Power, Profit, Poverty, and Access

POWER, PROFIT, POVERTY, AND ACCESS

Morality is a private and costly luxury.

Henry B. Adams, 1838–1918

Many of the questions raised by modern biology and genetic engineering are well worn in other arenas. Who should control technology? What should be banned or permitted and who should decide? Who should profit? Should access to novel and expensive technology be provided to those who cannot afford it? If so, who should pay, the government or private individuals? A related issue is that of access to technology for those who live in poor Third World nations. The answers to these questions differ according to personal beliefs and cultural outlook. In any case, they are neither novel nor restricted to biology, let alone biotechnology, and we will make no attempt to answer them here.

Over the past half century, the gap between the rich and poor has widened. This is true both between the industrial nations and the Third World and, more recently, within the industrial nations themselves. This is partly due to advancing technology. Mechanization has made unskilled human labor less necessary. For example, less than 5% of the population is needed togrow food for everyone in the advanced nations (compared to some 90% in medieval times). Automation has also reduced the number of people needed to produce industrial goods. Consequently, a significant proportion of the population has increasing difficulty finding worthwhile employment. Whether biotechnology will merely add to the prevailing trend toward automation or whether it will alleviate some of the problems of poverty is still unclear.

Many clinical procedures involving novel technology are expensive and are beyond the reach of the poor. This is the old question of the distribution of wealth, in a technological guise, and has no special link to genetic engineering. The rich have always had greater access to expensive health care, whether drugs, surgery, or simply high-quality nursing. For example, treatment with botulinum toxin (Botox) is now used to remove wrinkles from the skin of theold and ugly ( Fig. 25.1 )—provided they can afford it. Botox injections cost from $300 to $500 (more than a month’s wages in many Third World nations) and the results last for about5 months. More than 1.6 million people received injections in 2001. Botulinum toxin type Ais a protein toxin made by the bacterium Clostridium botulinum, which causes food poisoning.The toxin blocks the release of the neurotransmitter acetylcholine by nerve cells that controlmuscle contraction; hence its use in very low amounts to inhibit the muscle contraction responsible for wrinkles and frown lines.Those who discuss the social aspects of gene therapy and other new technology often mention the question of access by Third World nations. When millions die every year frommalaria, tuberculosis, and AIDS, there is little point in discussing the benefits of expensive high technology. Most inhabitants of Third World nations cannot afford basic anti malarial drugs, let alone AIDS cocktails. Many do not even have pure drinking water. Some scientific advances may indeed benefit the poor nations. Mass immunization against infections with cheaper, more effective vaccines is an example. Transgenic crops able to grow in poor soils and give higher yields without fertilizers may also help. Huge strides in traditional plant breeding increased crop yields drastically between the 1940s and 1980s (the so-called Green Revolution). But merely saving lives from starvation causes population expansion. This,  inturn, causes overcrowding, thus promoting the spread of infections. Unless the world can control its population, we will merely enter a futile spiral of trading one problem for another.