_NEWS
Biotechnology and development Problem: FWr every person in the north one the south is close to starvation, and the human population is expected to double in the next 40 years. Population control is impossible in the short term, and the escalating global food shortage cannot be solved by further improvements in conventional farming methods. Solution? Biotechnology-finding new genes that increase resistance of the crops to pests, weeds, and disease and enable them to thrive in harsh conditions. Problem: Infections and parasitic diseases cause incalculable morbidity and "silent genocide" of children in the south; malaria kills 1-5 million people a year, measles 2 million, and tuberculosis and hepatitis B each close to a million. Solution: Biotechnology can't do it all but it does hold tremendous promise of new and improved vaccines, diagnostic kits, and drugs. Biotechnology also has the potential to revolutionise farming of livestock (creating superbreeds and eliminating infection from herds), the fishing industry, and disposal of waste. There is even the prospect of replenishing the world's vanishing rain forests by cloning old, highly productive trees. No wonder biotechnology is regarded by some as the secular answer to man's salvation. But there is a down side, and this, together with a detailed appraisal of its huge potential, is set out in a report by Robert Walgate published this week by the Panos Institute, which provides independent information on environment and development issues. The down side has two main components. Firstly, the release, intentional or otherwise, person in
New vaccines -
Bacteria
Viruses
Infiveyears Haemophilus Influenza A and B Hepatitis A influenzae B Streptococcus pneumoniae Neisseria meningitidis Salmonella typhi Vibrio cholerae
Herpes simplex Parainfluenza Rabies Respiratory syncytial virus Rotavirus
In 10years HIV Mycobacterium leprae Japanese B Streptococcus groups encephalitis A and B
Escherichia coli
BMJ
VOLUME 301
21 JULY 1990
(A
0. z
dt cn
Nezv vaccines or more pain from biotechnology?
of genetically altered organisms, be they animals, plants, insects, or microbes, poses risks that are unpredictable. This concern is shared by scientists, ecologists, and environmentalists world wide, who, while not condemning biotechnology and genetic engineering out of hand, are currently urging extreme caution-especially over the release of new organisms into the environment. Secondly, most of the know how and raw materials of advanced biotechnology, par. ticularly genetic engineering, is in the hands of large private international companies. It is therefore questionable whether the priorities for research, which undoubtedly lie in improving the lot of those in the south, can be reconciled with the companies' overriding concern with profits. Past experience is not encouraging, and the problem is compounded by the growing number of legal wrangles over patent ownership. Walgate refers to the Chinese government granting exclusive rights to two American seed companies for a new hybrid rice variety capable of increasing rice production by up to a quarter. Ironically, this variety has not found favour with the American housewife, but because these companies own the patent rights the technology is being withheld from developing countries. Accidental or deliberate introduction of animals or plants from one continent to another has been disastrous on occasions, hence the strict quarantine regulations governing the movement of plants and animals that are enforced by most countries. Many have or are now seeking to enforce equally strict laws on containing genetically modified organisms in laboratories and
industrial plants and releasing them into the environment. Whether national and international draconian legislation is desirable or enforceable is the subject of hot debate. Biotechnology enthusiasts argue that in many industries-the brewing industry, for example-genetic modification techniques are merely a continuation of a selective tampering that has been going on for centuries. The introduction of one or two genes into a plant, animal, or microbe is unlikely to produce anything potentially dangerous. The enthusiasts argue that legislative red tape will limit the speed at which biotechnology can solve some of the world's most pressing problems. Sceptics, on the other hand, argue that no genetically engineered organism can be considered ecologically neutral and that careful assessment of every research proposal is essential. Meanwhile, releases of genetically modified organisms are becoming more common, particularly in France, where, unlike in the United States or Britain, the "environmentalists' foothold" is small. Public opinion will be important in shaping forthcoming legislation. People are becoming increasingly well informed about biotechnology and after Chernobyl and Bhopal have scant faith in paternalistic experts. Open, unbiased, investigative reports of new developments together with lay representation on national and international watchdog committees are widely held to be essential. -TESSA RICHARDS Miracle or Menace? Biotechnology and the Third World is available from the Panos Institute, 9. White Lion Street, London Ni 9PD.
