- Esther Casanueva, M.D.
Instituto Nacional de PerinatologÌa, Montes Urales No. 800,
Torre de Investigacion 1er. piso, Col. Lomas de Virreyes, MÈxico DF CP 11000
- RubÈn Lisker, M.D.
Instituto Nacional de NutriciÛn "Salvador Zubir·n"
\ Alessandra Carnevale, M.D.
Instituto Nacional de PediatrÌa
- Elisa Alonso, M.D.
Instituto Nacional de NeurologÌa y Neuropsiquiatria "Luis Velasco S_arez"
Eubios Journal of Asian and International Bioethics 8 (1998), 6-9.
The purpose of this paper is to explore and compare the opinion on matters related to genetic engineering among Mexican physicians with different specialties. Physicians from four of Mexico City's National Health Institutes (MNIH) were selected for the study. The following specialties were sampled: internists (n =56); pediatricians (n= 58); gynecologists and obstetricians (n = 50) and neurologists (n=27). The questionnaires designed by Macer were used. Even when 8 out of 10 physicians questioned responded they were interested or very interested in science, their knowledge on science and technology in general and on genetic engineering is poor. The survey results make it clear that there was consensus in that the intellectual property of ideas is acceptable, but not for the products of genetic engineering. Worth noting is the inverse relation between the acceptance of use of genetic engineering to modify physical, intellectual or ethical characteristics of individuals and the knowledge on the basis of genetic engineering.
Key words: ethics, -medical; genetic-engineering, human-rights, Mexico.
The purpose of the present paper is to explore and compare the
opinion on matters related to genetic engineering among Mexican
physicians with different specialties, using the instrument designed
by Macer (4).
Material and Methods
Two of us (RL and AC) modified part of the questionnaire used by Macer (4) and translated it into Spanish, to explore the perceived impact of science and technology in society. The questions identify the degree of agreement/disagreement in four different areas. The following aspects were included:
1. The genetic modification of entire live beings, parts of them or their products.
2. To change the genetic structure of plants or animals, with genes of the same or other species. Assuming that genes from most organisms are interchangeable the questions were (the answer options were: acceptable, unacceptable, I don't know.) :
What would you think if the animal gene came from a man or woman?
3. To change live organisms with different purposes (recreation, to obtain food, improve health). The questions were (the answer options were: I strongly approve, somewhat approve, somewhat disapprove, strongly disapprove or I don't know.):
b) What do you feel about scientists changing the genetic makeup of human cells to: * Cure an usually fatal disease, such as cancer, * reduce the risk of developing a fatal disease later in life, * improve the physical characteristics that children would inherit, * Improve the intelligence level that children would inherit or * make people more ethical.
4. Patenting the products of genetic engineering. The question was (the response options were: approve, disapprove, don't know):
Physicians from four of Mexico City's National Health Institutes (MNIH) were selected for this study. The MNIH are government institutions providing tertiary medical care, and are strongly involved in teaching and research. The following specialties were sampled: a) internists - working at the Instituto Nacional de la NutriciÛn, where only adult patients are seen and there is little experience with genetic diseases- were invited to participate. Approximately one out of three specialists (59 physicians) were randomly selected, and 56 accepted; b) pediatricians, an identical random sample to the above was selected at the Instituto Nacional de PediatrÌa, where they frequently see patients with genetic diseases or congenital malformations and 58 out of 59 agreed to participate; c) all gynecologists and obstetricians (n= 50) working at the Instituto Nacional de PerinatologÌa agreed to participate in the survey, and d) 27 out of 30 neurologists working at the Instituto Nacional de NeurologÌa y NeurocirugÌa participated in the study, they all have experience with hereditary neurological conditions.
The differences in agreement or disagreement were compared. Whether or not, a difference of 5% or even 10% between two responses, may be statistically significant, it may still reflect different attitudes in opinions regarding ethical matters (5), and this study is not intended to be only quantitative but to seek trends for further examination (5).
Some parts of the survey had been applied to medical students
by Macer et al in several countries, including Australia, Japan,
Hong Kong, New Zealand and Philippines, and Japan (6) It is important
to mention that we don't have information about the application
of this survey to physicians, in any place of the world, though
a survey is being conducted in Portugal (7). These are the best
comparisons available to physicians. It is important to mention,
that in general the students surveyed were approximately 20 years
old, 60% were male, and approximately 70% cataloged themselves
as religious, somewhat more in the Philippines.
The survey was applied to 191 physicians, 79% of which were males, 36% were more than 35 years old, and 72% said they were religious, predominantly Catholic (Table 1). No differences between the four specialties were found, and the results are therefore presented together. In general they reported to be very interested in science, but only 35, 29 and 9% said they were able to explain the technology behind computers, biotechnology or pesticides respectively. 96% (185) answered that research in the area of genetic engineering is appropriate, although only 26% (50 individuals) said they had knowledge of the procedure.
|++ (agree strongly); +(agree), =(neither); - (disagree); --(disagree strongly )|
|Science makes an important contribution to the quality of life|
|Most problems can be solved by applying more and better technology||
|Interested in science and technology|
|The natural environment has a valuable property that humans should not tamper with||
|Religion is very or partly important in your daily life|
(could explain it to a friend); (heard of it); (not heard of it)
|Could you explain biotechnology to a friend|
|Could you explain genetic engineering to a friend||
|Do you have any worries on the impact of research or applications of genetic engineering?|
|Do you personally believe genetic engineering is a worthwhile area of the scientific research?||
Table 2: Approval To Modify Organisms With Genetic Engineering (%s, for N=191)
If any of the following we to be produced from genetically modified organism, would you have any concerns about using them? How much?
