Articles

Genomics is a prototype of the coming "neo-Vesalian" biomedicine and health care of the near future. As Victor McKusik writes: "Specialists in all medical areas will approach the study of their most puzzling diseases by first mapping the genes responsible for them. Thus, just as Vesalius’s anatomical text of 1543 formed the basis for the physiology of William Harvey (1628) and the morbid anatomy of Morgagni (1761), gene mapping is having a widely pervasive influence on medicine"[1]. From this point of view genomics means new imaginative and pragmatic "localization" of human problems.

Localization constitutes the ground of any human action. In the book The Normal and The Pathological published in the occupied France in 1943, George Canguilhem wrote: "To act, it is necessary at least to localize. For example, how do we take action against an earthquake or hurricane? The impetus behind every ontological theory of disease undoubtedly derives from therapeutic need. When we see in every sick man someone whose being has been augmented or diminished, we are somewhat reassured, for what a man has lost can be restored to him, and what has entered him can also leave. We can hope to conquer disease even if it is the result of a spell, or magic, or possession; we have only to remember that disease happens to man in order not to lose all hope. Magic brings to drugs and incantation rites innumerable resources for generating a profoundly intense desire for cure"[2].

The Human Genome Project (HGP) is aimed at mapping the total set of human genes means another attempt at relocalization and ontological restructuring of the realm of modern medicine and as a consequence – creation of a new method of application of medical treatment. A large number of human pathologies are already relocated into different regions of human DNA sequences. This ontological shift generates innumerable resources for stimulating a profoundly intense desire for cure centered around intervention in the human genetic makeup. It gives new chances for people nowadays not to lose all hope when challenged by cancer, AIDS, aging, by criminal behaviour and even by disobedience of their own children turning this educational problem into a medical (genetic) one, for example, connected with a genetically determined attention deficit. A successful conclusion of the first part of HGP – completion of the human genome sequence – was announced in June 2000. During the next stage scientists should discover, localize and provide functional description of human genes.

In general, fascinating recent achievements of the HGP promise modern biomedical professionals enormous power to control genesis of human beings with desirable features.

But new localization for biomedical interventions does not mean deconstruction of traditional biomedical methods of localization and action – anatomical, histological, cytological and biochemical. That means that genomic relocalization is a further fragmentation of the biomedical “point of view" that could not grasp any integrated picture of human suffering.

If "knowledge is power" then how could we act when different parts of this knowledge do not compose a common picture, if the object of action is divided into pieces of events observed from a "partial points of view"? In the 20th century reductionism and holism each in its own manner tried to give a universal picture of the human body in norm and pathology. Collapse of these programs in the 1970s brought fragmentation into the general picture of body events and correspondingly fragmentation of internal scientific perception, imagination and theoretical conception. Virtually all discussions of the possibility of creation of a universal theory were ended. In this situation any exact intervention (therapeutic or scientific) is an ad hoc cooperation and adjustment to other activities (for the purposes of exact clinical or research case) of different localization without a general theoretically observable frame in a situation of fundamental uncertainty and risk.

New Cultural Situation
 

The progress of genomics is in synergetic relations with basic transformations of modern culture. It pumps resources of new cultural impulses and gives them tremendous acceleration. It provokes in human beings a new feeling of the power of recreation of their own nature and a new experience of defenseless-ness against this human might. For example, if some day genomics will be able to fix "genes of death" in our body the danger of death would not disappear being hidden, preserved and increased by genomics itself in the power of destruction localized in our "cultural genes" of freedom. Freedom of will is our basic cultural value as well as the cause of all kinds of practices of transgression (including criminal, terrorist etc.). This failure reminds us of the truth of Bible – the basic cause of death (as well as cultural progress – we could remark) is our "sins" – the moral and ontological condition of human freedom. Humans could control nature, but who (if the Lord is really "dead") could control "controllers"? Rethinking this question genomics produces a new feeling of sublimity that maintains the paradox of human might and ontological weakness.

The feeling of sublimity, presenting the limits of human existence, shapes specific to each culture play of number of other existential feelings among which basic feelings of fear and hope are the most important. The specific design of this play in modern genomics was constituted in the 60s by two great existential discoveries leading to the establishment of ecological movement and bioethics.

First of all, we should consider the birth of the ecology movement. Due to Martin Heidegger somewhere in the 17th -18th centuries in the European cultural world the Christian idea of salvation was substituted by two ideas of health and freedom, which were separate from the beginning. This substitution and separation constituted specific objects for scientifically oriented medical improvement and political action.

