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  Potential Answers To Genetic Engineering in Anthroposophic Medicine
  

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By: Sebastian Lorenz
(Original title: Moegliche Antworten der anthroposophischen Medizin auf die Gentechnik. Merkurstab 1995; 48:466-9. English by A. R. Meuss, FIL, MTA.)

The findings are reported of Group IV (genetic engineering and medicine) at the Gentechnik - Schluessel zum Leben Conference held at Rudolf Steiner House, Frankfurt-am-Main, on 18-20 November 1994. The group was led by Dr. Gmeindl. About 18 people with different specialist backgrounds took part. The chosen subject was a step-by-step progression, with an initial question giving rise to other questions, without specifically looking for answers in the short time available. The questions given below will show how the discussion went.

Concerning the significance of genetic engineering and its influence in medicine, the first thing to establish is how far individual diagnostic and clinical disciplines are already using this new, effective technology and what changes it has brought.

Current potential uses are in four main areas where genetic engineering is more or less intensely involved with the human organism: (1)   

1. Diagnostic procedures involving the Southern blot technique,(2) RFLP(3) and PCR(4)
2. Substitution treatment using enzymes or polypeptides produced by genetic engineering(5)
3. Enzyme defect repair(6)
4. Oncology(7)

Once they are sufficiently well developed, these techniques could be used at a reasonable risk-benefit ratio to avoid or minimize most single-gene inherited disorders; specialist workers are also hoping that they may be used to cure certain types of cancer. As representatives of anthroposophic medicine, we have to accept that people will ask what can really be said against genetics in diagnosis and clinical treatment if the risks are further reduced by modern technology so that the benefit dominates the picture.

A frequently-forgotten side effect of bioengineering innovations may be demonstrated by using diabetes mellitus as a example. In 1921, Banting and Best succeeded in making the necessary insulin available by using biotechnology (initially isolation from porcine and bovine pancreases, later biosynthesis). Diabetes research, which until then had been broad-based and wide-ranging, soon narrowed down as a result. The phenomenon of diabetes had been considered very comprehensively before that, with researchers interested in the essential nature of the disease. Once insulin was discovered, research merely considered the optimum dose adjustment and care of insulin-dependent diabetics as well as issues concerning ultrastructural changes and molecular etiology.

Genetic engineering enables us to diagnose conditions early and "stifle them in embryo." As a result no consideration is given to the essential nature of the disease in some of its forms.(8) Considering the significance diseases have in the human biography, this is a matter of serious concern. The significance of illness is an important element in anthroposophically-extended medicine.

We also need to ask what is actually happening when technology is used to make changes in genetic material, how genetic intervention changes the whole human being, and what significance the intention and the underlying attitude of mind holds for physician and patient. These questions lead to another: what kind of medicine do we want, both as a society and as patients?

To answer this question, we may start with everyday experiences in a hospital. Patients say again and again that they find it difficult to be regarded merely in a functional way with the aim to attempt repair. The patient's understanding of and feeling for an illness often differs enormously from the view taken by the physician. Patients feel they are living beings with a biography but are treated like defective mechanisms.

This phenomenon opens up the more general question as to what is life, something of which the patient has direct experience in pain and suffering, but which is largely hidden from the physician. This question is frequently asked, especially in conjunction with genetic engineering, and there have been hardly even the beginnings of satisfactory answers. Let us try and approach it with another question: how can we rightly relate to another living entity? What are the characteristic features of relationship to a living entity? We experience the nature of a personal relationship. Inner responsiveness develops, being sure of having an opposite number, a subjective presence. We recognize the presence of an essential nature when we meet a life form. Important aspects observed in following a life form through time are that it comes into existence and passes away again, growth and development, a time form in addition to and inside the form that exists in space.

How is this necessary and relevant relationship to the sphere of life reflected in modem medicine? A sick individual does, of course, want a physician who is fully informed as to what somatic medicine has to offer. But he also wants to be perceived as a biographic and spiritual human being. He needs a physician who thinks in terms of giving help rather than effecting repairs.

This need on the part of the patient demands attention to qualitative differences in interhuman relationships. Qualitative differences also apply for different substances and methods used clinically. We therefore pose the question of quality as a factor distinguishing between a medicine we have and a medicine we need. Calcium carbonate provides an example of the very different nature of two substances which superficially appear to be the same. Chemically purified lime from lime works only has its chemical basis in common with the lime from oyster shells we use in anthroposophic medicine. Everything else is really different. Only those who accept nothing but the chemical quality of a substance can maintain that chemically purified lime and shell lime are largely the same, with purified lime the better option.

The quality issue also applies to genetic manipulations on DNA. This will be more easily understood if we recall the role DNA plays as the material substrate for heredity. Heredity means powers being passed on from an individual to its offspring. The genetic material found in the cell nucleus has form-enabling and form-limiting functions. It is a necessity, but not the whole precondition, for the evolving form of a new life. Changing the "limiting" structures for creating images of inherited traits in the DNA is like straightening out the banks of a river. We eliminate preset developmental potential that goes in a pathological direction. This prevents the individual from expanding within the limits set by his genes in accord with his destiny and mission and becoming image-creative in this sphere. This should not be taken to mean that pathology should be left to go its own way. As Wolfgang Gruenewald put it, "the physician is the obstetrician for diseases that are a developmental necessity", but he always remains a guardian of life.

