|Datum nieuwsfeit: 24-01-2000|
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|Bron: Razende Robot Reporter|
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vws00000.093 brief min vws inzake biotechnologie
Gemaakt: 28-1-2000 tijd: 9:40
De Voorzitter van de Tweede Kamer
's-Gravenhage, 24 jan. 2000
vragenuur 25 februari a.s. aangaande biotechnologie
U heeft mij uitgenodigd voor het mondelinge vragenuurtje van dinsdag 25 februari 2000 over een artikel in het NRC Handelsblad van donderdag 20 januari jl. Dit artikel gaat in op een door mij gehouden toespraak tijdens een congres op diezelfde dag over biotechnologie in Den Haag.
Ter voorbereiding doe ik u hierbij de tekst toekomen van de toespraak
zoals ik die op dat congres heb uitgesproken. U zult daaruit kunnen
opmaken dat het artikel in het NRC-Handelsblad niet geheel overeenkomt
met de door mij uitgesproken tekst.
De Minister van Volksgezondheid,
Welzijn en Sport,
dr. E. Borst-Eilers
Speech to be given by the Minister of Health, Welfare and Sport, Dr E. Borst-Eilers, on the occasion of the conference 'Biotechnology, the science and the impact', 20 January 2000 in The Hague.
Madam Ambassador, ladies and gentlemen,
I want to congratulate you, Ambassador Schneider, on the excellent
initiative to organise this conference. Excellent and timely, because
we have just embarked upon a new century. It will no doubt become
known as the era of two important technologies: Information and
Communications Technology - ICT - and biotechnology. It is certain
that both will have a dramatic impact on our lives, but there is a
major difference. The two technologies are perceived in very different
ways. ICT gives rise to far less anxiety and suspicion than
I have never heard anyone ask 'should people be allowed to go that
far?' in connection with ICT.
Yet biotechnology constantly gives rise to this question, probably
because people regard it as a development which seeks to tamper with
Government policy with regard to any new technology cannot be based on scientific facts alone. When devising policy, a minister must also take public opinion into account. How do people view the new technological possibilities, their benefits and their risks? The Dutch writer Harry Mulisch, in his novel «The Discovery of Heaven» recounts a discussion between two gods in heaven about us humans here on Earth.
I quote: With each new invention people have stolen a piece of our omnipotence. (...) With their rockets they are already traveling faster than the wind, sound even, and one day they will approach the speed of light (...). They can see in the dark, they can look into the insides of a human being without opening him up. (...) If they want, they can even destroy the Earth. Excuse my saying so, but that power really was our prerogative. In the foreseeable future they will have mastered our absolute privilege: the creation of life.» End of quote.
Ladies and gentlemen, it is with the same critical stance as these
gods that many mere mortals observe the development of modern
The acceptance of new developments always takes time. Biotechnology - and particularly medical biotechnology - has long been seen as 'promising', and indeed from time to time it has already proved successful. However, there can only be further introduction of this technology in our lives if the opinions and feelings of the people affected by its applications are taken into account.
Let me take an example from the world of food production. To make
cheese we need the enzyme chymosine. This enzyme can be isolated from
calves' stomachs, or it can be produced from genetically modified
bacteria. Both methods produce an enzyme with exactly the same
structure and properties. However, while the scientist may truly state
that the enzymes are completely identical, this will not necessarily
put people's minds at rest.
The second method of production is 'biotechnological' and cheese thus
produced is seen therefore in a different light. Many people prefer
not to eat such cheese. We will not lay down such fears by labelling
them as irrational. We must take these fears seriously. Scientists
should take more time to explain the working of biotechnology, its
purposes, its risks and how they eliminate those risks. Furthermore,
consumers should have freedom of choice.
Some people consider genetic modification of living organisms to be
morally wrong. Genetic boundaries which are not crossed by nature
itself should not, they believe, be crossed by man. In other words, do
not implant human genes into a mouse, nor any bovine genes into a
bacterium. These consumers want to know whether the products they buy
contain ingredients derived from genetically modified organisms.
Proper labelling of products - especially food products - is an
essential precondition to the successful introduction of modern
biotechnology in food processing.
There are differences in the level of acceptance of the various
applications of biotechnology. There is, for example, a greater degree
of social resistance in the case of food than there is in the field of
Haemophilia patients are on the whole much happier with clotting
agents produced with biotechnology than with those isolated from donor
blood. With the natural product, the chance that this may be
contaminated with HIV, hepatitis B virus, or some virus we haven't
even discovered yet, is always at the back of their minds. Their wish
for their own safety seems to overrule any negative feelings about
I now turn to my main theme: What contribution can biotechnology make
to healthcare? I have no doubt that biotechnology will provide us with
new knowledge which will lead to many improvements in prevention and
therapy. Yet it can also provide us with knowledge which may lead to
Let me first give you some examples of the medical advancements of
biotechnology. To begin with, better vaccines. Many vaccines produced
by traditional methods have drawbacks, such as allergic reactions to
vaccines cultured on chicken protein. Biotechnological techniques
circumvent such problems. This development has already been put into
Then there is the development of better, safer drugs. I have already mentioned Factor VIII for the treatment of haemophilia. Another example is insulin for the treatment of diabetes.
A completely new field is that of pharmaco-genomics: the development
of new drugs by the application of our knowledge of DNA sequences.
This approach will lead to more effective and more specific drugs.
Currently, around thirty per cent of patients using some form of
medication derive no benefit from it at all. By targeting the drug to
the DNA of the patient or of his tumour, that percentage can be
brought down, and that will be real progress.
