• Will these workers have the resources to find out?
• Will there be a "genetic divide" between those who can afford to know their genetic information and to use it to their advantage and those who cannot afford to do so?
• How might new technologies be used by other cultures with different value systems?

The first steps out of the dumping ground

	Discussion
	How do you think genetic technologies will affect the gap between developed and developing nations?

Inside the plant, some have fashioned scraps of cloth into masks in an attempt to avoid breathing the toxic dust. Some have gloves; others do not. Outside, other villagers, some of them children, scour the dump sites for battery cases, taking them home to extract the small amount of lead that the plant had left behind. Each week, a new supply of old car batteries arrives from overseas, from a distant and far richer nation. The plant is officially a recycling operation, but it is really more of a dump.

Toxic wastes of all sorts are shipped across international boundaries, flowing downhill to the destination with the cheapest labor and loosest environmental controls.

International agreements and enforcement may indeed clamp down on such dismal situations. But it will likely be a continuing challenge to ensure that workers in developing countries are not made to bear the environmental burden of American consumption.

Even countries that make great efforts to protect their people may be hampered by a lack of resources to do the proper studies, prevention and remediation. They often rely on studies conducted in the United States to manage risks within their borders. Here too genetic technologies offer promise and present challenges.

Genetic susceptibilities may not be distributed the same within a country with a different ethnic makeup than our own. So a study of toxicity conducted in the Untied States may not give a good prediction of how another country might be affected. Studies of genetic variation can help calibrate the data to apply to different countries around the world. For example, perhaps a chemical that poses little danger to most US citizens presents a large risk for a particular ethnic group. A country made up predominantly of that ethnic group might make the reduction in the levels of that chemical in the environment a top priority.

Just as in the United States, genetic assay devices might be useful in screening workers for exposure to toxic chemicals--or unusual susceptibility to disease following toxic exposure. But just as in the United States, such screening may turn into a form of discrimination. Even the smallest countries will have to deal with issues arising out of the genomics revolution. But for many, the major issue may be access.

The economic divide
In the year 2000, the AIDS crisis in Africa and the lack of effective and affordable treatments for the disease in poor countries made headlines and squarely confronted governments in the industrialized world. While Americans suffering with AIDS often have access to life-preserving medications that were developed with cutting-edge technologies, those suffering in poor countries sometimes lack even rudimentary antibiotics.

The genomics revolution will bring about marvelous new cures, new screening devices, and new ways to address environmental problems. These marvels will come with a high price tag, at least in the near term. Even within the United States, unless steps are taken to prevent it, we may see a repeat of the "Digital Divide" as genetic technologies are available first to the wealthy or well-insured.

Whether the great human achievement of unlocking and continuing to understand the secrets of the human genome turns out in the short term to be a great step forward for humanity or a luxury for the wealthiest on the planet depends on the social choices we make in the next few years. If efforts are not made to spread the benefits to those most in need, then this great achievement will not truly be realized for many years to come.

As many other debates surrounding genetic advances, this one is really a more general debate about health care distribution. Our sense of common humanity and compassion is pitted against the known power of the patenting and market systems to drive technology to and past new limits. Finding a way to embrace both is an enormous challenge.

Moral consensus in a diverse world
What if the villagers living on the contaminated landscape depicted above had access to a drug that would alter their DNA, making them far less prone to the toxic effects of lead? Would it matter whether their offspring inherited the trait or if it were just an alteration to their own DNA?

The question is based on an unrealistic premise--that such poor people would be able to afford such a high-tech treatment. There is quite a bit of debate about when these genetic therapies might be available at all. Our ever-increasing technological capabilities make it inevitable that therapies that alter the expression of our genes could be affordable and widespread at some point in the future--depending on how they are regulated.

	Moral Dilemmas
	There is a sharp distinction usually drawn between genetic therapies that only affect the gene expression of an individual and those therapies that will affect the genome of an individual's offspring. The latter, germ-line gene therapy, involves moral questions about humans as a species and our continued evolution that the former therapies do not.

As discussed above, gene therapy evokes much controversy. It may be the technology that best exemplifies our hopes and fears in the technological age--the thrill of the newfound ability to transcend our apparent biological destiny and the dread that we might be leaving behind our human roots, our proper place in this world. Such lofty concerns seem oddly out of place when focused on the first practical examples of genetic therapies, such as treatment of head and neck cancers (a therapy in which only cancer cells are targeted) and immunodeficiency diseases.

The use of gene therapy to eliminate or reduce susceptibility to some environmental agents represents a step past these first efforts, a step closer to uncertain moral ground. Such therapies would alter the genome of an individual (rather than just attack cancer cells for example). They would also represent the alteration of a human person to achieve some more desirable physiology. It does not seem too far beyond this step to the alteration of other traits that confer, for example, decreased susceptibility to social insults, by way of enhanced intelligence, a better appearance or even perhaps a more sunny personality.

The confounding problem here is that all medications alter one's physiology. For example, instead of altering genes to obtain a more desirable expression of a certain protein, one could design a drug to deliver that protein. The physiological result could be nearly the same, so long as the drug is taken, but for some the moral apprehension is somehow diminished. Today's drugs already affect, in comparatively crude ways, the constellation of proteins active in the human body (although almost none will indefinitely exert such influence over one's offspring as a germ-line therapy would). Yet most have no qualms with traditional medicine.

The villagers near the car battery recycling plant deserve to be free of disease caused by others' pollution. If they could afford to pay for therapies that made them more resistant to the toxins that surrounded them, how would anyone be able to deny them that security? The all-important issue would be informed consent. Could such therapies be effectively forced on them either by employers or by their government? In areas of the world where people struggle to meet their basic needs, the line between direct coercion and economic coercion is a blurry one indeed, and a worker may have little real choice when confronted with the expectations of an employer. This path could lead to a frightening situation, to a sort of genetic engineering of a Third World workforce. Some profiteer in some poor country might make the small leap from eliminating susceptibility to enhancing other traits desirable in a worker.

That such a scenario is unrealistic at present, because of our technological limitations in developing genetic therapies and in their expense should they be developed, should not be cause for us to do nothing in the interim. Our best opportunity to ensure the protection of shared human values and to promote development of the genetic technologies that will enhance the quality of human life around the world exists now. We should seize it, through dialogue, international agreement, and cooperation between government and private industry.