television, your muscles have gotten bigger."

Designer muscles are just one potential feature of the Body 2.0, a new, customizable version of ourselves made possible by the decoding of the human genome and an evolving understanding of, and ability to manipulate, our own genetic makeup. The aftermarket options now in development are already astonishing: While Sweeney's team is working on muscle regeneration, others are looking at ways of genetically, permanently boosting red-blood-cell count (and thus aerobic endurance), creating whole-body tans (to ward off skin cancer), controlling metabolism and hunger hormones (to prevent obesity), spurring hair growth, and mimicking the effects of Viagra (on an on-demand basis). Researchers are saying that it may be possible in the next two decades to increase the body's healing power, induce it to regenerate lost limbs or organs, even to slow or halt human aging.

Obviously, such treatments could change us forever. University of Florida associate professor Sergei Zolotukhin, for example, called obesity gene therapy "the couch potato's dream." But the Body 2.0 isn't here yet. Gene therapy--which simply means altering the genes of a living person--isn't even considered safe; clinical trials have caused the deaths of at least seven people. But the writing is on the wall. More than 800 clinical gene-therapy (GT) trials have been approved so far. GT products are projected to account for $125 million in sales in 2006--primarily to researchers and universities looking for ways to apply them. By 2011, analysts expect GT products to be approved for clinical use, and the market to swell to $6.5 billion.

Style Thyself

The prospect that tailored genes might cure disease drives research around the globe, targeting illnesses as diverse as cancer, Parkinson's disease, and diabetes. At the same time, scientists are learning to make changes at more-precise locations in the human genome, with a lower risk of side effects and greater control over the genes' activity once they're inserted. Meanwhile, gene-sequencing power is increasing exponentially, speeding up the rate at which researchers can identify the functions of our 20,000 to 25,000 genes. Sequencing the first human genome cost $3 billion; today the cost has dropped to $20 million; by 2014, the goal is to pull it off for $1,000. Gradually--inevitably, it seems--we're acquiring the power to alter our genes to cause specific effects.

How will society react to this kind of power? A quick tour of your local drugstore or spam filter provides a pretty good guess. Just about anything that claims to boost vitality, roll back the aging process, increase breast size or sexual stamina, build muscle, or melt away unwanted pounds sells like crazy. In 2004, the Institute of Medicine estimated that consumers spend at least $16 billion a year on dietary supplements alone, a market with some 29,000 different (and sometimes dodgy) products.

The voracious demand is equally evident in the statistics on cosmetic surgery and newer nonsurgical procedures such as Botox injections. The number of all cosmetic procedures rose from about 2.1 million in 1997 to 11.9 million, one for every 25 people, in 2004. That's a 465% increase in seven years and a 44% rise between 2003 and 2004 alone. Nonsurgical procedures alone grew by a staggering 764% between 1997 and 2004, and 51% between 2003 and 2004. Botox treatments, the most popular of all, were performed 2.8 million times in 2004, versus 478,000 cases of the most popular surgical procedure, liposuction.

It seems safe to say that Americans are not immune to the allure of flawless skin and tight buns--and we're not too proud to pay for them. And the easier, safer, and cheaper we can get there, the more of us will line up. Gene therapy, then, with its promise of a single, transformational injection, has the blockbuster potential of a thousand Viagras.

So is the country turning into one mammoth Baywatch episode, with everyone jiggling and rippling in perfect harmony? Not necessarily. We may be famous (and widely lampooned) for our desire to stay young and look beautiful, but we also have a deep-seated urge to stand out, especially when we're in our late teens and early twenties. A 2003 Harris Poll found that 16% of American adults, and 36% of those ages 25 to 29, have at least one tattoo; and an Eastern Michigan University poll in 2003 found that about 30% of the student population had at least one body piercing (not including the ears). In other words, parents may want to look like movie stars and athletes, but their kids want to look more like MTV stars.

Designer muscles are just one potential feature of the Body 2.0, a new, customizable version of ourselves.