In the realm of biomedicine the basic threat for human identity was recognized in the external world of Nature and the path for "salvation" was found in scientifically designed technological control of external natural forces. Nature was blamed as the enemy and technology as the savior. That is why military metaphor was and is so popular in medicine, particularly in the ideology of acute diseases, political rhetoric (like "The war on cancer" of President Johnson) and even in commercials (like "Our soap kills all known germs!").

The ecology movement had turned this linear existential orientation into a circular or paradoxical one. At the core of this existential shift was the fundamental discovery of a new threat for existence of human beings. And what is crucial – it was found exactly in the same place where Western thinking was looking for "salvation" – in scientific and technological progress aimed at the conquest of Nature. We began to fear the ways of our hope. But we did not give up these technological hopes. The desire for technological control of natural forces is still the most powerful.

But today it is balanced by the opposite desire to preserve Nature, to save it from human beings The paradoxical play of existential feelings expressively illustrates the text of one commercial for mineral water I found recently in my postbox – "Natural spring water from the Russian forest manufactured with the use of the most advanced Japanese technologies".

The diagnosis of the new existential threat was made by science itself and what is wonderful is that the means of salvation from the new threat are designed by science itself, also in the growing industry of instruments of environmental control and protection as well as the manufacture of "natural" products. Science has become the threat and the savior in one body, or as the German sociologist Ulrich Beck would say – it has become "self-reflective", "self-doubting" and "self-limiting" The society that is growing on the new existential basis is what Beck called "risk society".

The ecological shift has pitted scientific thinking into conflicting voices of scientific "truths" "pro" and "con" exact technological innovations. Accompanied by the collapse of the demarcation lines in the philosophy of science (that attempted to establish a demarcation between science and non-science) this shift had legalized multiplicity of truth-oriented scientific discourses. It made science more "open minded" not only in relation to intra- and inter-disciplinary differences inside science itself, but also in relation to non-scientific reasoning (religious, astrologic, shamanic etc.) All of these different perspectives today are in permanent "dialog" (Mikhail Bakhtin), in evaluation of what is happening and in looking for prescriptions for what should we do in exact critical situations produced by technological progress.

Transplantation of ecological thinking into the area of bio-medicine happened after the thalidomide disaster (children were born without limbs whose mothers used thalidomide as sleeping pills during pregnancy were born without limbs) transformed the pattern of relationships between science and practical medicine. For example, the "development time" for new drugs from several weeks from the moment of synthesis of a new therapeutically active substance in the early 60s jumped to around ten years at the beginning of the 80s and the "development cost" escalated 20 times and even more The safety, that means – prevention of harmful effects of the "savior" (drug) had swiftly become a developing branch of medical science.

The second existential shift could be cold "bioethical". It happened because of the intervention of a multi-collared army of moral discourse into the area of medicine previously under monopoly-like control of the scientifically oriented reason (at any rate in self-consciousness) for biomedical science and health care practice. The success of this intervention was predetermined by another existential “discovery", which occurred in the form of a number of public scandals around biomedical research practice – the human body is not only an "object" of scientific research or medical treatment but also the "flesh" of a particular person – its owner. That is why any action in this field has an irreducible moral dimension principally invisible from the scientific point of view. This "blind spot' of scientific reason constituted a legitimate position for moral reason inside modern biomedicine. Together with moral reason, as its societal application to some extent, political practice has intruded into the world of biomedicine. Abortion, patients rights, the rights of people with disabilities, cloning genetic engineering, stem cell research – all of these and many other internal problems of biomedical science have become powerful motivators for political movements.

So, the conflict of "truths" in the ecological shift was upgraded by a conflict between scientific and moral reason in the bioethical shift. Not surprisingly moral reason appeared in this "boxing ring" not as a united agency, but as a crowd of conflicting moral points of view, perspectives, values etc. This constellation of moral discourses inside biomedicine is usually called bioethics – the word initially created by Van Rensselaer Porter for ecological obligations to the biosphere as a whole.

I think that such a paradoxical existential play of desires, the paradox of fear and hope constitutes the basic structure of the modern cultural identity the specific rhythm of existential repetition. The modern progress of biotechnology offers "protection" from powerful external natural forces. The ecology movement and bioethics provide complimentary "protection" from the "abuses" and "threats" of biotechnology itself.