137
high risk groups or having partners who do? The. American experience, usually regarded as being several years ahead of Britain's, is not much help in predicting what is likely to happen. Firstly, the Centers for Disease The Press Council has censured the Sun Control, Atlanta, does not publish separate newspaper for its coverage of the risks of results for this category (it subsumes cases developing AIDS from heterosexual interamong "others and indeterminate"). And, the council, the Sun's According secondly, intravenous drug misusers in headline "Straight AIDS' England and Wales do not seem to be acting give -official" "gross distortion" of as the "bridge" between those already statistical information, and editorial with infected with HIV and the rest of the populasimilar message "irresponsible." The tion as they do in North America (and theme of the editorial ("Forget the idea that Scotland and continental Europe). heterosexual AIDS and
"ordinary heterosexual people"
to
course.
sex cannot
was
you
a
an
a
was
ordinary AIDS")
people can next day by
taken up
was
doctor, Dr Vernon Coleman, in headed "AIDS
the hoax of the
which he claimed that AIDS
major threat
the Sun column
a
century," was
in
never
a
heterosexuals.
to
the Sun admitted
As
contract
it
last week,
wrong: WHO believes that 60% of all
was
global
HIV infections have resulted from hetero-
knowing this does not the question for its readers: What are the risks of acquiring AIDS from unprotected heterosexual intercourse in sexual intercourse. But
help
the Sun
to answer
this country with
belong
to a
The information
its claims
partner who does
a
not
recognised high risk group? on
from
came
a
which the Sun based
parliamentary
answer.
It stated that other than those in the acknow-
ledged high risk categories or whose partners were in these categories two women and six men in the United Kingdom with AIDS had acquired HIV infection through heterosexual intercourse up until 30 June 1989. Both women reported multiple contacts with men from abroad, and five of the six men reported contacts with prostitutes. Since then the number of in
this
to
2 1.
category This
has
equals
of AIDS
more
the
cases
of AIDS
than
doubled
total
of
number
that had been
reported in United Kingdom by September 1983
cases
the
-which
past
has
seven
occur
increased
years.
Will
160-fold the
over
among heterosexuals not
the
increase
same
belonging
C~~~or gJ)~~~~~ b~~
to
Predictions made of the numbers of cases of AIDS in England and Wales in the next few years have already been more than halved between 1988 and January this year (10 February, p 352) and seem likely to be further reduced. So what are the risks of AIDS among heterosexuals who aren't "homosexuals, bisexuals, junkies or [recipients of] a tainted blood transfusion," to borrow the Sun's description? According to government epidemiologists, the risks won't be known until the completion of a few years of anonymAous testing for HIV- 1993 at the earliest. * The World Health Organisation has designated 1 December World AIDS day with the theme of "AIDS and women." At the Department of Health's request Margaret Jay, director of the National AIDS Trust, is forming a group to coordinate the British response. (Details from Julian Meldrum at the trust, Room 1403 Euston Tower, 286 Euston Road, London NWI
3DN.)
After
years' analysis the Standing Advisory Comm-ittee has recom-
two
Medical
mended that the
TONY DELAMOTHE
effective method
most cost
of cholesterol
testing is for doctors to screen opportunistically. A system of calling in whole target populations for screening would not
merit the
extra
expense, while selective
testing of those at high. risk would be insufficiently effective. The comimittee recommends that doctors set up an opportunistic programme in which they identify patients with risk factors for coronary heart disease
give priority to testing highest overall risk.
and then the
Although the committee government
it
emphasises
are
look
to
at
was
support
to
national
a
to eat a
efforts
to
by the screening,
policy
give
intensive
to
persuade
healthier diet and increase its
smoking.
reduce
screening to
measures
cholesterol concentrations cannot
The committee
cholesterol
that
population wide tary and
asked
that its first recommendations
people
considers
those with
cholesterol
that the government should
be
are
regarded
as
and
reduce blood
"complemenalternatives."