Well, biotech aims to please: If the revolution is turned loose, today's tongue studs and Maori warrior tattoos are going to look about as edgy as a pair of Dockers. In the course of evaluating a GT baldness cure, San Diego researcher Robert Hoffman and his colleagues developed a test using a gene for a green fluorescent protein--only to discover they'd inadvertently found a way to make human skin or hair glow under black light, a technique that could be used on a tattoo or anywhere else on a person's body, temporarily or permanently. And because the brilliant reds, blues, and yellows of tropical birds, fish, and flowers are all products of protein dyes created by genes, GT injections could one day turn your hair blue, your skin red, your eyes yellow. Most of us aren't looking to make that kind of splash, but you can be sure there's a freshman at NYU or USC who'd jump at the chance.

As a society, we'd better get used to the idea that money can buy health and beauty (even more than it can today) and that individuals can design their own appearances (even more than they can today). But there may well be even more dramatic consequences of the biotech surge. At Southern Illinois University, for example, Andrzej Bartke has genetically engineered mice that live nearly twice as long, to an average human-equivalent age of 180 years, and as old as 200. Researchers at Stanford have genetically engineered naturally occurring vaginal bacteria to protect against HIV, while other researchers have found a rare mutation in the CCR5 gene that grants near immunity to HIV to around 1% of humans descended from Northern Europeans. Pathologist Ellen Heber-Katz is working to identify the gene that gives a rare breed of mouse the ability to regenerate from wounds--including injuries to heart muscle--no other mammal can survive. And others are looking at the genes that affect our minds: At Princeton, Joe Tsien created a breed of mouse that can learn twice as quickly.

As the formation of the president's bioethics council suggests, these sorts of changes will bring up myriad questions about policy and ethics: Who should have access to these technologies? Should insurance cover them? What are the social costs and benefits if people live 50 or 100 years longer than they do today?

Such a world might also evoke more visceral reactions. Entirely new sorts of prejudice, even hostility, may emerge in us, based on a rejection of the humanity of people who can do things no previous human could--or, conversely, on a rejection of the "unenhanced" as somehow inferior. The very shape and structure of society could change, with the rich growing older and older (beautifully and, perhaps, gracefully), while those with fewer resources remain subject to the same implacable biological truths they face now. Life expectancy could become increasingly tied to economic class.

Gene therapy to slow aging could save hundreds of billions in medical costs as well as the pain and suffering of an extended illness.

At the same time, the benefits to society of these technologies are not to be underestimated. Animals whose life spans have been genetically lengthened tend to live long, healthy lives and die without a protracted struggle. If the same is true in humans, gene therapy to slow aging could save hundreds of billions in medical costs as well as the pain and suffering of an extended illness. Greater longevity could also enrich society as scientists, artists, and professionals are given more time to learn, create, and build. And GT that boosts mental performance could increase economic productivity, leading to further scientific discoveries, better products, and more effective medicines.

Even so, a backlash against these technologies, and a political battle over their control, are inevitable results of this kind of transformation. The subtext of the bioethics hearings is that ethical people need to say no to the temptations of technology lest they be enticed into a new, nonhuman state. Just as President Bush's administration acted to restrict funding for stem-cell research in the United States, only to be partially rebuffed by California, we can expect plenty of wrangling over genetic technologies.

Legalize It

Trying to stop people from using products they clearly want is a pretty dubious exercise, however. Prohibition would simply create a black market, raising prices, eliminating effective regulatory oversight, and hindering long-term safety studies. As Steven Hyman, former director of the National Institute of Mental Health, has said, "Regulation that flies in the face of reality . . . decreases respect for regulation, and fails."

We're right to be cautious of new biological technologies until they've proven themselves, of course. Artificial limbs, pacemakers, birth-control pills, organ transplants, in vitro fertilization, even vaccinations--all took time to be accepted. But once they're proven to be safe, and to reduce pain, increase health and well-being, or just make climbing into a bathing suit a happier experience, we come to see them merely as products, weighing the costs and benefits accordingly. And, as Hyman says, if "we can find medications that will enhance our performance, lengthen our life, decrease the stress," then "no regulation in the world" will keep us from getting at them.

Ramez Naam is the author of More Than Human (Broadway Books, 2005). He helped lead the development of Outlook and Internet Explorer for Microsoft, where he is director of program management at MSN Search.

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