Let us try to understand the potential effects of gene manipulation. Chemotherapy for neoplastic disease might be considered an analogy to the organic consequences of genetic medicine, where little practical experience is as yet available. It also influences the nucleic acid DNA, causing destruction that interrupts growth of both neoplastic and normal tissues. Anyone familiar with the effects and side effects of cytostatic treatment will easily recognize that it is, in principle, inimical to life. A similar observation may be made with reference to the consequences of cytocidal radiotherapy. Skin and tissue scars caused by radiotherapy do not heal well, with the irradiated area never restored to full organic function. This form of cytoreductive treatment has something altogether sneaky and underhand, and so do its side effects. The dynamic of it is turned against the powers that generate both healthy life and overweening neoplastic life in the patient's organism. The ideal would be regulative cytotherapy working with the patient's inherent powers. It is evident that anthroposophically-extended cancer treatment goes in this direction, and the results (achieved over longer treatment periods) are superior to those of conventional medicine both in outcome and the low level of side effects.

It has to be emphasized that the decision to use genetic engineering fordiagnosis and treatment must, to a very large extent, be left to the individual patient. As physicians we cannot advise against life-saving treatment that depends on genetic engineering just because we feel we must object to genetic engineering on principle. It is important, however, to see the excessive power and presumed technologic omnipotence of this new medical armamentarium in relative terms and remove the impotence patients and physicians feel in the face of it by endeavoring to gain greater insight into the basis and effects of this technology. It will also be necessary to strengthen the anthroposophic medical armamentarium in such a way that its superior nature can be recognized. We have to remember that, qualitatively speaking, anthroposophic medicine is absolutely equal to the competition, even if the time required to achieve results may be longer. Conventional diagnostic and clinical methods that have proved highly successful in their own right are extended in it so that they are in accord with the true nature of the human being. We need to make progress in our efforts to gain insight into processes in the etheric realm, perceiving the changes imposed on them under the conditions of foreign genetic material introduced through genetic engineering, so that we may be able to inform our patients adequately and allow them to make well-founded decisions.

The fundamental issues to be clarified concern the nature of heredity and the nature of life. We must find ways of opening up the field of etheric research. With heredity, and death in particular, we have to ask if they can be approached in the same way as the sense-perceptible phenomena of life. Heredity precedes, death succeeds the time in which humans live in their organism. Both, therefore, do not really appear in life as such. The specific nature of heredity and death and the approach to be used if we are to understand heredity were discussed by Rudolf Steiner in a lecture he gave on 6 October 1918.(9) He spoke of the way heredity and death are bound up with the life of Christ Jesus, thus making the connection to the Christology.

Sebastian Lorenz, Ph.D.
Moosgrund 8
D-79110 Freiburg
Germany

Notes and references
1 A good review of current potentials and what is generally desirable in scientific terms is H.-G. Heidrich's (Gentechnik) Anwendung zwischen Akzeptanz und Ablehnung - Eine Bestandsaufnahme. MPG Spiegel 6 (Dez. 1994): 17-24. Obtainable from the author (DM 4.00) or for free from Max-Planck-Gesellschaft, GV, Hofgartenstr. 2, D-80539 Munich, Germany.
2 Blot: Search for a specific, known sequence in a nucleic acid (DNA or RNA). The fragmented nucleic add is electrophoresed to separate the fragments by size. The fragments are blotted on to nitrocellulose filter paper and overlaid with a labeled probe. The probe only binds to its complementary sequence. Radioactive scanning gives the relative position and amount of the specific fragment identified by the probe, from which conclusions are drawn as to the size of the fragment.
3 Restriction fragment length polymorphisms (RFLPs): the length of enzymatic fragmentation products of DNA segments can be determined analytically, permitting conclusions as to a segment, as fragmentation by specific enzymes depends on specific DNA locations that are inherited with the segment.
4 Polymerase chain reaction (gene amplification): method of amplifying minimal amounts of DNA to obtain sufficient amounts for tests that may prove diagnostic. Following separation of the strands, the small amount of the initially double-stranded material has a new partner strand synthetically added to each strand, using a polymerase reaction (doubling the amount of DNA); the new double strands are again separated, with new partner strands added to what are now four strands, and so on. The amount of DNA increases exponentially at every stage.
5 The most important of the approx. 20 drugs produced by genetic engineering today are human insulin, hepatitis B vaccine, human growth hormone, leukocyte growth factor, coagulation factors and erythropoietin.
6 Single-gene human defects that are major candidates for genetic medicine include cystic fibrosis, ADA immunodeficiency, familial hypercholesterolemia, Gaucher's disease, and Tay-Sachs disease.
7 Major proposed medical applications of genetic engineering are for malignant melanoma and renal cell carcinoma.
8 In the immediate future, medical applications of genetic engineering will be mainly for single-gene enzyme defects and in the field of oncology. Inherited conditions with multifactorial cause (e.g. "endogenous" depression, diabetes mellitus n, hip dysplasia) cannot yet be treated by these techniques. This is expected to change, however, once the whole human genome has been decoded.
9 Steiner R. Three Streams in Human Evolution (in GA 184). Lecture of 9 Oct. 1918. Tr. C. Davy. London: Rudolf Steiner Press 1985.






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