Much of the committee's report consists of
analysis,
economic
screening 69 would
and it estimates that
programme among those cost
about £271m
for each QALY
a
aged
a
40-
year and £-2979
(quality adjusted life year)
or
£3128 for each year of life saved. The programme would
* The World Congress on AIDS, fo'cusing on topics relevant to Third World countries, runs from 7-9 December in Bombay, India. (Details from Dr Ghanshyam V Bhimani, chairman of the organising committee, 1/F, Tulsi Bhuvan, Block 1, 23 Bhulabhai Desai Road, Bombay 400 026; tel 91 22 8519020; telex 11-75656 mKAY IN; fax 91 22 356957.)-
and compares
save
about 8000 lives
favourably
with
cervical cancer, which may lives
a
year and costs
which will
save
a
a
year
screening
save
for
about 1000
£4100-6900 for each
QALY, and screening for breast few hundred lives
cancer, a
year
until the year 2000 and 1500 lives thereafter at a cost
for each
QALY of
About 90% of the the
..1
cost
£:4100-6900.
of the programme
committee recommends is the
cost
of
A.........rs4JwI 0RC Men
Hnomosexualorbiexa Iuravenousru~~g.misuser Hotsana n dug mnssr
Expert committee wants opportunistic cholesterol screening
Women
'Total.
4e0
(n=280) (n153) (n=3433) (n=1869) 2734 2-734 1481, 90 50.
27.
117 50
* Pavu(s w*
5 24
KO SSO
R' iiet f blood:
cad fleteroisexua: 'Pwuarm (s) with.abxverinsk fct "M" With known exposuo abroad Withf no etvidencfe ofexow abioad-1 Child ofatri'sk orinfocted paret
24 9 ~~~~~~~~~~~~15 18
9
14 10
Othe, orudtepInd41 Prepared from direct vokutary cefi&detil reot
20
29
15
4
151
70
0 15. 6
2 25.
15
yclinciast h
4729 I
uares
I1989
'-99
Communicable, Disease Survillanc Cmre (081I 200 6868) and. the' Comuial
Disieises
Biotechnology and development Problem: FWr every person in the north one the south is close to starvation, and the human population is expected to double in the next 40 years. Population control is impossible in the short term, and the escalating global food shortage cannot be solved by further improvements in conventional farming methods. Solution? Biotechnology-finding new genes that increase resistance of the crops to pests, weeds, and disease and enable them to thrive in harsh conditions. Problem: Infections and parasitic diseases cause incalculable morbidity and "silent genocide" of children in the south; malaria kills 1-5 million people a year, measles 2 million, and tuberculosis and hepatitis B each close to a million. Solution: Biotechnology can't do it all but it does hold tremendous promise of new and improved vaccines, diagnostic kits, and drugs. Biotechnology also has the potential to revolutionise farming of livestock (creating superbreeds and eliminating infection from herds), the fishing industry, and disposal of waste. There is even the prospect of replenishing the world's vanishing rain forests by cloning old, highly productive trees. No wonder biotechnology is regarded by some as the secular answer to man's salvation. But there is a down side, and this, together with a detailed appraisal of its huge potential, is set out in a report by Robert Walgate published this week by the Panos Institute, which provides independent information on environment and development issues. The down side has two main components. Firstly, the release, intentional or otherwise, person in
New vaccines -
Bacteria
Viruses
Infiveyears Haemophilus Influenza A and B Hepatitis A influenzae B Streptococcus pneumoniae Neisseria meningitidis Salmonella typhi Vibrio cholerae
Herpes simplex Parainfluenza Rabies Respiratory syncytial virus Rotavirus
In 10years HIV Mycobacterium leprae Japanese B Streptococcus groups encephalitis A and B
Escherichia coli
BMJ
VOLUME 301
21 JULY 1990
(A
0. z
dt cn
Nezv vaccines or more pain from biotechnology?
