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Society's Choices: Social and Ethical Decision Making in Biomedicine
effectiveness of this massive technological effort in fields from physics to material science, as well as the development of biomedical procedures, there have been increasing calls to examine the potential harm that might flow from advances in science and technology.
The biomedical advance that perhaps most effectively illustrates the sometimes troubling consequences of technology was the development of kidney dialysis techniques to save the lives of patients with terminal renal disease. The technology was effective but expensive, and therefore not universally accessible. In the early 1960s, a kidney dialysis team in Seattle, recognizing that it would not be able to treat all medically deserving patients, established a selection committee to choose patients who would receive the treatment (Jonsen, 1993). The committee came to be called the "God Committee," and the well-publicized pain of its dilemma and its choices was relieved only by the passage of legislation that provided funding for treatment of all kidney patients. This experience served to alert both the general public and the medical community to the problems created by limited resources and the desperate need to anticipate such situations and institute equitable solutions.
More recently, advances in molecular genetics have delivered the promise of both technical benefits and ethical problems. Large collaborative efforts have already succeeded in isolating and characterizing some of the genes responsible for a number of our society's most burdensome genetic disorders, including cystic fibrosis, Huntington's disease, fragile X syndrome, and certain forms of common cancers (breast, colon, and prostate). Population-wide screening tests for these and many more disorders may be within reach. The Human Genome Project, well on the road toward its objective of producing a detailed map of the entire human genome, promises to identify many additional targets for genetic screening tests and gene therapy. Yet, it is likely that social and ethical concerns about employment and insurance discrimination and about the value of knowledge about one's future health will develop in concert.
Academic-Industry Relationships in Biotechnology
Recent dramatic changes in the research and development relationships between industry and academia threaten to upset the time-honored traditions of the biomedical sciences. In the past, academic scientists provided a constant stream of basic biomedical research and a cadre of new investigators as a source of renewed talent. Their activities were generously funded by NIH. Industry would center its attention on the development of their ideas into marketable products. Today, however, the process is undergoing radical change as commercial interests seek to direct scientific discovery.