 
Genomics and Bioethics
 

The Human Genome Project is a paradigmatic example of new biomedical science –very different from classical science in existence until the beginning of the 80s. In the history of science HGP was the first institutional response to the existential paradox induced by ecological discovery and bioethics in the field of bio-medicine. It responds with the paradoxical play of fear and hope including institutional activities in its own design which are unusual for classical science. The first time we could see that the development of fundamental biomedical research and the development of moral and legal protection from dangers connected with this research are incorporated into organizational structure of one and the same scientific project. In 1988 a special committee appointed by the US National Research Council endorsed the concept of HGP that included not only the creation of genetic, physical and sequence maps of the human genome, but also research into the ethical, legal and social issues raised by human genome research itself. (Ethical, Legal and Social Implications Program – ELSI). Other countries in different ways have implemented the same strategy. Even in Russia where HGP is dramatically underfinanced this project includes a special program of moral and legal research. One of the results of ELSI was the drawing up of lists of rules and restrictions on how genomic technologies should be applied in particular research and clinical circumstances.

What is peculiar to bioethics is that it accomplishes its critical function in genomics (as well as in other areas of biomedicine) although it was fragmented from the very beginning into numerous conflicting moral positions, philosophic and theological perspectives, religious confessions etc. In genomics there is no "central" moral authority that could provide demarcation between right and wrong in an autonomous and authoritarian manner. In its place we could find a net of conflicting public forum moral discourses that are tightened into junctions of decentralized social institutions called "ethics committees". Ethics committees exist at the level of research centers, professional organizations, at the national as well as international level in organizations such as the Council of Europe, UNESCO, WHO, HUGO (Human Genome Organization), etc.

On the basis of interdisciplinary discussions (in a form of a transition via multiplicity of points of view and moral positions) ethics committees develop norms and guidelines of morally founded scientific research and practical application of new knowledge. Moreover, this foundation is achieved in most cases not through theoretical or theological contemplation of the depth of moral order, but at the surface of public discussions in which each could appeal mainly to common sense. It comes as a result of negotiation, political deal. The inclusion of bioethical problems into the context of scientific activity constitutes a specific feature of the new type of science.

 
Temple and Market
 

Commercialization is another very characteristic feature of genomics as a new kind of science. It is developing synchronically with events related to ecological and bioethical restructuring of the field of biomedicine.

One of the first actions of Jesus Christ after his appearance to people and first disciples was that he drove those who sold oxen, sheep and doves, and money changers out of the temple. This just points to the demarcation between the temple, where the truth presents itself, and the market place where truth could become an object of a joke, commercialization, and be subjected to other forms of profanity characteristic of "carnival culture" (M. Bakhtin). The inequality of temple and market in the hierarchy of values, their separation by specific boundaries of appropriateness (e.g. laughter is not appropriate in a temple, but appropriate in the market square) constitutes internal polarization of culture as a basic condition of its dialogic development. Violating these boundaries is a serious sin, e.g. the now unanimously condemned marketing of indulgences? That is why commercialization in any traditionally noncommercial areas is received negatively. Particularly when it is related to an issue so important for modern cultural consciousness as science and morality.

It is not accidental. As a large number of scholars of culture put it, science in the epoch of Enlightenment have substituted in the European mentality the place that was previously occupied by religion. If a Christian thought him or herself created in the image of God, the enlightened humans think themselves basically created in the image of a Scientist. The education of a modern man or woman is profoundly an appropriation of knowledge accumulated by science. Sports and fine arts have marginal position in this system. Religion is excluded as a private issue.

From the very beginning modern science was connected with market and industry. But this connection was not direct. In line with Christian tradition the area of true knowledge (the area where knowledge exists in a form of "discovery") and the area of its practical application (where knowledge holds the status of "invention") were institutionally separated. Fundamental science (or the Science) as a specific social institution (in the form of university or academy) was independent of industry and market relations. It existed mostly on the basis of governmental support or charity. Buffer functions between science and the market per formed so called "applied science".

The emergence of the biotechnology industry in the USA as a new institution of not only applied, but also fundamental research during the 1970s was stimulated by several factors including: "(a) the greatly enhanced technical ability to “recombine”, “engineer”, or simply “manipulate" DNA and other molecules; (b) a regulatory environment that encourage the rapid application of research to applied problems, as well as change in the patent laws directed at actively encouraging (almost forcing) the commercialization of inventions in both industrial and academic settings; and (c) the eventual dovetailing of governmentally funded research with venture capital looking for investments to form an expanded base for molecular biological research and development"[3]. Commercialization helped to consolidate the necessarily resources for the breakthrough in HGP. It also had essential influence on ongoing change in the identity of science and scientists. It changed the self-perception of science and created a new self-identity of a scientist – "scientist-businessmen."