of genetically altered organisms, be they animals, plants, insects, or microbes, poses risks that are unpredictable. This concern is shared by scientists, ecologists, and environmentalists world wide, who, while not condemning biotechnology and genetic engineering out of hand, are currently urging extreme caution-especially over the release of new organisms into the environment. Secondly, most of the know how and raw materials of advanced biotechnology, par. ticularly genetic engineering, is in the hands of large private international companies. It is therefore questionable whether the priorities for research, which undoubtedly lie in improving the lot of those in the south, can be reconciled with the companies' overriding concern with profits. Past experience is not encouraging, and the problem is compounded by the growing number of legal wrangles over patent ownership. Walgate refers to the Chinese government granting exclusive rights to two American seed companies for a new hybrid rice variety capable of increasing rice production by up to a quarter. Ironically, this variety has not found favour with the American housewife, but because these companies own the patent rights the technology is being withheld from developing countries. Accidental or deliberate introduction of animals or plants from one continent to another has been disastrous on occasions, hence the strict quarantine regulations governing the movement of plants and animals that are enforced by most countries. Many have or are now seeking to enforce equally strict laws on containing genetically modified organisms in laboratories and
industrial plants and releasing them into the environment. Whether national and international draconian legislation is desirable or enforceable is the subject of hot debate. Biotechnology enthusiasts argue that in many industries-the brewing industry, for example-genetic modification techniques are merely a continuation of a selective tampering that has been going on for centuries. The introduction of one or two genes into a plant, animal, or microbe is unlikely to produce anything potentially dangerous. The enthusiasts argue that legislative red tape will limit the speed at which biotechnology can solve some of the world's most pressing problems. Sceptics, on the other hand, argue that no genetically engineered organism can be considered ecologically neutral and that careful assessment of every research proposal is essential. Meanwhile, releases of genetically modified organisms are becoming more common, particularly in France, where, unlike in the United States or Britain, the "environmentalists' foothold" is small. Public opinion will be important in shaping forthcoming legislation. People are becoming increasingly well informed about biotechnology and after Chernobyl and Bhopal have scant faith in paternalistic experts. Open, unbiased, investigative reports of new developments together with lay representation on national and international watchdog committees are widely held to be essential. -TESSA RICHARDS Miracle or Menace? Biotechnology and the Third World is available from the Panos Institute, 9. White Lion Street, London Ni 9PD.
137
high risk groups or having partners who do? The. American experience, usually regarded as being several years ahead of Britain's, is not much help in predicting what is likely to happen. Firstly, the Centers for Disease The Press Council has censured the Sun Control, Atlanta, does not publish separate newspaper for its coverage of the risks of results for this category (it subsumes cases developing AIDS from heterosexual interamong "others and indeterminate"). And, the council, the Sun's According secondly, intravenous drug misusers in headline "Straight AIDS' England and Wales do not seem to be acting give -official" "gross distortion" of as the "bridge" between those already statistical information, and editorial with infected with HIV and the rest of the populasimilar message "irresponsible." The tion as they do in North America (and theme of the editorial ("Forget the idea that Scotland and continental Europe). heterosexual AIDS and
"ordinary heterosexual people"
to
course.
sex cannot
was
you
a
an
a
was
ordinary AIDS")
people can next day by
taken up
was
doctor, Dr Vernon Coleman, in headed "AIDS
the hoax of the
which he claimed that AIDS
major threat
the Sun column
a
century," was
in
never
a
heterosexuals.
to
the Sun admitted
As
contract
it
last week,
wrong: WHO believes that 60% of all
was
global
HIV infections have resulted from hetero-
knowing this does not the question for its readers: What are the risks of acquiring AIDS from unprotected heterosexual intercourse in sexual intercourse. But
help
the Sun
to answer
this country with
belong
to a
The information
its claims
partner who does
a
not
recognised high risk group? on
from
came
a
which the Sun based
parliamentary
answer.
It stated that other than those in the acknow-
ledged high risk categories or whose partners were in these categories two women and six men in the United Kingdom with AIDS had acquired HIV infection through heterosexual intercourse up until 30 June 1989. Both women reported multiple contacts with men from abroad, and five of the six men reported contacts with prostitutes. Since then the number of in
this
to
2 1.
category This
has
equals
of AIDS
more
the
cases
of AIDS
than
doubled
total
of
number
that had been
reported in United Kingdom by September 1983
cases
the
-which
past
has
seven
occur
increased
years.
