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Brief Borst inzake haar toespraak over biotechnologie

Datum nieuwsfeit: 24-01-2000
Vindplaats van dit bericht
Bron: Razende Robot Reporter
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Tweede Kamer der Staten Generaal

vws00000.093 brief min vws inzake biotechnologie Gemaakt: 28-1-2000 tijd: 9:40

2

De Voorzitter van de Tweede Kamer

der Staten-Generaal

's-Gravenhage, 24 jan. 2000

Onderwerp

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 biotechnology.

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 life itself.

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 biotechnology.

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 medicine.

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 biotechnology procedures.

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 increased suffering.

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 practice.

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 lifestyles.

And it is this last application which brings me to the other side of the biotechnological coin, the side that can lead to increased suffering.

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 conscientiously uphold.

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 pro-active.

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 clinical trials.

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 risks.

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 communication.

Or, if Harry Mulisch will allow me to paraphrase the title of his book, «Only together can we discover heaven."


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