Other important consequences were changes in patenting practices. In 1980 the US Supreme court ruled that creation of new life forms fell under the jurisdiction of federal patent law. This opened the door for patenting not only of newly created microorganisms or laboratory animals, but also for patenting of human genes, DNA sequences, embryonic stem cells etc. The pragmatic interest in the protection of investments has changed the perception of the world. In the form of a patent it gave fundamental biological knowledge a form of market commodity. From a philosophical perspective this means radical fusion of cultural and natural horizons, of ideas of invention and ideas of discovery. This situation was virtually impossible in classical science. Nobody could wish to patent, for example, oxygen.

Commercialization in genomics created a new kind of market, new commodities, new ownership rights accelerating similar changes in other areas of biomedicine. At this point, having no time to dig into the details, it is necessary just to mention that as objects of commercial exploitation one could choose not only elements of the human body like genes or cells, but also a genome of an entire nation. E.g. in Iceland the private biotech corporation DeCode Genetics "purchased" exclusive rights to the commercial exploitation of genomic data of the Icelandic population for a period of 12 years.

The commercialization of fundamental science and proliferation of moral and ecological control in the world of biomedicine technologies make scientific expert knowledge more dependant on the opinion of lay people. Such a state of affairs is reflected in the "principle of publicity" (Henry S. Richardson). In bioethics justification must be offered in terms of reasons that may be publicly stated. Lay people play a double role – as genomic market consumers (e.g. genetic tests) and as representatives of public voting "pro" or "con" exact legal initiatives, or even participating in different kinds of "ethics committees" – new institutions in biomedical science, influencing via public organizations ecologic risk evaluation of new biotechnological innovations. In line with similar tendencies in modern culture relations between science and the public are in the process of transformation from practices of education (enlightenment) to practices of entertainment, from messages addressing reason to addressing the imagination of people.

In leading genomic research centers actively working departments of patenting, public relations and other market-oriented bodies have appeared. Discussions on perspectives and moral permissibility of development of new biomedical technologies migrate from the shadow of expert councils inside "temples of Truth" to the bright light of "market squares" in the form of endless "talk shows" and performances of recently emerged "bioethical theater" that pumps plots for performances from the live world of modern biomedicine.

Using the analogy with "anatomic theater" of the Renaissance period I shall call imaginative activity in the area of genomics "genomic theater".

 
"Genomic Theater" and Its Cultural Mission

 
The imaginative play of "genomic theater" that is performed on market squares of modern culture has a specific cultural meaning. This meaning could be invisible to actors who are pushed out of temples of science onto the stage of public performance by the will of cultural fate. Protesting voices are widely heard, offended by the intervention of incompetent profane scientists who insist on stopping public discussion. Smilingly philosophers confronted with the anarchy of opinions and moral positions vocalize their concern over the mere possibility of bioethics as a rational discipline. Tristram Engelhardt, Jr, one of the leaders of American bioethics, eloquently articulated a point of view characteristic of classical philosophy: “[T]here is a swarm of alternative ethics ready to give rise to a bubble of conflicting bioethics. This circumstance constitutes the basic moral challenge. It brings the very field of bioethics into question"[4].

I think, keeping in mind M. Bakhtin’s vision of thinking as a dialogue, that the conflict of "bubbling bioethics" is the precondition for existence of The Bioethics we have today and its most characteristic feature, the dialogical way of reasoning. Furthermore – the word "bubble" could instruct our thinking reminding us of some specific period in prior history of European culture that will help to illuminate the phenomenon of bioethics and its role in genomics in a new light.

According to the Oxford dictionary – to bubble means to speak “incoherently” "indistinctly or foolishly". I would like to remind you of the Renaissance period when such a social actor as ‘a fool’ had become a popular figure in scientific and philosophic writing. Just to mention two of the most significant examples: Erasmus Desidenus (1466-1536) in Praise of Folly appealed to the wisdom of “bubbling” in order to undermine scholastic teaching and to make space for the new image of Man in the Universe. In Galileo Galilei (1564-1642) Dialogue Concerning the Two World Systems one of the first role play “A Simple Man” (Symplitchio) – a lay man or "a man from a street" whose wisdom of everyday life helps Galileo to dispute Aristotle’s ontology.

At the very beginning of the modern epoch we could see "open minded" science that is in permanent dialogue with the "public" – a community of ignorant people. For example, Robert Hooke who developed the basic methodological principles of scientific research for The London Royal Society (principles of "autopsy") wrote that knowledge should be developed to the extent where scientists could demonstrate the truth in public. And public demonstrations of scientific experiments were routing activity of the Society at the very beginning of its life.