Will
160-fold the
over
among heterosexuals not
the
increase
same
belonging
C~~~or gJ)~~~~~ b~~
to
Predictions made of the numbers of cases of AIDS in England and Wales in the next few years have already been more than halved between 1988 and January this year (10 February, p 352) and seem likely to be further reduced. So what are the risks of AIDS among heterosexuals who aren't "homosexuals, bisexuals, junkies or [recipients of] a tainted blood transfusion," to borrow the Sun's description? According to government epidemiologists, the risks won't be known until the completion of a few years of anonymAous testing for HIV- 1993 at the earliest. * The World Health Organisation has designated 1 December World AIDS day with the theme of "AIDS and women." At the Department of Health's request Margaret Jay, director of the National AIDS Trust, is forming a group to coordinate the British response. (Details from Julian Meldrum at the trust, Room 1403 Euston Tower, 286 Euston Road, London NWI
3DN.)
After
years' analysis the Standing Advisory Comm-ittee has recom-
two
Medical
mended that the
TONY DELAMOTHE
effective method
most cost
of cholesterol
testing is for doctors to screen opportunistically. A system of calling in whole target populations for screening would not
merit the
extra
expense, while selective
testing of those at high. risk would be insufficiently effective. The comimittee recommends that doctors set up an opportunistic programme in which they identify patients with risk factors for coronary heart disease
give priority to testing highest overall risk.
and then the
Although the committee government
it
emphasises
are
look
to
at
was
support
to
national
a
to eat a
efforts
to
by the screening,
policy
give
intensive
to
persuade
healthier diet and increase its
smoking.
reduce
screening to
measures
cholesterol concentrations cannot
The committee
cholesterol
that
population wide tary and
asked
that its first recommendations
people
considers
those with
cholesterol
that the government should
be
are
regarded
as
and
reduce blood
"complemenalternatives."
Much of the committee's report consists of
analysis,
economic
screening 69 would
and it estimates that
programme among those cost
about £271m
for each QALY
a
aged
a
40-
year and £-2979
(quality adjusted life year)
or
£3128 for each year of life saved. The programme would
* The World Congress on AIDS, fo'cusing on topics relevant to Third World countries, runs from 7-9 December in Bombay, India. (Details from Dr Ghanshyam V Bhimani, chairman of the organising committee, 1/F, Tulsi Bhuvan, Block 1, 23 Bhulabhai Desai Road, Bombay 400 026; tel 91 22 8519020; telex 11-75656 mKAY IN; fax 91 22 356957.)-
and compares
save
about 8000 lives
favourably
with
cervical cancer, which may lives
a
year and costs
which will
save
a
a
year
screening
save
for
about 1000
£4100-6900 for each
QALY, and screening for breast few hundred lives
cancer, a
year
until the year 2000 and 1500 lives thereafter at a cost
for each
QALY of
About 90% of the the
..1
cost
£:4100-6900.
of the programme
committee recommends is the
cost
of
A.........rs4JwI 0RC Men
Hnomosexualorbiexa Iuravenousru~~g.misuser Hotsana n dug mnssr
Expert committee wants opportunistic cholesterol screening
Women
'Total.
4e0
(n=280) (n153) (n=3433) (n=1869) 2734 2-734 1481, 90 50.
27.
117 50
* Pavu(s w*
5 24
KO SSO
R' iiet f blood:
cad fleteroisexua: 'Pwuarm (s) with.abxverinsk fct "M" With known exposuo abroad Withf no etvidencfe ofexow abioad-1 Child ofatri'sk orinfocted paret
24 9 ~~~~~~~~~~~~15 18
9
14 10
Othe, orudtepInd41 Prepared from direct vokutary cefi&detil reot
20
29
15
4
151
70
0 15. 6
2 25.
15
yclinciast h
4729 I
uares
I1989
'-99
Communicable, Disease Survillanc Cmre (081I 200 6868) and. the' Comuial
Disieises