At this point, it seems apt to say something about gene therapy. It
is, in theory, possible to permanently replace defective genes, which
cause disease, with healthy genes. However, there is still a long way
to go. Another form of gene therapy, in which the new genes need only
work for a limited period, seems to offer more possibilities. In the
case of cancer, certain genes can be introduced into tumour cells,
rendering them more visible to the body's own defence system, which
can then destroy them effectively. In cardio-vascular disease,
replacement genes can stimulate the growth of new blood vessels and
hence alleviate symptoms or even effect a cure. A remarkable research
project is being conducted in the US at the moment, involving the
administration of nerve growth factor to patients with Alzheimer's
disease. A trial is shortly to commence involving eight people
suffering from a mild form of Alzheimer's. Skin cells, genetically
modified to produce nerve growth factor, will be implanted into their
brains. This approach has already proven very successful in rats with
regressive cognitive brain functions.
Another possible development is that of xenotransplantation. This is currently the subject of some debate in the Netherlands. It is, of course, still in the experimental stage. However there have been positive reports concerning transplants of genetically modified cells derived from animals - for example, in the treatment of Parkinson's disease. The use of a similar technique in cases of acute liver failure - where the patient's liver function is temporarily taken over by liver cells from pigs - has actually saved lives already.
Finally, many useful applications in the field of prevention may be
derived from new diagnostic techniques on the DNA level. Prenatal
diagnosis provides an indication of the likelihood of genetic defects
in future children. DNA testing at a young age can inform people about
their own disposition to certain diseases, such as cardio-vascular
disease or lung cancer. They can use that information to adapt their
And it is this last application which brings me to the other side of
the biotechnological coin, the side that can lead to increased
Unfortunately, the opportunities for diagnosing genetic abnormalities are developing faster than the therapeutic possibilities. One of the most harrowing examples of this is Huntington's Disease. Here, a genetic defect inevitably leads to a condition which reveals itself in early adulthood and then steadily progresses to result in death within ten to twenty years. By 'inevitably', I mean just that: one hundred per cent certainty. In the final stages of the disease, the patient develops dementia. We now have excellent means of prognosis, but absolutely no means of prevention or treatment.
In a situation like this, it is essential that people receive the very
fullest information, so that they can decide for themselves whether
they wish to know their fate or not. Everyone has the 'right not to
know'. This is a fundamental and inviolable right which we must
Ladies and gentlemen, knowing that biotechnology can bring many improvements to health care, what should be the government's role in the development and introduction of medical biotechnology?
The Dutch government has a positive attitude towards medical
biotechnology. It is essential that the government is seen by the
general public to be both trustworthy and credible. People's
confidence in science and scientific methods can no longer be taken as
read. However, people are prepared to place their confidence in
careful and conscientious procedures, by which I mean procedures in
which various parties examine a development or product from various
perspectives. The government must ensure that this is what happens.
The policy I advocate therefore, is one which is open, careful and
We therefore apply a number of measures to ensure that the patient's
interests are foremost. First, all health risks are identified and
assessed. The moral issues are raised and discussed both in a public
debate and in parliament. The benefits of the new applications are
examined and weighed against the risks. A Central Committee for
Medical Research judges the clinical research protocols on all these
aspects before giving the green or the red light for the first
I have to admit however, that government practice in this country is
sometimes not quite as clear-cut as I have just described. For
example, a Dutch biotech firm under the name of Pharming has shifted
much of its animal related biotechnology experiments to other
countries because Dutch legislation made it almost impossible to do
them in Holland. One of these experiments has resulted in the
production in rabbits of a human enzyme called alphaglucosidase. The
lack of this enzyme causes a serious metabolic disease. The enzyme is
now imported from abroad to treat Dutch children suffering from this
disease, with the approval of my Ministry.
This is not a logical sequence of events and it is time, I think, to
clarify our position in these issues.
Ladies and gentlemen, I arrive at a number of conclusions.
Firstly, I believe that biotechnology must be regarded as one of the
most important technologies of the twenty-first century. It therefore
is the responsibility of government to create and maintain an adequate
knowledge infrastructure for biotechnology and to encourage research
in this field.
My second conclusion is that biotechnology will lead to useful new
forms of diagnosis and treatment. It is important to asses the
developments on the basis of their added value to health, a sound
cost-effectiveness analysis and a careful weighing of benefits and
Third: given the sensitive nature of the subject, and especially the
bio-ethical considerations, it is important that all new developments
are introduced in an open and communicative setting and that people
are given the opportunity to express their views. Information and its
dissemination must meet high standards.
Finally, biotechnology will change the character of health care, as
predictive medicine comes to play a greater part. One consequence will
be that doctors and psychologists must be trained in providing proper
guidance to patients to help them in dealing with the new knowledge
which predictive medicine provides.
Ladies and gentlemen, we shall lose a great deal if we don't move
forward with biotechnology in healthcare, but many questions remain to
be addressed. These questions are not primarily the concern of doctors
and geneticists, but that of the social scientists, behavioural
scientists, bio-ethicists and public administration experts. My
request to the researchers working in medical biotechnology is
therefore: be open to cooperation and interaction with these
disciplines. Your work and its products will not automatically be
accepted by society. You are dealing with extremely complex matters
with far-reaching consequences. They require a process of continuous
Or, if Harry Mulisch will allow me to paraphrase the title of his
book, «Only together can we discover heaven."
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