At the same time we could see the development of similar phenomena in medicine that was called "anatomic theater". On the famous frontispiece of A. Vesalius De Fabrica Human Corporis a scene is shown from one of the anatomic "performances". Among the "spectators" we could see a lot of leading thinkers and political leaders of the time including Martin Luther. What was the role of those "fools" – people ignorant in anatomy crowded around Vesalius? What was his role?

Vesalius was not a teacher of spectators and they were not "students." Both parts participate in the magic of anatomic theater. Vesaliuses role was cutting decomposing disfigured flesh to recreate in the imagination of spectators the young flourishing athletic body. It is the paradox of the anatomic way of seeing (autopsy).

Pictures of the human body that were published by Vesalius, (made by one of his students), in the book De Fabrica Human Corporis were composed through the gathering of information from autopsy of only several cadavers. In no sense do they represent any statistically "average" anatomical features. Guiding Vesalius and his followers "was the belief that the human body expressed in miniature the divine workmanship of God, and that its form corresponded to the greater form of the macrocosm"[5]. The last is organized due to the Pythagorean notion of mathematical proportionality and symmetry. That is why Vesalius had presented as normal athletic bodies of young men and gentle, harmonious bodies of young women.

The Renaissance ideal of the human body was incorporated into the normative order of display and representation in medical human anatomy. Not surprisingly Pythagorean ideas were forgotten, so that this ideal now is experienced as "natural."

I suppose that the role of spectators was that of jury in court hearings. Vesalius like "an expert" attested to the new truth of human nature. His attestation competed with the attestation of the rival "theater" of The Church. And those ignorant fools were to decide which attestation is more persuasive and which is less in this historic case of Vesalius versus Galen (The Church). So the "bubbling" of "fools" (the public) pronounce verdict on expert attestations of the conflicting ongoing court hearings of History.

The same kind of "bubble" constitutes the heart of bioethics as specific intellectual activity so vividly presented in genomics. To some extent this issue is acknowledged by the above-mentioned "principle of publicity". In bioethics justification must be offered in terms of reasons that may be publicly stated (Henry S. Richardson). The need for "profanation" of professional knowledge of scientific truth or moral goodness is the same as it was in the Renaissance period – the conflict of truths and conflicting ideas of good could be solved only in public "court hearings" (at any rate in a civilized manner).

To slightly change one of Paul Ricouer sayings – the conflict of truths is a provocation that sends "experts" to a court of appeal – to make attestations in front of juries composed of lay people (the public). In such attestations rival experts (e.g. scientists and moral philosophers) could not appeal to jury knowledge of foundations of the truth they are presenting. They should move reasoning from the "depth" of knowledge to the "surface" of narratives of public presentations. According to Paul Ricoeur narration is the "summit" of scientific (descriptive) and moral (prescriptive) reasons. They could meet each other and be in conflict only on the surface of life stories. "The actions figured by narrative fictions are complex ones, rich in anticipation of an ethical nature. Telling a story, we observed, is deploying an imaginary space for thought experiments in which moral judgment operates in a hypothetical mode"[6].

In this sense attestation of rival moral and scientific "experts" in bioethics in front of the public (a "jury") is basically a storytelling – imaginary thought experiments in which an expert constructs a version of a "life plan" – how life would change for good or bad if proposed ideas (new norms or new methods of treatment) would be accepted by the "jury." In order to disprove this "dramatic" attestation rival experts should create their own imaginary versions of life stories – possible changes (surely negative) in the life of lay people. In other words – bioethics looks like a kind of competition of storytellers or tragic poets in antique theater. The public (spectators) is the agency that grants gifts (awards) of recognition to those whose "stories" mostly fit their taste. "Playing God" – the creation of an improved "remake" of human nature is the plot for the most popular of such stories.

Too often Humanity is trying to solve historic conflicts of ideas of the Truth and the Good through political violence or war. Genomic theater offers a more civilized peaceful solution that rests on the power of the public (res-public). This is the cultural mission of genomic theater.

 References

[1] McKusick, V. A. The Human Genome Project: Plans, Status, and Applications in Biology and Medicine (1992).

[2] Canguilhem, G. The Normal and the Pathological (New York: Zone Books, 1991).

[3] Rabinov, P. Making PCR. A Story of Biotechnology (University of Chicago Press, 1996), p. 19.

[4] Engelhardt, T. The Foundations of Bioethics (Oxford University Press, 1996), p. vi.

[5] Sawday, J. The Body Emblazoned. Dissection and the Human Body in Renaissance Culture (Routledge. London and New York, 1995).

[6] Ricoeur, P. Oneself as Another (University of Chicago Press, 1992), p. 107.

First published in BioMediale Contemporary Society and Genomic Culture. Kaliningrad, 2004. pp.60-72.