[No, Few, Some]
Vegetables 83 13 4
Dairy products 82 15 4
Meats 75 20 6
Humans* 26 17 57
* (mean of the answers of question 3b).
Table 3: Approval To Modify Products With Genetic Engineering (%s, for N=191)
Acceptable Unacceptable Don't Know
potatoes with maize genes
83 5 12
chicken meat with animal genes
74 9 18
potatoes with animal genes
52 26 22
chicken meat with human genes
29 52 20
Regarding the justification to improve organisms, there was strong consensus for humanitarian goals, i.e. 97% would agree to improve plants in order to produce better food for man, while no consensus was reached in other circumstances, such as modifying fish for recreational purposes (Table 4). The same table shows the opinion on the modification of human genes, practically everyone agreed in the case of curative (99%) or preventive medicine (96%).
Between 30% and 38% would agree to genetic engineering to enhance physical or intellectual characteristics of children, and a similar proportion would use the procedure to make people more ethical. Table 5 shows that there was high agreement to the patenting of the products of intellectual activity in general, but not for biological material.
|Use||Question||Yes No Don't know|
|Nutrition||tomatoes with better taste|
|cows which produce more milk|
larger sport fish
cure a usually fatal disease, such as cancer
prevent children from inheriting a
non-fatal disease, such as diabetes.
make people more ethical
improve the physical characteristics
that children would inherent.
improve the intelligence that
children would inherit.
Table 5: Support For Patenting (%s, N=191)
Patenting Approve Disapprove Don't know
87 8 4
Books and other information
83 15 3
New plant varieties
51 35 15
New animal breeds
41 39 20
Genetic material extracted from plants and animals
47 39 14
Genetic material extracted from humans
39 47 14
Table 6: Knowledge On Genetic Engineering and Approval of Human Gene Therapy In Seven Countries comparing to Macer (1994) (%s).
|Can explain to friend|
|Objective of gene therapy|
It is difficult to know how representative of the Mexican medical profession the physicians sampled are, but it can be stated that their working in the MNIH, makes them opinion leaders and their knowledge of medicine should be at least average. It is important to note that the knowledge of this particular population on science and technology in general and on genetic engineering is poor, even when 8 out of 10 started they were interested or very interested in science. However, surprisingly 6 out of 10 physicians considered that one should not tamper with nature. These results show that it is important to increase the bioethical maturity of a society, and decrease its fears (8)
According to the results, there seems to be agreement with the utilization of genetic engineering to modify plants or animals, as long as no Kingdom barriers are crossed, which is the same fact encountered in the other countries of the International Bioethics Survey (4) and the United States (9). Regarding the use of gene therapy in humans, it is of interest that more people are in favor of both curing and preventing disease, although the latter is clearly more cost-effective.
The survey results make it clear that there was consensus in that the general idea intellectual property of ideas is acceptable, but not for products of genetic engineering. In fact, there is much International debate whether substances produced by life should be subject to patents. This norm should probably be revised because it has limited research by the pharmaceutical industry as some substances produced by humans which may have therapeutic uses, can not be patented and therefore can not produce revenue (10). It seems that patent issues are decided more on economical reasons than ethical ones.
It is interesting to note that probably only 26% of the interviewed specialists felt capable of explaining to a friend the basis of genetic engineering, and there was a marked resistance to accept the modification of chicken meat with human genes (only 28% agreed), while more than 80% agreed to improve potatoes with maize genes. This leads to the thought that the interviewed specialists ignore that genetic information is the same in the animal and vegetable reigns.
In the case of modifying human characteristics that can only be evaluated through value judgments, the different countries can be divided in three categories (Table 5) those such as New Zealand, Australia and Japan, in which the acceptance rate is low, intermediate values in Mexico and Philippines, and high rates in public samples as seen in Hong Kong (6). It is noteworthy to observe the inverse relation on the acceptance of genetic engineering to modify the physical, intellectual and ethical characteristics of the individuals and the knowledge on the basis of genetic engineering. Increasing claims about the relationship of genetics to ethically and politically significant traits and behaviors are challenging human self-understanding and the capacity of social institutions to respond adequately (11).
This may be related to the relative lack of information in the
underdeveloped nations of human rights in general. This is important
because the people interviewed were physicians or medical students,
who should be at least familiar with the Universal Declaration
of Human Rights, which states that the psychic, physical and moral
integrity of every individual should be respected (12) Some may
say that this type of enhancement is to improve individuals, which
immediately raises the question as to which is the "ideal"
and is reminiscent of the eugenic excesses that occurred earlier
in this century.
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